It’s 2 a.m. And I’m in the emergency room. There are beads of sweat dripping from my forehead. One of my nurses comments that I just don’t look quite right. I can feel the urge to vomit and know where the nearest trash can is at all times.
I’m clearly sick. Febrile. Shouldn’t be working. But it’s the middle of a night shift, and I’ve got patients to see. I place a mask over my face. Not to protect myself, but to protect the patients I’m seeing.
I take a deep breath, blow my nose — and soldier on.
It’s not a pleasant experience, but I get through it.
The next day when I awake, things are much worse. I’m rigorous, have pain all over, and find myself with abdominal cramps. I can’t seem to will myself out of bed. I have another shift to work at ten that night. There’s no way I’m going to be able to function.
But — I still consider it.
What if I just sleep off the rest of the day and take a bunch of meds right before my shift? It can’t be any worse than last night, right?
I hesitate to ask my colleagues for help.
I’m concerned about what the response might be.
In the five and a half years I’ve worked here, I’ve never actually taken a sick day. I mean, doctors don’t take sick days, right?
You’ve got to be on your deathbed, need emergency surgery, or be experiencing some unexpected tragedy in order to ask for help, right?
Why is it so hard for me to ask for help when I’m sick?
Strangely, in a profession where we spend our time ensuring the well-being of others, we don’t often care for ourselves all that well. And for a guy who is trying to write a blog about physician well being, you think I’d know better. But sadly, at times, I’m bad at taking care of myself too.
To start, there is always work to be done and people to see. The emergency room never closes. Days and nights, holidays, and weekends.
Sometimes it’s my turn. A shift that I cannot work has to be covered by someone else. If it’s a night shift, then it’s another night shift that someone has to work on top of all the other nights that they already work. It’s a tough thing to ask someone.
And generally speaking, it’s never really a true “sick day.” Most of the time, I resolve to pick up a shift from my colleague in the future to pay them back for the favor. So, in the end, I might get the night off, but there’s extra work in my near future.
And of course, unlike most office workers and our nursing colleagues, my sick days aren’t paid for. If I don’t work, I don’t get paid.
If you work in a specialty clinic or operating room, then people have been waiting for months to see you. They’ve had this day circled on their calendar and have scheduled their day around getting in to seek your advice or care. Canceling a day’s worth of work and trying to reschedule all of your patients is a difficult task. It’s a tough thing to impose on patients, and so we all guilt ourselves into coming to work.
Our medical culture is to blame too. We’re often made to believe both in residency and beyond that self-sacrifice is part of being a doctor. And so we try and persevere even in cases when it’s not in our best interest or the interest of our patients.
We should never feel guilty about a sick day. The average office worker gets ten sick days a year. I just took my first one in over five years. And it prompted me to write a freakin’ blog post about it! The guilt factor in medicine has got to go.
We have got to stop frowning upon our colleagues when they’re unable to work.
Of all professions, we should be the ones to understand that illness happens from time to time and that it’s out of your control.
Taking a day off of work when you’re sick does not make you “soft.” It makes you sane!
Isn’t our first duty as a physician to “do no harm”?
Yet, when a survey of over 500 clinicians in JAMA Pediatrics found that while 95 percent believe working sick could harm their patients, 83 percent show up anyways.
Guilty, as charged.
It seems that due to our medical culture, and the peer pressures within it, it is sometimes just easier to take the “heroic” route than the intelligent one. Sending an email to your colleagues and trying to arrange last-second coverage can be more uncomfortable than just working with your illness.
What’s the solution to this?
Firstly, we’ve got to change our medical culture. It seems that cultural change in medicine happens at the pace of an iceberg, but progress is possible! Taking a sick day off of work shouldn’t be seen as wimpy and should be encouraged.
Secondly, we’ve got to build some redundancy into our scheduling to allow for the occasional last-second emergency. In my workplace, we have a “backup” doc who is responsible for coverage in the case of a last-second absence. This has worked quite well, although there is still a great hesitancy to call them in. Resident work schedules should be organized to have something similar.
And we’ve got to think of the patients that we see as well. Often times, they are much more vulnerable to the illnesses we carry. Those patients, if asked, would not want you when you’re not at your best. And they certainly don’t want to be exposed to your germs and viruses.
I write a number of “sick notes” each shift. I certainly don’t look down on people for taking time off of work when they’re really sick. In fact, I encourage it. When are we going to start following the advice that we give to others?
You’re sick today? Have lots of fluids, take some rest, and go back to work when your symptoms resolve. It’s not that complicated.
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