Friday, November 12, 2010

Sick Days

Recently, there was a post I ran across on Kevin M.D. that argued that doctors who are sick should just stay home, for their patients.

I'd post the link, but it was a while back, and I don't feel like searching for it.

Calling in sick is antithesis to our profession. I know of neurosurgery and anesthesia residents, dehydrated and drained from GI illnesses, who hook up their veins to a bag of normal saline to keep working through the night. As a pathologist I thought - lucky that they had the resources and know how to be able to do that.

I called in sick once during residency - it was the night before my rotation at the State Crime Lab. I had been up all night vomiting due to God knows what bug and remember laying on the bathroom floor at one point with my arms drawn up in a semi-state of paralysis, probably induced by a dearth of electrolytes. I could not face my first Monday morning of bodies swarming with blowflies - knew instinctively that it was a bad idea. I felt horribly guilty, and showed up on Tuesday apologizing profusely.

Although I have been sick in my three years in private practice (I have two kids - they bring home lots of bugs), I haven't once called in. This decision probably caused illnesses that might have lasted a few days with some good old fashioned R&R to drag on for a couple of weeks unchecked, but there was really no precedent that I could find making "calling in sick" acceptable. Not that I begrudge this aspect of the M.D. work ethic - it had been set up in residency and even on clinical wards as a medical student.

To be fair, a pathologist doesn't really see patients that often, and I think the crux of the article I read had to do with not exposing your patients to the bugs you yourself are suffering from. But it made me curious. The only partner I know (of my 13) who has called in sick in the last three years was in the ER with perforated appendicitis. And one of my senior partners once went to the ER with heart issues, but we all covered him for a few hours and he was back at the end of the day to finish his work.

So I wonder - how many people out there feel justified in taking sick days? Have you ever taken one? If you are a clinician, or anyone in the medical field, how do you feel about exposing your patients to your own illnesses?


26 comments:

  1. i think this has a lot to do with the mentality that doctors are somehow more than human, and i think it's wrong. we have every right to call in sick, and honestly i think we have more of a responsibility to do so. we're constantly exposing our already-compromised patients to bugs that could be contained to your household. it's worse than sending a kid to school and infecting the whole class because we are charged with protecting, not infecting, our patients. don't ever feel guilty for being human, no one has the right to make you feel so.

    granted, this shouldn't be abused. sick days should be honest sick days, and not "hey i don't feel like work today" sick days (which i know are REALLY tempting!)

    thankfully, most of my professors and attendings are incredibly understanding and allow us to make up sick days by coming to their on-calls (which are sometimes more fun than the scheduled rounds!)

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  2. I'm glad you made this post because I'm someone who seems to get sick a lot. I was sick as a dog yesterday and dragged myself to work anyway. Partially because I don't think I realized quite how sick I was till I got to work, but also because the grand total of sick days I am allowed all year is.... FIVE. That's right, I am allowed to be sick less than one day every other month. So when I'm sick, I have to think to myself, "Is this the sickest I'm going to be for the next two months?" With the cold and flu season coming up, I didn't want to blow my meager sick days on a moderate illness.

    But in any case, when you give a physician five sick days all year, the message is clearly that they want me to come to work while sick. This is a message that's heeded by the other physicians at my hospital, who in fact got me sick in the first place.

    And furthermore, when I came to work, sneezing and coughing violently, did anyone tell me to go home? Not even one. No one even suggested it as a possibility. In fact, last year I dragged myself in for a busy clinic after spending most of the night throwing up with a stomach flu, and when my attending saw me looking horrible, did he tell me to go home? No, he said, "Thanks for coming in, even though you're sick."

    This is not just some macho philosophy in medicine, but it's the EXPECTATION. There was a woman in my residency who called in sick somewhat frequently and everyone hated her because of it. For that reason, whenever I was sick, I'd at least drag myself in for the morning so everyone could see how horrible I looked or that my laryngitis was so bad that I literally couldn't speak more than a few words. But thanks to daycare germs, I have been sick a LOT and while I do occasionally leave early, I mostly just tough it out.

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  3. I'm generally reluctant to call in sick at my work as well. I'm in an anesthesia group that covers three different hosptials, all a minimum of 20-30 minutes away from the other. Generally we run on a shoestring and barely have enough people to cover the ORs as it is. When one person calls in, it sets a ripple throughout our whole system and often results in people being shuffled from place to place or someone on vacation being called in. If you are sick and come in, generally you muddle through the first few cases in the morning and as the day settles out, you get sent home.

    The other reason I don't call in is that we have no designated sick time. Our vacation/conference/sick time is combined into one, and we schedule it in Oct/Nov for the next calendar year. If you take a sick day, you then owe one of your vacation days back. Some people in the group don't schedule all their vacation time, and use that extra week for sick days.

    Overall though, the culture in my workplace is that you are weak if you call in sick.

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  4. I am just a medical student, and I already feel this expectation. I was working in the ICU last month, around sick and immunocompromised people and was ill for several days, but still came in. I wore a mask in patient rooms and carried a tissue and hand sanitizer with me everywhere I went. I was hoarse and coughing, but again, no one told me to go home. I feel now part of this expectation is because I have "bosses" (my residents and attending), but never thought about it extending to your peers' expectations of you as well. I witnessed the trash-talking of one resident who called in sick as well. It is a very real expectation, and not always for the good of the patients, I feel.

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  5. Thanks for all comments!

    Fizzy - I love that you brought up the fact that we are "rewarded" for coming in sick. I felt this especially during my fellowship year - I had just finished nursing my son at 8 months, had a daughter who was almost three, and I developed walking pneumonia for a few months while I was studying for my boards. I was a wreck - physically and emotionally. I was my skinniest ever - a size 2 - which is completely ridiculous on a 5'10" frame (I'm back up to a healthy 8/10 now, by the way).

    During my fellowship - I had the additional responsibility to present path at the weekly breast conference - necessitating taking pictures for the 20 or so cases late into the evening the night before. I remember being so sick one day I had to leave breast conference for 15 minutes I was hacking so bad, and I had to leave once during a thyroid needle. No one suggested I went home, and I felt more rewarded for "sticking it out."

    I don't believe that sick days should be abused, but I do think that our profession neglects to acknowledge that being sick is acceptable, often to our detriment, and unfortunately, maybe sometimes to our patient's.

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  6. Love this perspective, as I know the medical personnel comes in contact with nasty, germ laden crap all the time.

    My spouse is in law enforcement. I remember his first year on the job he was sick a lot! As a first responder he came in contact with so much nasty stuff, a lot courtesy of the transient population. In his line of work, if they are pretty sick, like you mentioned ( not just a cold) they tell them NOT to come into work. I remember one time he felt like he had to go in, and he looked like death warmed over and he could barely stand up. One of the fellow officers was angry and said, "If I was out on the street and getting my butt kicked, would you be able to be my back up, jump in and give 100% and get me out of there." My spouse answered " Uh no, probably not." The response? "Then what the *F* are you doing here?"
    He learned fast, that being ill was a liability in his line of work ( we live in a sue happy world) because he didn't have a "desk job" and requires him to be hypervigilant while on the job. Fortunately, their municipality has plenty of sick days worked in.

    I cannot imagine what it is like when you are in a private practice, or as the above anesthesiologist mentioned, being spread thin as it is.

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  7. Go law enforcement! They obviously have one up on us in this department. I would have loved for someone watching me hack up my guts in breast conference to actually acknowledge my illness rather than ignore it. To look at me and say, "What the *F* are you doing here?" instead of, "See you in clinic!"

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  8. I agree it's still the norm to expect doctors to work after not sleeping for 36 hours or when they're sick or in labour or their mom just had a heart attack or whatever.

    I really think though that this kind of attitude is going to change the more we see things like SARS and H1N1. One of the things my group had to do last year in order to prepare for H1N1 was to come up with a contingency plan in case whoever was supposed to be on call ended up getting sick. Just in general, I have to say that my group is really awesome and we do a great job of supporting each other when someone's sick or there's a family emergency or something like that.

    Most of my patients are pregnant, so I'm pretty militant about getting my flu shot every year. I haven't been sick since finishing residency (3 years, woot!) but I would not risk exposing my patients when I do get sick.

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  9. I think women have it particularly hard with this regard. I hate coming in sick but I more often save my "sick" days for when my little ones are sick and need me to stay home with them. There a limited number of days and pressure to not compromise the already tight schedule.I also feel the pressure of having taken 3 maternity leaves. I was sick a few times in the months after coming back but soldiered through because I could feel the resentment from my colleagues for having to cover for me.
    -Sunni

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  10. I remember in my final year as a student being given a "survival guide for internship" which included a list of 10 commandments, one of them, "Do not call in sick unless your GCS is 10 or less...it just makes your colleagues life more difficult"

    As a former nurse i find this mentality horrendous. I was ordered home a few times when I went to a nursing shift sick, for my patients and my own sake. And here is Australia nurses get double the normal government allowance of sick days...why? Because they're exposed to sick people.....but doctors are not given extra sick days? WTF? Apparently we are super human but my body didn't get that memo. When I get sick I get sick for so long due to my "soldiering on"
    It really doesn't help my patients, my family or me.
    I hope this changes in my career. Maybe Generation Y can help with this?

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  11. >>would you be able to be my back up, jump in and give 100% and get me out of there>>

    I reschedule routine appointments when I'm too sick to work safely, because if I'm too weak to manage the horse my client will be in danger. Emergencies are a different matter, as I am on-call 100% with no backup.

    I've worked injured many times. Virtually all of my equine veterinary friends have worked with back injuries. I've worked with fractured fingers and toes, which isn't a big deal considering I have friends who have worked with arms or legs in casts.

    The reality is when you're self-employed: you don't work, you don't eat.

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  12. Well, I was out for 4 weeks because of a hysterectomy, but of course that was planned in advance. Then there was the day I was out from a GI bug my grandson caught. The daycare funk is very powerful indeed.

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  13. I agree with those who have observed the culture of "you're weak if you're sick" in medicine. This is part of the overall "you're weak if you ask for help" culture that is amplified in surgical training. I just abhor this. It's one of my pet peeves.

    However, I tend to come in if I'm functional and if I don't feel I'm contagious. Missing a day does horrible things to the schedule, and I pay for it for the next 2 weeks. I have no compunction about taking a day off if I feel really bad. I'm lucky that this happens very rarely.

    On a couple of occasions I've cancelled a day of surgery because I was up all night on call the night before and didn't feel I could do justice to that day's patients. The patients overwhelmingly have appreciated this. In fact, patients routinely ask me in preop holding if I had a good night's sleep or if I'm feeling well.

    Being able to take a day off without compromising vacation time, etc. is clearly one of the advantages of being in independent private practice.

    Having said all this, I must admit that I'm not exposed to a lot of infectious stuff in adult neurosurgery, and my 12 year old is above day care age. So, again, I'm fortunate.

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  14. I'm a FP intern with a 18mo old in daycare. I've taken 2 sick days so far.

    Seems like a clear-cut, common sense decision to stay home when I'm sick.

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  15. Interesting. I think that our (doctors') relationship to sick days is likely the same as that in any other business where someone has no back up: we don't take them unless we're dying.

    In my field (Emergency Med), if I call in sick, that means that one of my colleagues has to get called in on their day off. Not fair to them, unless 100% necessary. Moreover, I get only 2 sick days a year (!!); I save those for if either (a) I am dying or (b) my daughter desperately needs me home.

    On the other hand, it could be worse! My husband, who is a small-business owner, has the same (if not stronger) ethos. If he doesn't show up for work, there's no-one to cover for him -- nor does he get "sick days" at all. If he doesn't show (like Outrider), he will lose money.

    So I guess I feel like, yes, we should take better care of ourselves, but we also have to recognize that some of these limitations are inherent to our staffing solutions and payment plans. It's not just "medicine," it's any business where people are depended on and there's limited backup available.

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  16. I wondered today, while reflecting on comments, how much of this work ethic is cultivated by ourselves. The sense of responsibility we feel in being there, no matter what. Not wanting to shuffle work off on others. I have a wonderful group, and I know that they would cover me in a second if I didn't think I was up to the task, but I'm not the type to make that call unless I am in the ER with an appendix perf and the doctor is saying I need to go to surgery. Neither would many of my partners. As Outrider said above about "you don't work, you don't eat" - it's not just not eating, it's being an intricate cog in a big wheel that doesn't function nearly as well when someone isn't there. So if at all possible, we suck it up and go to work. It's personality type, and not limited to medicine, I certainly agree! But is it functional or damaging? I guess it goes both ways.

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  17. The patients overwhelmingly have appreciated this. In fact, patients routinely ask me in preop holding if I had a good night's sleep or if I'm feeling well.

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  18. At my medical school, they tell you that during 3rd and 4th year, "You are either IN the hospital, or you are IN the hospital" meaning that you are either on your rotation in the hospital or you are so sick that the only reason you aren't on your rotation is if you are sick in the hospital.

    I hope to one day start changing this mentality. I'm a huge fan of being sick for as little time as possible and really milking my body's healing time. I'm also a fan of mental health days. I know I'm probably in the minority, but hopefully as younger people get into positions of authority, we can change the mentality that to be sick is weak and that doctors are not allowed to succumb to an illness.

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  19. >>It's personality type, and not limited to medicine, I certainly agree!>>

    The minimum-wage barn workers and clients I know seem far less likely to call in sick to work than white-collar workers. The toughest workers I've ever met are racetrack backstretch workers. These people work when deathly ill or seriously injured because if they take a day off to seek medical attention, they may return to find they've been replaced and now have no job.

    I think working sick or injured is an American quirk not specific to doctors. My parents (blue collar, manual labor) worked sick all the time.

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  20. RH+ says (who is having trouble logging into blogger):

    I have not found patients to be overly understanding. When someone in our group is sick or has a personal emergency, the other partners see all the acute patients and reschedule non-urgent stuff such as paps, ect. Recently one of my partners sister died unexpectedly, and the complaints we got from patients who were rescheduled(EVEN after we told them the reason) were unbelievable. Really? You are that sad to miss your pap smear?

    I think 5 sick days a year is pretty generous... considering in private practice each day of work I miss puts me back about $5,000. (Not that I make $5,0000 a day, but I have to pay my overhead whether I'm there or not)

    I don't get sick often, but as a practice we encourage each other to stay home when needed and cover for each other.

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  21. Anonymous has it summed up for those of us in private practice, which is similar to any other small business. It's not that you can just stay home and not have any income that day. A missed day COSTS you several thousand dollars, as the rent/staff salaries/general overhead are still payable. The encouraging part is that as your children get older and as you have been in practice longer, you seem to develop pretty good immunity to "the crud".

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  22. I have already taken about 2 days off, thanks to some kind of bad vomiting bug. When I'm so queasy I can't stand up, I stay home. Otherwise, I work through any upper respiratory illness and remember to wash my hands well! My colleagues haven't had to cover much for me, since I'm in private practice and don't do much inpatient (a little before, now none at all), so the main thing that happens is the patients get rescheduled.

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  23. Dr. Nana - I'm already seeing a little light at the end of the tunnel - now my kids are 5 & 7 we seem to be getting a little less (knock on wood, knock on wood, knock on wood) of the bugs. That is encouraging.

    It is really interesting to hear comments from doctors who actually have patients and the patient's varied reactions.

    Rh+ - if I was your patient you could re-schedule my pap smear anytime:)

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  24. I know someone who was so upset about her child's routine peds visit being rescheduled due to the doctor's illness that she switched practices.

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  25. My first sick days in practice were for vestibulitis. (The first time it was not only my office manager who suggested I go home, but the first couple patients as well. The other two times, I just called in sick in the morning.) I have also taken a day off for a norovirus and one for influenza. I've also done clinics in a mask for more basic colds. I found that my patients, as long as they were told that I was ill, were OK with being moved a day or 2 down the road. When I had surgery, I took a week, then another week of half time (albeit booked off a couple weeks ahead); my colleagues were evenly mixed with saying, "why are you taking so much time off" and "what on earth are you doing back at work so soon."
    It goes to show that you have to decide for yourself what your body needs.

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  26. Love this perspective, as I know the medical personnel comes in contact with nasty, germ laden crap all the time.
    It is really interesting to hear comments from doctors who actually have patients and the patient's varied reactions.

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