Friday, September 28, 2012

When Does The Doctor Get To Call Out Sick?

We've seen posts on this before... But I struggle every time I'm ill. This week, it's not so much my own illness that's been the major problem. It's the kids'. Because they can't sleep. And if they can't sleep, we can't sleep.

It started last week with this upper respiratory bug that's going around. Cold viruses mutate just enough over time that every few years, I get hit hard. I call it the "Three Year Cold". This one was really bad as it hit me on top of my undertreated seasonal allergies and having a 9 month old who doesn't sleep through the night. (I'm just not getting to the Neti pot.)

So no surprise that after a week of this virus, I started to get an earache. Within an hour the earache went from kind of annoying to consistently throbbing. I had a colleague look at my ear to confirm that there was a dull, red, bulging TM there. By the time I got to the pharmacy to pick up my antibiotics, it was screaming, pulsing, popping. I kept putting my hand to the canal expecting to feel pus and blood.

This is on top of a toddler and a 9-month old with copious nasal discharge and coughing. The baby HATES having her nose aspirated, but is used to sucking her binky as she falls asleep. With all the green mucous, she can't suck the binky and breathe at the same time. Thus, misery, for her and us. It's been over a week with this struggle to clear her little nasal passages so she can soothe to sleep...

Our toddler is a bit better off, but still cranky, clingy, picking at meals, whining... And waking up during the night coughing. A cup of juice and some quiet rocking lulls him back to dreams, but meantime, either me or hubby is up, again.

Night before last, it was midnight, and neither child had been able to fall asleep yet for more than a few minutes. Stuffy snotty noses, coughing, diarrhea poopies, fevers, et cetera et cetera, and we had spent hours trying all the tricks... Steamy shower, nasal aspirator, saline wipes, Tylenol, juice, singing, reading, cuddline, cartoons... And I had to be up at 5:15 a.m. for a 7:40 am start time in clinic.

I admit that I kind of lost it. I was personally miserable with my own symptoms, exahusted from several nights in a row of this sort of shenanigans, and I knew I would have only a few hours' poor sleep before I had to truck it to the city and take care of people.

"You have to call in sick," insisted my husband.

"I CAN'T," insisted me.

And I didn't. The kids eventually drifted into snoring/coughing but sustained slumber. My alarm went off at dawn. I hauled my sorry drugged-up ass into the shower, and made it to work alive. I popped Phenylephrine, chugged Dextromethorphan, snorted Afrin, gulped a whole lot of coffee, and tucked a full bag of Ricola into my white coat pocket. I saw my full panel of patients. I got some looks from people, colleagues and patients alike, for my red, swollen, flaky nose, and this wet cough. I kept assuring people, "I'm at the tail end of a cold, I doubt I'm contagious. It's my own misery."

I've commiserated with colleagues. Everyone's been through this before. But we all agree. You SHOULD call in sick for this stuff.... But we all feel like we CAN'T call in sick for this stuff.

So when can the doctor call in sick?

I remember as an intern on a busy overnight call, one of the senior residents started the evening with GI bug symptoms. It was severe, coming out both ends. By 1 a.m., he was laid out in the call room, and the nurses hooked him up to IVs. Still, we interns were coming to him for all the usual overnight precepting: running admits by him, reviewing labs, discussing cases. There was no question of, could he go home sick. We knew that he was febrile and dehydrated and not thinking straight, but it was like, there was no choice. And in the morning, the attendings heralded him as a hero for sucking it up and holding down the fort, despite having active nausea/ vomiting and diarrhea... that was contagious. That left a strong impression on me. Today, I think that was INSANE.

More recently, I had to fight with a patient of mine who also happened to be a surgeon. She had developed flu symptoms and wanted Tamiflu, but didn't want me to test and confirm Flu, so she wouldn't have to call out sick, as is mandated by Occ health. "I'm on the schedule, I have to operate," she explained.
Those are extremes. More common, I think, is our family's situation. We're all miserable, but can't justify calling out.

What would you do?



18 comments:

  1. I passed out on L&D - dehydration from pneumonia. The problem was, in a 3 person group, 1 was in Florida on vacation and the other was on maternity leave.

    A friend in another practice took over the rest of the weekend call. But if he hadn't, I would have sucked it up. There is no other choice. :(

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  2. The thing the concerns me about this particular cultural tidbit is the harm it does to patients to have sick doctors and surgeons caring for them when they are sick, immunosuppressed, cut open, etc.

    We are all agreeing to put up with this expectation by our continued compliance with the practices but the patients don't have any say.

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    1. I wonder what patients would say if they had a choice. I have a friend who switched pediatricians because on one occasion when she brought her kids in, her appointment had been canceled due to the doctor being sick.

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  3. The only time my husband has called in sick was when he was out with pneumonia. I have seen him go in and operate sick as a dog. I always tell him if I were the patient I wouldn't want my surgeon to be sick while working on me. He says his schedule just doesn't allow for any time off. Re-scheduling cases is not an option. :(

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  4. I call out sick when I have a GI bug and can't stand without feeling like I have to go puke or sit on the toilet bowl. Everything else upper respiratory and sleep-deprivation that's kid induced, I suck it up and work through it. It totally sucks. We do also send kids to school sick with URIs when they are still contagious. Yes, they aren't treating sick patients who are potentially more vulnerable, but we'd be off a whole lot if we took all the days when we were sick with URI stuff. It does depend on where you work and what you have though.

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  5. I once rounded out at the conclusion of a 24hr gyn oncology call in residency wearing a mask and carrying an emesis basin after spending the entire night bonding with the toilet bowl. One of my favorite patients who had watched this process worsen over the 24hrs offered me her AM dose of Zofran...I cried.

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  6. Doctors are persons, not super-heroes nor Gods. So they get sick...too!! If they have infeccious disease they MUST stay at home and prevent spreading the illness to patiets or coleagues. If they feel bad enough, how can you go and take care of other people with the serenity and alertness you must?

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  7. I talk about this all the time. As a fellow, I came to clinic with a serious GI bug and everyone commented how awful I looked. But instead of telling me to go home, everyone applauded me for coming in.

    Your conversation sounds similar to ones I've had with my husband. He's not in medicine and always telling me to call in sick. He calls in sick for practically anything. He just doesn't get it.

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  8. Do what you would tell your patients to do. If you are sick, stay home. I was on bedrest for a week during my first pregnancy and then had to be out 2 weeks with mono the following year. Guess what? The world went on without me. No one is indispensable, not even doctors. Maybe we secretly don't want to think that and that's why so many doctors struggle through the day when they should really be in bed. We need to get over ourselves.

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  9. The problem is lack of adequate back up.

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  10. I do not call in sick for minor URI. But I have when I have fever (just like I tell patients), vomiting/diarrhea (just like I tell patients, and because of high risk of contagion). I would certainly call in sick for something as severe as pneumonia.

    I know most of my patients are thankful for me not to spread my infections to their families.

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    Replies
    1. I agree Doc Fetz. That seems like a good, sound policy... But many docs don't feel like they have the option.

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  11. I'll work with a cold or wretched first trimester nausea but I did take 4 days off when I had a miscarriage. My non-urgent patients were rebooked and several colleagues took on the urgent visits into their schedules, which was lovely (and a big reason why I joined the practice that I did). I remember coming back and one of the docs remarking she was glad I took the time off -- she didn't feel able to take the time off a few years earlier when she was a new associate. She miscarried at 12 weeks at work, and carried on with her week. :(

    Thankfully, very few patients complained about the re-booking for the doc being "off sick"... if someone left the practice over something like that (as noted above!) I doubt those patients would be missed.

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  12. I was recently ill enough to be hospitalized for chest pain. Despite the fact that I looked and felt like death, my colleague wanted to know who was covering my call when I told him I was leaving on my call day. He apologized later for being insensitive. This is the third time he has done something like this so I know he is not insensitive just a jerk. So when I was in the ER with a bp of 169/99 and arm numbness while on call with 2 pts in labor, I knew that I had to find a way to make it work and not call my "partner" for help. And yes, I am looking for a new job! P.S. I thought the right arm numbness was related to a car accident.

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  13. Thanks for all the feedback. I think that a safe, sound, and reasonable policy is for us to stay home with serious febrile illnesses or obviously highly contagious GI/ Influenza bugs. We shouldn't be treating people while we are seriously ill and our minds are compromised. And we shouldn't spread bugs around to our patients and colleagues. Can we work to make that "reasonable policy" accepted in the medicine culture?

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  14. I am married to a doctor and dated one throughout his residency. Calling in sick was just never an option unless one was admitted or dead!

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  15. I agree, it's a tough position to be in. Even in an outpatient setting, calling out sick means affecting (i.e. rescheduling) 25+ patients and placing more work on my fellow physicians that are in that day. I even had a patient change primary care physicians after his 2 appointments were rescheduled (months apart) - first was the day I went into labor (literally worked up until that very day I went into labor) and the 2nd one was due to a terrible GI bug when I was 3 months post-partum. I literally have had anxiety about calling out sick due to the impact on co-workers and patients, even though I knew I wasn't in the best state to effectively take care of patients!

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  16. I've called in sick once in the last 5 years. Granted, I've hardly ever been sick but since having my kids, sadly, my immune system has taken a healthy beating. It comes as a shock to my patients, but I'm sure they'd rather see someone else in the practice rather than have me coughing up half a lung in their face.

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