Wednesday, March 21, 2012

Playing healthy

A friend of mine once wisely said, "It's easy to act drunk when you're drunk."

I find the opposite is true of being sick. I find that I can be sick as a dog, yet still give a very convincing picture of someone who is completely healthy.

Recently, I had a cold. It wasn't one of those colds where I was sniffling or coughing, but I felt congested deep in my chest, had bad sinus pressure, and even felt slightly feverish. Yet every time I walked into a patient's room, I said perkily, "Hi, I'm Dr. Fizzy! How are you today!" Nobody was the wiser. And my germs were thus disseminated.

Like other doctors, I don't like to give the impression of ever being sick. So I'm going to act well, no matter how crappy I'm feeling.

The downside of this, which unfortunately is what happened to me, is that when you're sick with "that thing that's going around," so are other people. So you can be sick as a dog, planning to get your work done and get yourself the hell out, and then you get the call:

"Dr. SoAndSo is going home sick. Can you cover?"

And all you can think to yourself is, "But I'M sick too!" Except you came to work and you have been pretending not to be sick all day, so it doesn't sound terribly convincing. And damn it, you don't want to admit to being sick.

Guess I'll be covering.


  1. Grawr! As a patient, I hate this tendency in the medical profession so much that I overcame my dislike of your lack of anonymous commenting to comment! Seriously, doctors need to not be coming in sick, and I will put up with having to reschedule appointments or deal with covering doctors if they'll just not be showing up where I can catch something! It's bad enough for me being exposed and I have a fairly decent immune system-- my boyfriend tests *just barely* in the normal range of immune function, a hair lower and he'd be actually immunocompromised, and I wind up worrying every time he goes into a hospital because doctors do this and he's going to be guaranteed to catch it... all because doctors just have to prove their toughness by coming into work sick.

    Personally, I think this behavior shows a deep and internalized disrespect for the patients.

    1. I didn't realize I had a lack of anonymous commenting. Thanks for pointing that out.

      It's not due to a disrespect for patients on my part. I get 5 sick days the whole year. FIVE. That amounts to less than one day every other month when I have two kids that are practically petri dishes. What do you suggest?

      And while you may be understanding about having your appointments rescheduled, other patients are not. I had one inpatient who screamed at me for like twenty minutes when I told him my attending was going to be off the next day (Christmas). Being out sick --> loss of business --> loss of job.

  2. I normally don't comment but I wanted to chime in on this issue. As an emergency medicine resident, it has nothing to do with "proving my toughness." There are limited doctors working in any given area and calling in sick for every cold could very well leave you with no one working in the hospital.

    I disagree with the idea that this shows any disrespect. I think it demonstrates a commintment to our profession. And I know on a personal level when i'm sick I try to wear a mask when seeing patients to avoid the spread of germs.

    Unfortunately medicine is not like many other professions where missing a day of work is not a big deal or there will always be someone to cover.

    1. Ditto, Betsy. If I had said "no, I can't cover because I'm sick," then who would have seen those patients? Nobody? Is that better?

  3. It is a damned it you do, damned if you don't situation...
    making sick people sicker with your sickness is probably not a great situation
    having no doctors in a hospital isn't good either
    There really is no good answer.

    I was covering for someone who was "sick as a dog" when I was "sick as a dog"...
    The manager looked at me after I had run out of cold meds and said, "We're cancelling everybody - get the H__l out of here!" I must have looked like death.

  4. As a pilot, we face similar problems of being sick and unable to work. We are required to self-assess fitness to work (unless it's a significant change in medical status that requires a visit to a medical examiner). I think that doctor's are put in a hard position, but believe that change is possible by employing more doctors 'on reserve' and using other techniques that work well in aviation - clearly a model that works in both the government and public's opinion. In essence, hospital administration and the healthcare system in general all but force doctors to work when sick, and it needs to stop. The pressure should come both from patients and from doctors. The problem, of course, is that this would require training and hiring more doctors, but didn't we face the same thing when residents' on-shift hours were restricted?

  5. If anything, I think the doctor shortage is probably going to get worse in the future, because the growing elderly population, more complicated medical problems, and Medicare cutbacks. Maybe ten years from now, I'll only have three sick days instead of five.

  6. I agreed with serakit's statement that doctors working through illneess is disrespectful to patients trying to get well. However, I don't think it's a personally help disprespect- anyone who can convincingly work through an illness like that is obviously dedicated to their profession. I think the disrespect plays out on an institutional level- like only giving a doctor 5 sick days a year, and not hiring enough doctors to cover each other.
    I find it interesting that we see the physician shortage as an insurmountable problem, when it's a very structurally determined, and therefore reversable, situation. When doctors and patients both clearly suffer from doctors working through their illnesses, I think it would make more sense for docotors and patients to use their combined influence to see that there are more doctors.
    What is the main bottleneck for training more doctors? Residencies? Let's get more of those. Government won't pay? Maybe hospital administrations could shave a little off their profit to fund a few more each.
    The only argument I've heard against the (theoretical) benefit of doing this is that if we open up the field of medicine to meet the demand, both the quality of accepted applicants and the pay of doctors will fall. What do you think?

  7. And I am home sick today- please forgive my typos. Ha.
    -Anonymous from above.

  8. I don't think hospital administrations would willingly shave off some of their profit to prevent doctors from working sick. Residencies are funded by Medicare, which is now facing huge cutbacks. We're heading in the wrong direction, if anything.

    The pay of doctors can't decline that significantly due to strong doctors unions, plus the fact that doctors end up a quarter of a million in debt from training, work for minimum wage through residency, and make considerable sacrifices in their personal lives during both the decade of training and afterwards. I think that if the salary didn't justify all this, then it would be harder to find people to become doctors. Maybe if medical training were free, things would be different.

    1. Oh, and if the risk of lawsuit wasn't so high too...

  9. I get the point you're trying to make, but you just agreed with the saying you "disagreed" with - "It's easy to act drunk when you're drunk." It takes a lot more work to fake healthy when you're sick. When you're healthy, you don't have to figure out how to hide the fact that you can't breathe...

  10. I can call in sick - as a teacher - but proper lesson plans take 4 hours for me to write up and organize. It is easier to work sick.

  11. I really think too many people are making excuses for why it won't work. This is a problem that comes up any time anyone tries to significantly change a profession. We need to agree that there is a problem, and only afterward are we going to be motivated to find a solution.

  12. It isn't just doctors that are in this position. The world is set up so that we get no breaks. I'm a student (pre-med) and I work part time at a convenience store. Both my university and my workplace are breeding grounds for viruses. The vast majority of my classes are labs at this point, and if I miss one class my grade can slip from an A to a C. If I miss a day of work, I run the risk of getting fired and therefore losing the wonderful privilege of eating and paying for school.

    People go places when sick. Every time go to work, I know that at least one person will cough in my face. Really, we need to worry less about giving people time off and spend more time researching ways to improve our immune systems.