A lot of times people make the argument that when doctors refuse to call in sick (because we selfishly love working while sick), it harms the patient. A patient who is unwittingly being exposed to a vicious URI.
So I say, maybe we should ask the patient...
Say you are about to have an elective hernia repair. You have arranged to take time off from work and you're mentally prepared for the surgeon. You are on the way to the hospital when you get a call from the hospital, saying that your surgeon has a runny nose and can't do the surgery. And there is nobody to cover, so you'll need to reschedule your surgery for some point in the future.
Are you okay with that?
Say you're in the ER with a stomach ache. You've been waiting two hours. A nurse comes in to tell you that one of the two doctors in the ER has a runny nose, so you'll now have to wait twice as long to be seen.
Are you okay with that?
Say you're about to give birth. One of the anesthesiologists has a runny nose and wants to go home, and since the only other anesthesiologist in the hospital is in an emergency surgery, you won't be able to get your epidural.
Are you okay with that?
(Well, of course you are. Because medicated childbirth is evil!)
In any case, I think it's pretty clear why doctors try to work through illness. And I think most of those patients would chose a sick doctor over no doctor.
Not to be horribly cynical, but I think that a lot of people invoke "protecting patients" because they don't want to feel as bad about staying home sick for a day rather than out of actual concern.
ReplyDeleteMy rule is this: if I have a fever that won't go below 100 with tylenol on board, or am actively vomiting, then I will stay home. This is more or less because if either of these two symptoms is happening, I am unlikely to be able to stand. At all.
Fortunately, this doesn't happen to me that often. I will not stay home for a cold/cough with no fever no matter how horrible I sound. Perhaps as I get older my list of things I'll stay home for will get longer, but hopefully not!
I am a newly-immunosuppressed patient, reluctantly taking the lovely methotrexate + Orencia combo, and it seems I can't even get a small nick on my finger to heal in any amount of time under two weeks. So if a doc is sick, even with a mild URI, it's potentially a huge problem for me. That being said, I would love it if I was given the choice to see a sick doc or not because, as noted, many patients would be ok with it (even me, on occasion). The problem is, those phone calls are more overhead and aren't covered by insurance, so while the concept is great, would this ever actually happen?
ReplyDeleteWould seeing a doctor who's wearing gloves and a mask be worse than being in any public place, where there's likely to be someone sick during any cold and flu season?
DeleteHard to say. I now hit the grocery store late at night so I have less direct contact with people (and then go home and scrub my hands thoroughly). With a doctor, I feel that s/he has more direct (and close) contact (the physical exam, for example). But I guess the biggest factor for me is will each doctor more thoroughly and frequently wash their hands, etc on the days when they are sick. Heck, I still see doctors forgetting to wash their hands before conducting physical exams. Its those docs I would rather have stay home when they aren't feeling well.
DeleteThis is an interesting issue. I know they make drs with URIs wear masks at the hospital I'm a student at. If I recall correctly, there have been patients that nurses or drs with cold symptoms are NOT allowed to see if they're sick (a sign would be posted on the door). Not sure how effective this is or whether it has been studied.
DeleteAnecdotally-- I just saw a doctor who thought she had the beginnings of an URI -- just a bit of a runny nose -- so she wore a mask for (90% of) the visit because I'm on immune-suppressing drugs for AI disease (I am not Anonymous of Oct. 3, btw). A week later, and I'm in the middle of a full-on cold that is making me miserable. Chances are I got it from her? I'm in plenty of public places, but it seems like if I'm in a closed room in close contact with her for 45 minutes, I'm more likely to catch her virus than a random virus from wandering in public. But I could be wrong, so correct me if I am (no science background here.
DeleteSo, at this point, I think I would have preferred the doctor call in sick or rescheduled my appointment rather than catch this cold. Blech.
(And yes, I actually remembered this post and came back to comment on it in light of my experience and OMDG's curiosity.)
Dr. Fizzy,
ReplyDeleteYou make very good points here. I've had two doctors out in the last three months, which definitely was very annoying. The first doctor "called in sick" or so his staff said; (they're always reluctant to provide any information, which I understand.) The second took an unexpected leave of absence for an unknown length of time. You're right. My gut reaction was to protest. It inconvenienced me even though nothing I had was life-threatening. How am I supposed to get continuity in care when my doctors keep checking out on me??
Then, I realize that people make the same complaint about me in my profession. From another level, I have to step away from the perception that doctors are superhuman and somehow immune to the tragedies of life. They're human, too. In fact, their humanness distinguishes them from the robots who can't figure out what's wrong with me and definitely don't even try to relate to my life. And humans get sick, get in car accidents, suffer personal tragedies, and have emergencies.
It's been a humbling experience for me over the last few months to step away from my personal indignation and to mourn with and pray for these people who have become a big part of my life. I'm sure that, just like me, they would move the world in order to make it to work and do what they've promised to do. I'm learning to show the same compassion and mercy toward them that they've shown to me.
Abigail Cahshelle
P.S. I've definitely observed doctors take unscheduled time off for illness and even for non-communicable events in their life. I have also seen doctors working through illnesses.
By constantly using "your doctor has a runny nose" you're slanting the argument one way. What if your doctor has been vomiting once every two or three hours, has a headache, and feels dizzy? Aside from worrying about catching something from them, I'd worry that they're not in a state of mind to do their work properly.
ReplyDeleteThis is a gray area, because some people have a greater tolerance for physically challenging conditions, and not everyone gets sick to the same degree. If you just have a runny nose and a cough, be responsible - consider donning a face mask and wash your hands more frequently. If you're completely out of it, stay at home. We must know our limits.
In terms of "economics" of patient care, we could also consider the benefit of resting. If a doctor takes a day off and almost entirely recovers, isn't it better that one day's worth of patients were inconvenienced, than that three days' worth of patients received sub-standard care (and possibly caught something)?
I purposely said runny nose because that's the most common and the biggest gray area. Obviously, some docs DO work when they're very seriously ill. But the most common thing is that people come to work with a bad URI where they've got the sore throat, running nose, low grade fever, etc., but are still mostly cognitively intact.
DeleteLast time I visited my Doc she was sick (URI). I felt bad for her but glad that she was there instead of passing me off to one of the PAs.
ReplyDeleteas a future PA I am curious as to why you wouldn't want to "be passed off"? It makes me wonder if you understand what a PA is and if you feel the same way about NP's.
DeleteTiffany
Because the reason for my visit was beyond the scope of what PA or NP should be doing. PA's and NP's have a place in healthcare, buts lets be realistic, there are limitations to what they should do (and when it comes to my health care, it does not matter what the State boards say, there are limitations). Keep in mind if I get stabbed in the arm and my choice is between an EMT and Oncologist, I will go with the EMT.
DeleteNo, it apparently wasn't, according to your doctor. Your doctor, and the state medical boards, will determine that. That is why we are here.
DeleteIf it still "does not matter", feel free to take it up with the aforementioned doctors about who YOU feel is capable of managing your condition. And then find a medical practice that meets your lofty standards. Concierge medicine may work for you, most are cash-only though.
Better yet, since your judgement is superior to that of us mere doctors, what's your consult rate?
Wow, if you want the respect of a doctor than you should have become a doctor. Maybe your attitude is part of the reason that patients might want to wait for a MD or DO visit over you. While many people prefer the care of NP or PA, there are an equal amount that prefer their care come from an MD or DO. That is their choice and honestly who cares if they are willing to wait for that level of care.
DeletePart of being a mid-level provider, is understanding that some people some people dont want their care provided by mid level provider.
And by the way, I am a Pediatric Resident in the US, and often go a PA for my medical care due to my schedule restraints. And I love the NP and PA's I work with!
I would just like to clarify that the future PA that posed the first question (Tiffany) did not post the rebuttal. Not that I totally disagree with it but there was no way I was going to change someone's mind over the internet.
DeleteI was truly curious as to why the original poster did not want to see a PA, I understand that some patients just won't want to and there will be little I will be able to do to change their minds (just as some patients don't want to see students, as I am learning now), but there are plenty of people who prefer the PA or NP over the MD or DO, and those are the patients that will give me the same respect as a doctor. It is what it is...
~Tiffany~
Hey, if it keeps the evil epidurals away, I'm all for it. : )
ReplyDeleteI agree that these situations are all problamatic. We need a better system, more doctors and fewer viruses. Let's get to work on that.
I'm a NICU nurse and we're always told to "stay home, protect the patients," yet we don't have designated sick time (it comes out of general PTO bank) AND if we call in more than twice in 4 months, we can get written up. So, we're told to stay home, but our unit doesn't support it. Patients don't get any more immunocompromised than what I see in my unit. There are times I KNOW I should be at home (not quite 24 hours with abx and positive strep test, fever, GI bug), but I don't. I don't have the PTO to do it (it takes me a month to earn one shift off!) and I don't want to risk being written up. I wear a mask, wash my hands often, and take lots and lots of drugs. It stinks and I HATE doing it, but I feel like I'm left without a choice.
ReplyDeleteOn a personal note, I had v-tach diagnosed when I was pregnant with my second child. When she was 3 weeks old, I had a cardiac ablation performed. I got to the hospital, got my 2 IVs, was NPO since midnight, and my ablation got canceled because the nursing staff was short because of the flu. Thankfully they got me in the next day (I was considered more in need of my ablation than others),but it stunk. So, I've dealt with it on both sides of the fence--as the patient and the nurse.
And don't get me started on the time I had a 102.5 degree fever in nursing school and my clinical instructor wouldn't let me go home....
Melissa
Exactly! Much as I'd love to stay home when I'm sick, I earn less than one sick day every other month, and I mostly try to save those for when my kids are sick. Whereas my husband, not in medicine, has *unlimited* sick days, and will stay home with a simple URI.
DeleteMy dad does anesthesia and he always goes to work sick. He might be able to get someone to cover him, but it's a huge pain and he doesn't like to inconvenience other people. Plus he would then "owe" them time.
ReplyDeleteHaving to reschedule a days worth of patients is often more work than just working sick. I'll often let my immunocompromised patients know and reschedule them, but my regular patients could care less how my health is.
ReplyDeleteI think most of us in healthcare are pretty savvy about knowing what kind of illness constitutes a legitimate sick day. (Some abuse this, but we are not talking about them.) There are a lot of things that make us feel lousy, but are not terribly contagious or debilitating. We are supposed to be experts at minimizing exposure to others, after all. If you are going to be in the bathroom every 15 min with a GI bug, either hook yourself up to a liter of Ringers and get some Zofran while you work or go home - your presence is not worth it.
ReplyDeletePersonally, I would rather have a care giver (MD or nurse) who has a common bug than someone who is hungover! (Or, again, bring on the IV, Zofran, and O2 for an hour.) Frank ETOH on board is universally frowned upon, but you would not believe how many people think that they are not impaired with a hangover and the shakes. (I'll start my own IV, thank you very much.)
That said, do I dare bring up the dreaded snow storms? This is obviously geo-specific, but here in the northeast, it can be a real attendance suck. There are those who cannot/will not drive in the snow, those who cannot find immediate coverage for the kids snow days, people who get into fender-benders trying to drive in, people who lose power, and people who simply love curling up on the couch with hot chocolate while the white flakes swirl (though I would not suggest using that as an excuse when you call in). Of course, the mood of those left behind does not improve when we arrive and find that people who live closer than we do called in. Tricia
I don't know if people in healthcare are indeed savvy about what constitutes a real illness. I've seen a lot of people at work who very clearly should have been home.
DeleteThough I don't have enough experience to weigh in on going to work with a GI bug or URI, I can say I feel horrible when I have a shift with a fresh outbreak of cold sores. I end up with a lisp and feel like I have the flu, but I take in something to numb the lip, a pocket full of tissue to keep it dry and wash/sanitize my hands all the time. I feel terrible knowing how contagious cold sores can be, but I can't drop shifts and usually (hopefully) I can take precautions against spreading it. Luckily I don't kiss many patients haha.
ReplyDeleteIs that really true about cold sores? I was discussing this with someone the other day. My understanding is that almost 100% of the population is positive for HSV-1, yet only people who are susceptible actually develop the sores. Like I know lots of couples where one person gets cold sores and the other doesn't.
DeleteIt's not 100%, but it's up there. And you can totally get it from the chalice at church too -- no kissing necessary! Getting the sores themselves does appear to be genetic.
DeleteI have no idea on the rates, tbh, all I know is that I got them from my mother and whenever I get one, people who have lived/shared space with me end up getting them as well- although not usually as severe. At home with family, we tend to pass them around (that's a weird image, actually). If I get one, everyone ends up getting them. I'm terrified of passing them off to an uninfected person since I know how miserable they make me, and since they've been getting worse the last couple of years.
DeletePharmacy - I feel like I can't call in sick either, especially not just with a cold/bad allergies. I have been known to use up an entire bottle of hand sanitizer in 1 day.
ReplyDeleteI can't call out sick for many reasons:
1. I get 1 sick day about every other month. If I don't work enough shifts, I don't get my benefits, and there goes my health insurance
2. If there is no pharmacist, the pharmacy legally has to close. Patients/Customers/Guests/Other pharmacies/doctors/nurses would be VERY angry and they are not understanding.
3. pharmacist/tech ratios. If we are short a pharmacist, we "break" our ratio and then some of the techs would not be able to work. So someoneelse's pay check would also suffer.
4. There isn't anyone to cover when I'm sick. Last time someone called in sick, I ended up working a double with no lunch (or supper) break. Not safe.
I'm here to work and won't call off for other than a high fever or wicked GI bug. But I'm perfectly willing to get fired for it if I call off and someone doesn't like it. A year ago I had a run-in with C. diff and I told med staffing that if I got one more phone call I was going to come in with my IV pole and a diaper.
ReplyDeleteThen again, I went out of my way to hire into for a better environment so I'm not on the knife edge, backup-staffing wise. I'm not sure I would be comfortable in some of the environments you guys describe.
I'm in pharmacy too, but my environment is different than Anonymous of 10-3. Working for a large chain in an area that borders on overstaffed, there is typically someone available to cover. I'm part-time so I don't get sick days at all, but I can usually make it up at another time in the pay period. And if I can't, I'd frankly rather miss a day of pay than overwork myself and make myself miserable, because I hate being sick and I need my energy to take care of myself and my family. I'll call out for a URI because in my view, nobody suffers the consequences except me (it's not like it's such a horrible burden on the scheduling staff or the covering pharmacist), and I'm okay with those consequences.
ReplyDeleteradiologist here and... we dont call out either. we have no control over our volume and have no real redundancy. ive worked for this group for 3 yrs.. and i can think of 2 people who called out.. one was recent and it was cause he had a seizure and was back the next day (heh makes the workup easy when you dont have to wait for imaging) and the other actually got forced by coworkers to go home cause he was short of breath. ended up tubed for 2 days and the second he was extubated insisted hed be back as soon as he was released. he was forced to take a week off.
ReplyDelete- radmd
I'm an anesthesiology resident. I've only called in sick twice. The first time was because I broke my leg; that happened on a Saturday, and I was back in the OR by Tuesday (I missed a 24 hour call that Sunday, then I spent Monday getting x rays and seeing ortho). The second time, I missed 4 days of work because I had to have surgery on the broken ankle, and I had a home nerve block pump/was on opioids. Currently, I've been non-weight-bearing for the last 6 weeks from all this. I'm getting around the OR/ICU/L&D/going to codes with the help of a knee cruiser.
ReplyDeleteIt sucks, but there was no way I could miss more work than I did. I'm out of sick days for the academic year and would have had to give up my vacation and/or make up the time at the end of residency. Plus, getting call covered is a bitch, and I felt awful putting my burden on my co-residents.