This isn't a whine about the flu, even though I certainly don't like the flu. This is about about being who go around saying they have the flu.
When I was in my first year of residency, I was about four months pregnant and doing a rotation with an attending, who came in one day wearing a mask and announcing she had the flu. I was pretty irritated for a number of reasons:
1) I didn't think she had the flu, for starters. It was early October, not really flu season yet. And she didn't seem that sick. I tried to point this out to her and she insisted it was the flu as she coughed all over me.
2) If you have the flu, don't come to work and tell everyone about it! For God's sake, stay home! Especially if it's so early in the season that nobody has been vaccinated yet.
3) I hadn't been vaccinated yet. And I was pregnant!
OK, I've written about how it's hard to take time off if you're a sick doctor. And I stand by that. But at the same time, if you're going to come to work sick, you're obligated to at least play down how sick you are, not play it up. Telling everyone you have the flu as you cough on them is not cool.
:( Oh Dear Fizzy How can you be upset at some one just because you 'thought' that they don't have the flu?
ReplyDeleteIf Doc Flu had skipped work then there would have been a whine about how people play hookey just because of something so trivial as a 'flu'!
Being a doctor , you have got to be the most empathetic to a fellow Doctor in times of sickness .
Instead all I hear is judgmental accusations of how some ones sickness has brought forth huge inconveniences to you
The flu is not trivial. If you really think you have it, you should stay home instead of transmitting it to your patients on vents and your pregnant resident.
DeleteIf you don't have it, then you can come to work but stop telling everyone you have it because that's just frightening.
Doctors are never empathetic to each other during times of sickness. "I had it, I got over it; so get over it." I was sick for 8 out of 12 months last year (I only stayed home once, and missed call once). I feel awful about coming to work while sick. Admittedly, I got it from my patients and they were spreading it to each other anyway. But I obviously can't miss 8 months out of 12.
DeleteAnyway, I don't take to whining easily. I WILL recommend a medication that worked well for me for specific viruses. But I will not tolerate "I have a headache, but I refuse to take anything for it, so I'll just whine about it all day." I WILL be empathetic if they did take an appropriate medication, and it still didn't work.
And a doctor should (and does) know the difference between "flu" and "cold".
I don't think it came across clearly in the above comment:
DeleteFizzy is not being accusatory or judgmental. Sometimes you have to have been in these situations to understand why somebody says something. I have been in similar situations, and what Fizzy said is very much appropriate and well understood.
There's a test we used to use in the tech world: you are lying in bed. You see out of the window a $50 bill blowing around outside your house. Do you get up and catch it?
ReplyDeleteIf so, you don't have 'flu.
So if she was walking around and being at work... no.
I dunno man. If I see a $50 bill blowing outside my house, I would get up to catch it no matter what, unless my legs didn't work.
DeleteAt the end of a long day, it has to be a shower of $20s for me to get up off my couch.
DeleteI once had the flu (verified by my PCP) in July, so I'm not sure you can base a decision of flu/no flu on the time of year.
ReplyDeleteIf you were pregnant at the time, wasn't it better to know that *maybe* she had the flu? As someone on immunosuppressants, I would prefer someone tell me if they thought they had the flu, rather than not say anything at all. Given the choice, I will definitely try to sit farther away from them at meetings, not borrow their pen, etc.
I wouldn't have complained if the attending gave me license to not be too close to her. But my job was to be her little shadow, and anything less would have been unacceptable.
DeleteIf you were pregnant and the attending knew it, and the attending thought she had the flu yet also thought you still needed to shadow her, she's a heartless bitch.
DeleteThat attending was constantly being insensitive to my pregnancy. I got in a fight with her because she wanted me to go down and hold a patient's head during flexion-extension X-rays, when no other attending expected me to do that while pregnant. "What's the difference? You'll be wearing lead." Or else she could just have taken 15 minutes of her own time so I could avoid that exposure.
DeleteI also remember that I let her know a week in advance when I had to leave a little early one day to get my oral glucose tolerance test. She said it was fine and she'd cover me. Then on the day of, she decided that she needed to leave early that day and tried to get me to reschedule or find someone else to cover.
So, really this isn't about people saying they have the flue. Honestly, I'd rather know if someone has the flu. Now, if I was pregnant and they're making my life a living hell while I'm pregnant, which includes them telling me they have the flu to taunt me, then that's another story.
DeleteMaybe it's just not about you? I worked in the cath lab while pregnant. Much more exposure- OB and Rad Safety Officer had no issues with it. My hospital made people who didn't get flu shots wear masks- but with masks, they had no limitations on patient care. Maybe the attending was a bitch, maybe she just didn't appreciate an intern critiquing the attending's tough decision she had made about coming in sick? (Not saying I agree with it, but you have acknowledged the issue.). This reads as "I challenged my boss' actions and that went badly, and I didn't get extra (unnecessary) consideration when I was pregnant."
ReplyDeleteAre you saying that at your hospital, people with active influenza were allowed to participate in patient care?? Because at my hospital, anyone diagnosed was immediately sent home.
DeleteI have talked extensively in the past about radiation exposure while pregnant. Ultimately, yes, it probably would have been safe. But keep in mind that working in the cath lab was a learning experience for you. Holding a patient's head is pure scutwork. She could have spared me that with very little effort on her part, but she chose not to. Every other attending I worked with insisted on not allowing me to have this exposure.
I didn't challenge her in real life. When did I say I critiqued her to her face? I did mention that I thought it was unlikely she had the flu considering she didn't look that bad and it wasn't flu season, but that was it.
It frustrates me that the culture of medicine pressures physicians to work while they're sick. Certainly they should stay home if they have the flu--if not for their own health then for the protection of the patients and to sequester pathogens from the already virus/bacteria-ridden hospital environment. The obligation to come to work is always obeyed when they have a cold, even with the knowledge that a wee rhinovirus infection is enough to push a respiratory-compromised patient over the edge.
ReplyDeleteMy biggest beef is with healthcare workers and cough etiquette. Why does almost everyone cough or sneeze into their hands?! This drives me insane. Everything you touch is now a fomite. Thanks. At the very least, cough into the crease of your elbow.
I would refer you to an article, but it's in my physical copy of CMAJ, and I can't be bothered to look it up.
DeleteAnyway, they were saying that cold viruses - especially H1N1 - needed to be airborne and inhaled in order to infect. The particles would otherwise get stuck in the oropharynx and be unable to cause an infection. Basically, they were saying that hand washing only gets you so far, but it's the flying particles that will get you.
That said, seriously, people shouldn't cough into their hands. I see four year olds that know to cough into elbows. There is no reason medical personnel don't know this.
Also: I sanitize my hands before and after all patients (I'm a bit more liberal with masks), and I got the fricken gastro twice this month. So I gotta agree - the stupid viruses fly a lot better than we think. I don't think it was from hand-to-mouth exposure.
"I tried to point this out to her..." That's where you said you challenged her- either her self diagnosis of flu, or her decision to come in. Regarding the head holding- Interns do scut work. Attendings don't. People with active flu would be sent home- but people are contagious for days before becoming symptomatic- the risk of spreading the flu was there, and what you seemed to object to. (Even though you didn't think she had the flu). If you object to being near radiation whe pregnant but protected, you should object to my working in the lab even though it was educational.
ReplyDeleteAttendings are not Gods. If she says she has the flu, I'm allowed to point out reasons why it might not be the flu. And it's physically possible for them to do small amounts of scutwork too. Many are not so arrogant as to consider themselves above this.
DeleteAnd you really don't see the difference between taking a calculated risk for the purpose of learning (stuff that you'd *need* for your training) and exposure that is pure scutwork? I don't think I'm some bastion of good will, but if that situation came up with me as an attending and my resident, I would never even suggest she expose herself.
Of course they aren't gods. But there's a pecking order, and there are social graces. You come across as "I knew better than she did even though she has years more experience, she put me at risk even though she didn't have what she said she did, and she should have done my intern work because even though I'm a woman of science and evidence based practice and the science/evidence say the job I was asked to do was perfectly safe, my boss should have gotten off her high horse and given the pregnant me special treatment." There is a difference between the lab and a couple plain films- more exposure, still safe. Therefore what you were asked to do should have been no big deal.
ReplyDeleteFor the record, I wasn't an intern, I was a resident. And on days when I was out, she was expected to work alone and do all the scutwork. So she wasn't immune.
DeleteI think you're arguing this because you feel guilty that you spent time in the cath lab while pregnant and or at least you feel judged by others to the point where you think you have to defend what you did. But you have no reason to feel guilty. Every risk is a calculated risk taken for a reason. Going into the cath lab and taking a small risk for the sake of your career and advancing your training is certainly nothing to feel guilty about it. On the other hand, when a risk does not need to be taken (i.e. it's a piece of scut that could easily be done by another non-pregnant person), then it's an entirely different situation. I swear, I don't think you're a bad person because you were in the cath lab while pregnant. And you shouldn't attack me for not wanting to even take a teeny tiny risk when it was completely pointless.
Furthermore, while *you* may have researched radiation exposure before going into the cath labs while pregnant, I assure you my attending did no such research. She just didn't give a shit if I got exposed or not.
You're wrong. I felt no guilt then, I feel no guilt now. I checked the facts, and I did my job. I was religious about my lead, and appreciated people making sure I was suited up before they fluoro'd, but that was MY responsibility. Researching the risks wasn't your attending's job, it was yours. If you had found someone to hold the head for you and she demanded it must be you, then I'd agree she was a bitch. But making the switch was on you, not her.
DeleteI assumed you were feeling this guilt because I can think of no other reason why you'd be so defensive and so insistent that the attending not help me, even though it would have cost her less than 15 minutes of her time, and if not spared my fetus physical harm, at least spared me significant psychological distress. Also, when I have a resident (I don't always), I share the scutwork with them, and actually feel kind of guilty asking them to do anything that I feel is pure scut. It's not "the resident's job" to do scutwork, in my opinion. Their job is to share the work and to learn.
DeleteAs for a pregnant resident, I would feel like a total slimebag if I asked her to get in front of a radiation beam, lead or not, when there was absolutely no learning benefit whatsoever. And as I said, she was the only attending who dared to even suggest that I do it. Other attendings would just say to me, "No way! You're not going down there!" Actually, on an occasion when I *wasn't* pregnant and had to do this task, the radiology tech grilled me on whether or not I was pregnant before letting me lead up.
Furthermore, when I was pregnant, I had a painful injury to my ankle and went to the ER. There was literally an hour-long debate over whether or not I should get an X-ray, because they were so terrified of exposing me with my pregnancy. And that was when it was of direct benefit to me.
So while your cavalier attitude about radiation while pregnant may be supported by the evidence, it's not an attitude embraced by most physicians. And I don't think you ought to attack me for reasonably worrying over the safety of my unborn child, probably the most precious thing in the world to me. It's actually very callous.
Also, this is a post from MiM that you may or may not be familiar with, written in response to my mentioning this exact incident on MiM:
Deletehttp://www.mothersinmedicine.com/2011/05/pregnant-in-cath-lab.html
The woman who wrote the post felt like my complaining about radiation was a personal attack on her mothering, even though she acknowledged that it really wasn't. That is why I assumed you reacted the way you did. It's an interesting post, which I think you should read. Ultimately, she says that we should make a pact "to steadfastly protect and promote the (physical and mental) well being of our gravid counterparts." I agree with that sentiment.
Attendings have no reason not to do "scut work". It's such a big fricken deal when an attending writes a note in a chart "to help you out". Or makes a phone call for you. Majority of attending don't even know how to reach anyone at the hospital. They rely on the resident.
ReplyDeleteThis perception of "the attending has earned it" is absolute nonsense and exists only in teaching hospitals, where the workload is put onto the resident. The idea is that residents are supported by staff and are there to learn. Instead, it has turned into - and has been widely accepted - the staff refusing to work without a resident because that "would be too much work." How do non-teaching hospitals do it???
I've actively participated in "scut work". Also, it's not scut work. It's normal work and is part of taking care of patients. Holding a patient for the CT is part of the job of caring for a patient. There is NO REASON a staff can't do it. NONE. Especially with a pregnant resident. I've done extra work for pregnant staff and residents to help them out. (Only when I feel it's genuinely appreciated, of course)
Also, in medicine, it may be "just one scan and you'll have lead on", but there are a hell of a lot of "just one scan" and it sure adds up.
"Flu? You keep using that word. I do not think it means what you think it means."
ReplyDeleteor
"You should ask someone what "flu" means and what the symptoms are, like maybe a doctor would know. Do you know any doctors"?
I'd think it, but maybe not say it. And for the record, I tell patients that the difference is that flu LEVELS people.
One more thing re: the comments. One of the reasons I work where I do is that if one of the other attendings tried this kind of crap with a res, we would get in their ass and/or get the medical director involved. Normal abuse is one thing but that's just plain stupid. We regularly answer the unit secretary phone, fetch our own supplies from the cart, etc. No princesses. (Well, maybe one. Actually, two)