Do You Keep Seeing Patients When You're Sick?

Batya Swift Yasgur, MA, LMSW

Disclosures

March 27, 2014

In This Article

The Problem of "Misplaced Dedication"

"When you go to medical school, there's a 'hidden curriculum' that you have to be 'strong'," observes Dr. Wyatt. "The unstated rule is that if you succumb to illness, you've succumbed to weakness, and you're not cut out to be a doctor."

Worrying about being perceived as weak isn't just a matter of low self-esteem. There are real-life consequences, too. "Medical students, interns, and residents are afraid of a poor evaluation," observes Eric Widera, MD, Director of the Geriatric Fellowship Program at the University of California at San Francisco. As a result, he says, they come to work sick when perhaps the wiser course would have been to stay home.

That type of mentality continues even after residency, Dr. Widera says. Many mature physicians continue to regard themselves as "weak" or "unfit" if they call in sick -- even when they no longer need to worry about the censure of superiors.

One Los Angeles-based radiologist recalled, "When I was a resident and wanted to go home because of a migraine, I was sternly told by the chief resident, 'Doctors don't take sick days unless they're admitted to the ICU.' That message echoes in my ears every time I think of staying home."

She ignored the "echo" only once -- when she had pneumonia -- and, even then, she "felt like a wimp."

But is it really all about perceived weakness?

The answer is no, says Anupam B. Jena, MD, PhD, Assistant Professor of Healthcare Policy and Medicine at Harvard Medical School, whose team studied presenteeism in residents. "Over half of respondents reported coming to work sick at least once in the previous year, but only 12% were afraid of being regarded as weak."

The 2 most important motivations for coming to work when sick turned out to be concern about abandoning patients and concern about overtaxing colleagues. "I call this a culture of 'misplaced dedication,'" says Dr. Jena.

An additional factor is that calling in sick leads to a "bureaucratic nightmare" of scrambling to reschedule patients, triage those who must be seen immediately (often to physicians with already overflowing waiting rooms), or cancel patients who might have been waiting for weeks or even months for their appointment, adds Danielle Ofri, MD, PhD, Associate Professor of Medicine at New York University and author of What Doctors Feel: How Emotions Affect the Practice of Medicine, which was published last year by Beacon Press.

While Dr. Ofri concedes that it's noble of doctors to not to want to leave anyone in the lurch, "it doesn't occur to us that it might be unfair to our patients if we expose them to contagion," she says.

Dr. Widera agrees, adding that doctors need to begin "unlearning" some of their conditioned responses to their own illnesses. "Mindfulness is a process of reflection," he says. "Ask yourself, 'How am I feeling?' 'Why am I going to work if I'm sick?' 'Do I really need to be there?' This begins a dialogue within oneself that's the first step toward making changes."

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