Do You Keep Seeing Patients When You're Sick?

Batya Swift Yasgur, MA, LMSW

Disclosures

March 27, 2014

In This Article

What Should the Rules Be for Doctors Working When Sick?

"It feels like we doctors are being asked to shoulder the responsibility for this issue -- how to scramble and arrange coverage or balance our own needs against those of our patients," says Dr. Ofri. "But really, it's an administrative issue."

"Physicians don't have built-in sick days. There's no pool of substitutes as there is when a teacher is ill," says Douglas S. Diekema, MD, MPH, Director of Education at Treuman Katz Center for Pediatric Bioethics at Seattle Children's Hospital. "Even institutions that talk a good game -- meaning, tell all their employees not to work when they're sick -- have disincentives for calling in sick." For many physicians, the job requires working a certain number of shifts per year, which means they'll have to make up those shifts down the road. "So when they're sick, they'll pay a price later on," Dr. Diekema says.

Physicians agree that fixing this problem rests in part with leadership -- specifically, the administrators of large medical practices and other institutions, which generally have more flexibility in scheduling than 1- or 2-doctor offices. "Leadership must make a clear statement to physicians: 'You can't come to work when you're ill and we won't penalize you,'" asserts Dr. Wyatt.

Each hospital system has a different set of challenges, of course, which administrators must address. "For example, if you're the only cardiovascular surgeon in a small-town hospital, it's incumbent upon leadership to create backup plans in case you're ill, such as arranging for patients to be transported to a larger facility if necessary," says Dr. Wyatt. Physicians, he adds, may need to get involved in "educating" administrators so that they can accurately assess the needs of the community and who will fill certain coverage gaps when a doctor is sick or otherwise unavailable.

The experts we spoke with have several suggestions for physicians who become ill, whether they're in a solo, group, or hospitalist practice. Among them:

Use your office staff more effectively. Have a nurse, nurse practitioner, or physician assistant see urgent but uncomplicated patients. Less-urgent cases can be rescheduled. Patients with urgent and complex problems should be advised to go to the emergency department.

Have a written policy in your practice. Put a sign in your waiting room informing patients that if the doctor is sick, they'll be rescheduled for their own safety.

Set money aside for a rainy day -- and a sick day. Because canceling patients involves financial loss, try to build this contingency into your budget so that you're not caught unawares.

Conclusion

As the saying goes, doctors generally make bad patients. "We go into medicine to help others, but often at a cost to ourselves," Dr. Widera notes. "Potentially infecting others comes from a larger mindset of ignoring our own needs."

Dr. Diekema concurs, advising physicians to engage in preventive self-care. "Keep up with flu shots. Wear masks, gowns, and gloves whenever possible if you're around contagious patients. Practice good hygiene." Get good rest and exercise, eat well, and engage in other activities that strengthen your immune system.

In short, if you don't take care of yourself, who will? And if you don't put yourself first when you're sick and not firing on all cylinders, you, your colleagues, and, most importantly, your patients will undoubtedly suffer.

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