COMMENTARY

Is Being Sick an Excuse to Miss Work?

Brandon Cohen

Disclosures

August 07, 2015

Should an ailing physician come to work or stay home? How great are the pressures to attend one's patients? Does the decision to get out of bed depend on the type or severity of the illness? Are patients better served by the sick doctor coming in or staying away?

These questions were discussed by healthcare professionals during a recent discussion accompanying a reader poll on Medscape. Overwhelmingly, the answer to the question was to suck it up and come in to work. A full 90% of respondents to the poll claimed to have come to work sick at least once in the past year, and the comments fleshed out the statistics with some grisly details.

A primary care physician in solo practice laid it out clearly for doctors in her situation:

If I don't work then the doors are closed. I don't earn sick time or vacation time. I get paid what is left over at the end of the day. There is no one to cover for me as I am the only provider in the office . . . If I call in sick then all appointments get canceled and moved to a new day or patients go to urgent care. But I still have to pay for overhead (building and staff) so I get doubly hit if I take a sick day.

For an anesthesiologist, the problem was not one of isolation but of interconnectivity:

[I work at a] community hospital. If I call in sick, at best, the operating room will be thrown into disarray and significantly delayed while a colleague on a day off is dragged in from home, or clinic is canceled to free someone up, or the person on call the night before is begged to soldier on. Worse case, the whole list gets cancelled. When the patients who have planned their lives around this day are told they will have to be rebooked, what do you imagine their response is?

An ophthalmologist pulled back to find a bit of philosophical distance:

We are trained to see ourselves as indispensable, and we also see ourselves as above the law, including the laws of nature! Our bugs are just as contagious as other people's bugs—we don't have a special shield around us that protects others from us when we are contagious. Still, we nearly all go to work when sick, as we feel there will be no one to care for our patients if we do not; and that is true.

A critical care physician raised the prospect of punishment for missing a day:

As a resident, that is the doctor with the most direct contact with the sickest patients, I could never call out sick unless I wanted to get punished by my seniors or shamed by my co-residents. I went to work with fevers of 104. I went to work with vomiting, with productive cough, even with pink eye . . . This is the reality.

Another healthcare provider underscored the danger posed to patients by sick healthcare professionals:

It disturbs me what our patients are being exposed to. We have a policy that if you have fever, vomiting, or diarrhea, do not come in to work as you are infectious. We have dealt with norovirus outbreaks in patients and staff from multiple units at the same time due to ill staff and physicians working . . . Patients, especially newborns, do not need to have this exposure to infectious agents . . . This truly shows that healthcare is not near having the culture of safety that patients and families, insurance companies, and the government expect us to have.

A rural pediatrician claimed that the situation in less populated areas was even more extreme than that of big-city doctors:

If I tried to stay home, sick people would actually come to my house or the hospital would send a truck out to get me for a C-section. Absolute truth!

But there were some doctors who seemed to manage to forge a little recovery time. A primary care physician found a bit of time off, but it just wasn't enough:

This year I had carpal tunnel release surgery, and . . . I did take one week off with a medical certificate; however, I had to take another two days off due to infection and I was placed on no-pay leave! I have over 200 hours of sick leave! It's sad as doctors that we cannot take our sick leave when we need it!

An internist, though, seemed to have things under control to an enviable degree: "I do stay out of work when I have a fever. I do work when I have mild colds controllable with decongestants and antitussives."

But the final word goes to an anesthesiologist who summed up the prevailing attitude succinctly: "Sick days pertain to everyone but those of us in the health profession."

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