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5 Tips for Feeling Less Guilt When Calling Out Sick

Giancarlo Toledanes, DO

Disclosures

July 30, 2021

5 AM

He had been well just the day before and now he was getting febrile. I grabbed the temporal thermometer on the side table and swiped it against my son's burning forehead.

It was like raking hot coals.

The red light blinked 102° F. I made a mental inventory of all his symptoms: mild rhinorrhea, a little cough, no rashes, no respiratory distress. To borrow from the pediatric hospitalist's lexicon, I knew that he was "ill but not toxic." However, he still would not be able to go to school.

5:30 AM

I hesitated as I reached for my cell phone and dialed the phone number to our on-call scheduler.

"Hello," I said. "I'm sorry but I can't go to work today because my son is sick with a fever."

An uncomfortable feeling bubbled up inside of me, composed of guilt for calling out sick and staying home to care for my child.

Why did I feel this way?

Physician, Heal Thyself

Physicians are used to being self-sufficient and we find it difficult to ask for help. We know that our days are busy, and asking for some time off to care for family members or ourselves can be potentially burdensome to our colleagues. In my case, having to rearrange someone else's schedule to accommodate my own made me feel selfish. After all, nobody wants to go in to work on his or her day off, including myself.

My call out also occurred in the middle of a particularly challenging inpatient service week. A combination of complex medical cases, COVID patients, and social challenges awaited me every day. I worked hard to build rapport with my patients, and the disruption of a call out threatened to negate this work. I also hesitated to relinquish control to my colleague for fear of losing continuity of care.

Being a pediatric hospitalist, I sometimes find it difficult to separate my role as father and pediatrician. My son was certainly sick, but I did not feel that he was sick enough to miss school and therefore necessitate my calling out. In a JAMA study, 57% of respondents perceived an ambiguity about what symptoms constitute too sick to work. Although the study did not address absence due to a family member's illness, I surmise that the same perceived ambiguity is present when a family member is ill.

"Guilt is the thief of life." –Anthony Hopkins

The guilt produced by calling out results in presenteeism with consequences to both physicians' professional and personal lives. Along with the potential risk for spread of infection, working while sick can lead to emotional burnout, cynicism, and depersonalization of patients. The guilt also produces a work–family conflict that can result in strained relationships between partners. Clearly, something has to give.

Changing the Perception of Sick Days

Here are five tips we can use to help us change the perception of sick days to care for our family and ourselves.

1. Focus on what is most important in your life.

Author Greg McKeown recounts a story in his book Essentialism: The Disciplined Pursuit of Less, where he attends a business meeting the day after the birth of his son. Believing that his client would receive this action as a positive attribute, he was very surprised to find that the client looked upon him unfavorably for leaving his newborn son and wife in the hospital to attend the meeting. McKeown advocates taking a deep, hard look at what really matters in our lives and "getting the right things done." What is more right than our families' health and ours?

2. Be transparent.

Nobody needs to know explicit details, but if you are dealing with an illness that is keeping you from going into work, then you should inform your team, colleagues, and staff members, in the case of private clinics. Although emergencies do occur and sometimes call outs are made at the last minute, it is still helpful to notify everyone as soon as you know that you are most likely calling in.

3. Establish formal backup systems.

As a pediatric hospitalist in an academic center, I am fortunate to be part of a large physician group with a formal backup system. We have on-call schedulers that can call in the scheduled backup physician to work at any time any of us need to call in sick. Private practice can be a bit more challenging, especially if you are a solo practitioner, but establishing a plan with your clinic should unexpected circumstances arise is still a good idea. These plans may include rescheduling routine visits, having your partners (if you have any) see a few patients, referring acute patient calls to urgent care clinics, and having a plan for your front office staff.

4. Lean into your teammates when you do need help, and reciprocate the help.

Backup systems are an agreement between individuals in a group, and a mutual understanding exists to not abuse the system. Willingly accept the available help and pay this forward for someone else in the future. When reliable help is available and reciprocated between colleagues, the hard feelings from being called in and the guilt from having to call out is mitigated.

5. Acknowledge our humanity and that doctors and their families can get sick as well.

Finally, physicians need to confront the unrealistic expectation that doctor's do not ever call in sick. It is not a sign of weakness to call out to care for yourself or your family. Rather, it is a reflection of our dedication to the medical profession and our inclusion in the human condition.

In the end, my son's fever broke and he recovered after 1 day. My colleagues cared for my patients in my absence and I learned a valuable lesson as a father and physician.

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About Dr. Giancarlo Toledanes
Giancarlo Toledanes, DO, is an assistant professor of pediatrics and a pediatric hospitalist at Texas Children's Hospital and Baylor College of Medicine in Houston. His professional interests include quality improvement, health equity, faculty development, and social psychology. When he is not in the hospital, he is a cook and a handyman to his wife, an amateur LEGO builder to his son, an aspiring unicorn to his daughter, and a walking burp cloth to his baby daughter. Connect with him on Twitter: @ ToledanesGian

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