(Influenza Virus, courtesy freedigitalphotos.net)
The surgery resident was seeing stars as she sutured the wound. "I need a chair," she whispered, slowly sitting back into the air behind her (where no chair currently existed). The nurse caught her, and I ran over. "I'm just not feeling well. I threw up earlier this morning." I gave her an antiemetic medication. She took a short break but returned only to experience the same thing. Eventually, one of the other nurses put an IV in her and gave her a liter of fluid. Then she returned again to finish the 8-hour case. No one ever told her to go home.
You wake up with an acute illness - say, a GI bug or a bad upper respiratory infection. You're sick, weak, and dehydrated. What is the next thing you do? If you're a normal person, you struggle over to the phone, call your office and tell them you won't be coming to work today. If you're a physician, you suck it up and go on in.
WHY? Why do we do this? It's so wrong, and it greatly upsets me every time I see it. As a medical student or resident, it is an unspoken rule that you show up for duty unless you've died or been rendered immobile. This USA Today article reported on a 2010 JAMA study that found 58% of 537 polled residents in 12 hospitals across the country admitted to having worked while sick. A third of those polled had done it more than once, and around 50% said they had not "had time" to see a doctor about their illness. What about all the patients they're exposing themselves to?? I too was offered the IV fluids and antiemetics on a couple of occasions, but I was never told to leave. Only once in the handful of times I was acutely ill during training, I was successfully able to stay home from work. The key? I had such bad GI distress that I literally couldn't leave the bathroom!
It's a culture that continues on after we finish training. There are many sick patients to see who are depending on you to help them get better, and you are the boss. By virtue of the profession, physicians tend to put their patients' needs before their own. This instills a belief by both us and our patients that we are somehow immune to the same types of problems. Doctor Grumpy blogged about this here, admitting that he too suffers from migraines (a common ailment seen in is field of neurology). He did also say that three patients in his career so far had changed to other doctors due to him calling in sick and cancelling his clinic. Unfortunately, the practice of ignoring and working through acute illness grows into a practice of ignoring basic health maintenance, which extends to chronic symptoms or nagging health problems... until eventually the doctor becomes a patient.
You see, I know all about ignoring symptoms, putting off health tests, and becoming a patient. If I could fast forward that period of my life when I pressed on, thinking my health issues were just related to my stressful job and getting older, I would. I don't want that to happen to anyone else. So let's stop being martyrs, take care of ourselves and encourage the residents to go home when they are sick!