Calling in sick

[TRAMD]

I figured this was a relevant topic for myself as I am sitting at home right now after doing just this.

I am feeling guilty like I let my patients down, my nurses down and my residency down. I guess I just didn't want to be blowing my nose in front of patients all day, spreading disease, looking like crap and feeling like crap while I am supposed to be on my toes at all times. I also just don't think as clearly when I am sick. BTW-it is a cold on top of an acute sinus infection.

Anybody have stories of calling in sick? Has anyone gotten in trouble or had your residency not believe you? Thoughts in general? Anyone wanna vindicate or prosecute me? Why do I feel guilty when I know I am too sick to be working? Is it the demand for perfection that I feel as though society has placed on me in my chosen career? Is it just the demand for perfection from myself? [shrugs]

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[Blade28]

What field are you in?

In general, the culture of medicine (and surgery, in particular) is to just tough it out, unfortunately. I've been lucky so far *knock on wood* and I've only felt sick a couple of times thus far in residency, but both times I just sucked it up and went to work.

The most recent time, back in March, I had a terrible cold/flu/URI for 4 days and was alternating popping Advil and Tylenol at work to bring my high fever down. It was miserable.

The old joke is that there are only two reasons to call in sick, and both involve something growing inside you...either a fetus or a tumor.

 

[Blade28]

I should add it's also tough to call in sick here - many times you can mess up the call schedule; if you're a senior on the service someone needs to cover the ICU patients; cases in the OR have to be covered by someone else (sometimes from another service).

I personally don't know of too many people here who have taken sick days, though perhaps the fact that it's not widely known means it's not a big deal.

Obviously, it goes without saying that if you're truly sick, you need to stay home and take care of yourself!

 

[Winged Scapula]

As blade notes, the response you get most likely is predicated on your field and program.

I have never called in sick, but have on a few occasions done rounds walking around with an IV pole and some LR. I have worked through some fairly horrendous migraines, me vomiting into trashcans in the SICU...fortunately, I had some Chiefs who also were sufferers as well as a pharmacy who would give me some meds, but it was still pretty miserable.

I came back to work post-op hour 36 after emergency surgery (having suffered with abdominal pain for a few days, figuring it was menstrual cramps), only to do the same and kept working until an attending finally sent me home because "the nurses are caring for you more than they are the "real" patients". I conveniently scheduled my surgical emergency for my day off...although I did have to miss part of the following day while still in the PACU and hospital. Poor planning on my part...I should have gone to the emergency room before 10 pm (didn't get into the OR until about 2 am).

We had one year at Christmas when I was a PGY-2 and almost all of us in house for call had some horrible vomiting, achy flu...the call rooms were a bit unpleasant when we left!

I can also recall the time when an intern of ours called in sick....word of this peculiar behavior spread like wildfire, "what was this 'calling in sick'?" Apparently someone in a position of power called her to explain that, in our program and specialty, we did not call in sick as she showed up an hour later.

My program was the only residency in the hospital which did not give you sick or personal days...you had to sell them back each year; goes to show you what the attitude was toward calling in sick. Unlike blade's program, we were only allowed to call in sick for two reasons: dead or perhaps along his lines, baby crowning (otherwise you were expected to work up until delivery date).

Mind you, I was raised by some fairly hardy parents who pooh-poohed most illnesses and injuries as insiginificant, so I have little sympathy for many reasons people call in sick so my stance is colored by my upbringing. I cannot see calling in sick for a cold, sinus infection, etc.

Yet despite training in a program and a field which derides calling in sick as irresponsible and my upbringing, I think the mindset is ridiculous. Patients certainly don't want to be cared for by someone who is coughing and sneezing, nor do your co-workers want to be exposed. As blade notes, it is a real pain to rework the call schedule and work load when people do call in sick, but there has to be a reasonable approach to it.

The OP likely feels guilty because he knows that by being absent his fellow residents are working more, because there is such a stigma (even in more resident friendly fields than surgery) against calling in sick - we are supposed to be supermen...caring for others even when we are in pain...and yes, because YOU expext more from yourself.

 

[snoopy brown]

I have never called in sick, but have on a few occasions done rounds walking around with an IV pole and some LR.

Isn't it wonderful how the medical field has taught us to praise this? And at the same time demand sympathy for our patients because they are sick?

 

[8744]

I figured this was a relevant topic for myself as I am sitting at home right now after doing just this.

I am feeling guilty like I let my patients down, my nurses down and my residency down. I guess I just didn't want to be blowing my nose in front of patients all day, spreading disease, looking like crap and feeling like crap while I am supposed to be on my toes at all times. I also just don't think as clearly when I am sick. BTW-it is a cold on top of an acute sinus infection.

Anybody have stories of calling in sick? Has anyone gotten in trouble or had your residency not believe you? Thoughts in general? Anyone wanna vindicate or prosecute me? Why do I feel guilty when I know I am too sick to be working? Is it the demand for perfection that I feel as though society has placed on me in my chosen career? Is it just the demand for perfection from myself? [shrugs]

The only time you should call in sick is if a) You are not on call and won't screw over one of your friends who will have to cover your call b) You are on a rotation where your presence doesn't matter (and I have been on a few). Other than that, I too have done call while so sick that I had to set up a command post with my pagers and my cell phone in the crapper.

As for passing your diseases to the patients. Yeah. Maybe you will but on a practical level, what choice do you have? You can't screw over your collegues having them cover for you every time you get the sniffles.

 

[oldbearprofessor]

Residents routinely show up sick to the NICU. We routinely send them home as fast as we can.

 

[Winged Scapula]

Isn't it wonderful how the medical field has taught us to praise this? And at the same time demand sympathy for our patients because they are sick?

I think its ridiculous (as I noted in my earlier post)...but yeah, for some reason we have to be superhuman and work under conditions we would expect others to be home in bed getting rest.

Please do not praise me (if anyone were so inclined)...this behavior was part my upbringing, part fear of retribution from my residency program and partly because I felt like I could continue working without having to screw over my colleagues. That said, my personal feeilngs on the subject perhaps lead me to feel less sympathy for colleagues and patients who I deem as being "whiners" or complaining about minor ailments.

 

[snoopy brown]

The only time you should call in sick is if a) You are not on call and won't screw over one of your friends who will have to cover your call b) You are on a rotation where your presence doesn't matter (and I have been on a few).

Every time I say anything that would support the status quo (e.g., accepting that we have to work long hours), you give me a lecture on how I'm "pro the massah," even though I've said a number of times that I agree with much of what you say about residency being set up to basically enslave people for a period of time. And yet here you are doing the same.

 

[snoopy brown]

Patients certainly don't want to be cared for by someone who is coughing and sneezing, nor do your co-workers want to be exposed.

I just want to point out that "what you want" doesn't even figure into the decision, notice? I understand we're on the same wavelength, just wanted to point out how indoctrinated you are. Shouldn't it be irrelevant whether you patients want to be cared for by a sick person? It should just be, "I'm sick." The fact that it skips over that statement to "I'm sure this would be bad for patients" is pathetic.

 

[TRAMD]

I have gone to work, miserable, when I was on call because I didn't want to make someone cover for me. My residency is family medicine. Today I missed my 3 hour clinic that will most likely be rescheduled and in which I would have seen about 5 patients. I am currently on a rotation in which I don't matter even a little bit so no problem there. I was actually just as sick yesterday but went in and suffered because I had an ACLS course that I HAD to finish. One time I had a temperature of up to 102 oral and did not sleep all night due to extreme chills and bed-drenching sweats. I decided to push through it and was in surgery the next day. I have NEVER felt sick during surgery for any reason, doesn't bother me a bit. However, the heat of the gown, my illness and the fact that a light was misplaced and shining directly on the back of my neck all lead to me feeling lightheaded and having to leave the room. That was very embarassing and I won't have that happen again. I also just don't think patients appreciate a doctor in clinic sniffling and blowing his nose and then touching their kid (even if you do wash your hands first). Also, sick days come out of our days off. I would definitely prefer to have a day off healthy than sick, but oh well.

 

[Blade28]

Sounds miserable - I feel your pain! During my aforementioned illness back in March, I scrubbed into a 10-hour redo-AVR...partway through the circulating nurse had to carefully lift up my mask and give me 800 mg of Advil with a sip of water to combat my high fever. Ah, good times.

Today I missed my 3 hour clinic that will most likely be rescheduled and in which I would have seen about 5 patients.

5 patients in 3 hours?! God I want your clinic!

Ours are anywhere from 8-45 patients in 4 hours.

 

[TRAMD]

5 patients in 3 hours?! God I want your clinic!

Ours are anywhere from 8-45 patients in 4 hours.

How can you see 45 patients in 4 hours? I have worked with orthopedic surgeons who will see 30 in 4 hours but 45 sounds insane.

As an intern I am only allowed to see one patient every 30 minutes in MY clinic. I have had anywhere from 2 to 8 patients in a 3 hour clinic. It is nice because I can have time to consult with my attending, order and follow-up on x-rays and dictate after each patient. My residency truly does rock. The worst I have had it time-constraint-wise is rounding on 10 patients in 2 hours that I know nothing about; but that was still pretty easy.

[edit] I should mention that those 10 patients were multiple problem IM patients, not 40cc from drain, incision dry and healing well, pain controlled, no BM, tolerating liquid diet, 4-line-note surgery patients.

 

[snoopy brown]

I also just don't think patients appreciate a doctor in clinic sniffling and blowing his nose and then touching their kid (even if you do wash your hands first).

That's OK because I don't appreciate them bringing in their kid sniffling and blowing his nose all over me, either. It's called biological warfare, either he kills me or I kill him!

 

[TRAMD]

That's OK because I don't appreciate them bringing in their kid sniffling and blowing his nose all over me, either. It's called biological warfare, either he kills me or I kill him!

. . . [sniffle, cough] . . . . . .

 

[Winged Scapula]

I just want to point out that "what you want" doesn't even figure into the decision, notice? I understand we're on the same wavelength, just wanted to point out how indoctrinated you are. Shouldn't it be irrelevant whether you patients want to be cared for by a sick person? It should just be, "I'm sick." The fact that it skips over that statement to "I'm sure this would be bad for patients" is pathetic.

I understand your point that I am leaving the "you" out of the equation but I wuld argue that this is not a result of "indoctrination", "drinking the Kool-Aid" or "giving in to THE Man" or whatever cliche you'd like to use which Panda and others like to bandy about whenever someone doesn't argue against conventional practice.

Rather, in my case, this is the result of my upbringing which teaches that the wishes and needs of others are paramount to my own. I further understand that this concept is alien to many of the current generation in which "YOU' is the most important factor in any relationship. While I do admit that much of my disinterest in calling in sick was the result of the prevailing attitude at my residency program, I have held many many jobs before residency in which I held the same attitude and went into work sick. This would include jobs where if you didnt' work you didn't get paid (ie, no sick leave), jobs which had sick leave but there was simply too much work to be done to miss time. I suspect many others have experienced the same.

Therefore, I would argue that me wanting to call in sick, regardless of other's needs (which would include my patients and co-workers), is selfish. Obviously this begs the question at what point do you cross the line between protecting other's concerns (about excess work load, etc.) and protect patients, especially the immunocompromised from your illness. I fully support not having ill persons in the NICU, the Heme-Onc unit, etc, and made every effort in the former to avoid contact when I was sick and I agree, it is miserable to work when you feel absolutely awful. But agian, I would argue that my needs are not more important than those who are expecting me to show up to work.

 

[Blade28]

How can you see 45 patients in 4 hours? I have worked with orthopedic surgeons who will see 30 in 4 hours but 45 sounds insane.

45 patients for the entire clinic. Usually me, another resident, and an attending.

 

[8744]

Residents routinely show up sick to the NICU. We routinely send them home as fast as we can.

That was one of those rotations where my presence didn't matter and I took two sick days just because.

 

[8744]

Every time I say anything that would support the status quo (e.g., accepting that we have to work long hours), you give me a lecture on how I'm "pro the massah," even though I've said a number of times that I agree with much of what you say about residency being set up to basically enslave people for a period of time. And yet here you are doing the same.

Whoa. I am perfectly willing to stick it to The Man but calling in sick when you have call sticks it to your colleagues. In other words, I can insist on not coming in for my shift if I am sick but I will screw over one of my friends who is on "back up" call and there is no getting out of it short of quitting. So you see, I would rather work with admission-grade gastroenteritis than force one of my peers to come in on one of their few days off.

 

[exPCM]

Hospitals are paid 125k per year per resident on average by the US government through Medicare funding. If the hospital chooses to have barebones staffing such that when one resident calls in sick, patient care is somehow jeopardized, is it the resident's fault or the hospital's fault? The hospital always has the option to improve the staffing by using their funds to hire moonlighters, midlevel providers, etc. so that there is still adequate coverage when a resident is sick. Don't blame your sick fellow resident for making your life harder when he or she calls in sick. You need to look at how the hospital and atendings are truly responsible for providing the manpower to take care of the patients.

 

[snoopy brown]

I am perfectly willing to stick it to The Man but calling in sick when you have call sticks it to your colleagues.

Right, but it's only that way because it's set up deliberately to do that. It's actually very clever because it sets up this dynamic that you exhibit where you feel you're hurting "your team" by doing something absolutely reasonable. What other industry or workplace is set up in such a manner where literally nobody can ever be sick? I've done it too, a number of times, where I've been extremely ill and still worked and probably prolonged the sickness as a result. I understand that you don't want to hurt another person because I feel the same way. I'm just saying that it's another mark of how stupid residency is that they made it that way knowingly and deliberately.

 

[OldPsychDoc]

Does no one here (besides Old Bear Professor) ever question whether patient care and safety might be compromised by residents who are either a) functioning poorly due to illness, or b) recklessly transmitting pathogens to already ill and possibly immunocompromised patients???

 

[DrMom]

Does no one here (besides Old Bear Professor) ever question whether patient care and safety might be compromised by residents who are either a) functioning poorly due to illness, or b) recklessly transmitting pathogens to already ill and possibly immunocompromised patients???

We've been known to work wearing masks/gloves to protect the patients from us. At least it is something.

 

[Hoo\/er]

As blade notes, the response you get most likely is predicated on your field and program.

I have never called in sick, but have on a few occasions done rounds walking around with an IV pole and some LR. I have worked through some fairly horrendous migraines, me vomiting into trashcans in the SICU...fortunately, I had some Chiefs who also were sufferers as well as a pharmacy who would give me some meds, but it was still pretty miserable.

I came back to work post-op hour 36 after emergency surgery (having suffered with abdominal pain for a few days, figuring it was menstrual cramps), only to do the same and kept working until an attending finally sent me home because "the nurses are caring for you more than they are the "real" patients". I conveniently scheduled my surgical emergency for my day off...although I did have to miss part of the following day while still in the PACU and hospital. Poor planning on my part...I should have gone to the emergency room before 10 pm (didn't get into the OR until about 2 am).

We had one year at Christmas when I was a PGY-2 and almost all of us in house for call had some horrible vomiting, achy flu...the call rooms were a bit unpleasant when we left!

I can also recall the time when an intern of ours called in sick....word of this peculiar behavior spread like wildfire, "what was this 'calling in sick'?" Apparently someone in a position of power called her to explain that, in our program and specialty, we did not call in sick as she showed up an hour later.

My program was the only residency in the hospital which did not give you sick or personal days...you had to sell them back each year; goes to show you what the attitude was toward calling in sick. Unlike blade's program, we were only allowed to call in sick for two reasons: dead or perhaps along his lines, baby crowning (otherwise you were expected to work up until delivery date).

Mind you, I was raised by some fairly hardy parents who pooh-poohed most illnesses and injuries as insiginificant, so I have little sympathy for many reasons people call in sick so my stance is colored by my upbringing. I cannot see calling in sick for a cold, sinus infection, etc.

Yet despite training in a program and a field which derides calling in sick as irresponsible and my upbringing, I think the mindset is ridiculous. Patients certainly don't want to be cared for by someone who is coughing and sneezing, nor do your co-workers want to be exposed. As blade notes, it is a real pain to rework the call schedule and work load when people do call in sick, but there has to be a reasonable approach to it.

The OP likely feels guilty because he knows that by being absent his fellow residents are working more, because there is such a stigma (even in more resident friendly fields than surgery) against calling in sick - we are supposed to be supermen...caring for others even when we are in pain...and yes, because YOU expext more from yourself.

What a joke. Only in medicine. I'm so glad I got out of this $hit hole called medicine when I did. I'm glad you guys enjoy being abused both physically and mentally by people who don't give two $hits about you in the first place.

Did they teach that in your medical school, too? They tried to teach it to me, but I told them to shove it up their @ss.

Hoover

 

[nradsoit3]

Hoover, you rock.

Calling in sick in residency is absolutely verboten. I am too afraid they would send the Gestapo to my lavish sized apt (I kid) to drag me back to the hospital kicking and screaming if I did such a thing. During my internship, I suffered a severe bout of laryngitis losing my voice completely. I did my rounds in sign language that day. Residency blows.

 

[Winged Scapula]

What a joke. Only in medicine. I'm so glad I got out of this $hit hole called medicine when I did. I'm glad you guys enjoy being abused both physically and mentally by people who don't give two $hits about you in the first place.
Did they teach that in your medical school, too? They tried to teach it to me, but I told them to shove it up their @ss.

Hoover

Curious response given the fact that not a single person here, including myself, has defended the system which essentially forbids calling in sick.

The OP asked for other stories and whether or not people were allowed to call in sick. That's what we gave him; I fail to see any responses in which any of us have claimed to enjoy it or even sanction the behavior by programs.

 

[Winged Scapula]

Does no one here (besides Old Bear Professor) ever question whether patient care and safety might be compromised by residents who are either a) functioning poorly due to illness, or b) recklessly transmitting pathogens to already ill and possibly immunocompromised patients???

Of course...we ALL realize that as a problem.

However, surely you must recognize the powerlessness most residents feel in such a situation, especially when faced with a program that outrightly tells its residents that calling in sick is not an option. In most resident's minds, to do so, risks a red flag next to their name when it comes time to decide about contract renewal.

I would dare say that no one is unaware or insensitive to the issue of spreading illness to patients and co-workers, as well as the fact that most of us perform at less than optimal levels when sick. BUT the change really needs to come from the attending and faculty level...whom in most cases, seem unconcerned about residents working in such conditions (except in the cases as OBP notes, involving NICU babes or other immunocompromised patients) and seem to only care about whether or not the work gets done.

 

[3dtp]

My former program:
Senior resident has rapid onset RLQ abd. pain, fever, chills, rebound tenderness. Off to the ER where, lo and behold, she was admitted, dispatched urgently to the OR and the burst appendix was removed, started on the usual abx and the Chief came into her room while we were rounding the next morning and told her that he expected her to be able to cover the ICU as scheduled that evening. He was serious. We were stunned. Drive through appys anyone?

 

[TRAMD]

45 patients for the entire clinic. Usually me, another resident, and an attending.

Oh, ok. Phew.

 

[TRAMD]

My former program:
Senior resident has rapid onset RLQ abd. pain, fever, chills, rebound tenderness. Off to the ER where, lo and behold, she was admitted, dispatched urgently to the OR and the burst appendix was removed, started on the usual abx and the Chief came into her room while we were rounding the next morning and told her that he expected her to be able to cover the ICU as scheduled that evening. He was serious. We were stunned. Drive through appys anyone?

Haha! Recently one of my seniors was nowhere to be found. He finally answered one of my pages and said "I'm in the ER with appendicitis . . . " and hung up. He was back to work a couple days later.

 

[bulletproof]

My former program:
Senior resident has rapid onset RLQ abd. pain, fever, chills, rebound tenderness. Off to the ER where, lo and behold, she was admitted, dispatched urgently to the OR and the burst appendix was removed, started on the usual abx and the Chief came into her room while we were rounding the next morning and told her that he expected her to be able to cover the ICU as scheduled that evening. He was serious. We were stunned. Drive through appys anyone?

WTF?, "you'll work this evening, and wear the illness you brought upon yourself as a badge of Shame.If you read your contract you'll see that a ruptured appendix is acceptable during your scheduled time off only. Here, now put on these shackles...."

 

[KidDr]

My former program:
Senior resident has rapid onset RLQ abd. pain, fever, chills, rebound tenderness. Off to the ER where, lo and behold, she was admitted, dispatched urgently to the OR and the burst appendix was removed, started on the usual abx and the Chief came into her room while we were rounding the next morning and told her that he expected her to be able to cover the ICU as scheduled that evening. He was serious. We were stunned. Drive through appys anyone?

un-friggin-believable

 

[snoopy brown]

especially when faced with a program that outrightly tells its residents that calling in sick is not an option.

Heh and you were telling me that I was in a crap program based on where they made me park? I think we know who won this round.

 

[snoopy brown]

My former program:
Senior resident has rapid onset RLQ abd. pain, fever, chills, rebound tenderness. Off to the ER where, lo and behold, she was admitted, dispatched urgently to the OR and the burst appendix was removed, started on the usual abx and the Chief came into her room while we were rounding the next morning and told her that he expected her to be able to cover the ICU as scheduled that evening. He was serious. We were stunned. Drive through appys anyone?

What program? Don't feel any sense of loyalty, just run it into the ground. Did she do it?

 

[gwen]

honestly, i don't think i would ever feel comfortable having an IV w/ LR running through me while i was rounding, i'd much rather be home trying to get better. something just isn't right with that picture. why would you be screwing anyone over if you know you are going to make it up to them another day or another week? i agree with cox in that calling in sick depends on what rotation you are on. i'm in medicine...so i would have to be really really sick to call in sick for say, an icu rotation. but i would not just "suck it up" no matter what. who are we trying to prove this braveness to? the hospital? they don't give a rat's a$$ about you...they need a body. the other resident who will cover you? its called being a human...you help someone and they help you back.

we choose to work as hard as we want to - this is a personality issue. this doesn't just show up in residency...it also shows up when you are an attending...the choice of rounding and working until 10pm or getting your work done and going back to your family.

 

[Pir8DeacDoc]

Just want to echo what many of the other surgeons have said already. Just as "there's no crying in baseball", there's no sick time in surgery.

As a fourth year student I did a rotation at a program known to be pretty intense/malignant. One of the new hand fellows who had done his GS at another program called in sick while I was there. All the other residents automatically labeled him as weak.

Luckily for me I haven't had any serious illness while a resident. Been tired as all hell a lot and even hungover a few times, but nothing too much more than that. Although with my stupid nail biting habit it's truly a miracle. Maybe I've already battled and defeated all the pathogens the hospital has to offer.

I think it's different in fields other than surgery where there are a lot of "off service" rotations. Generally these off service groups could care less if you show up. So why not take a day to heal up? You'll likely never see any of the other residents or attendings for that service again anyway...

 

[Winged Scapula]

Heh and you were telling me that I was in a crap program based on where they made me park? I think we know who won this round.

Touche (although in my defense I was referring to any number of programs in which that attitude exists)! I think we can both agree that our programs are better than the one 3dtp was at!

 

[Coastie]

Rounding with an IV pushing LR is just plain idiotic and very careless with regards to patient care. Any program that requires that of residents who are sick should be shut down and defunded!

honestly, i don't think i would ever feel comfortable having an IV w/ LR running through me while i was rounding, i'd much rather be home trying to get better. something just isn't right with that picture. why would you be screwing anyone over if you know you are going to make it up to them another day or another week? i agree with cox in that calling in sick depends on what rotation you are on. i'm in medicine...so i would have to be really really sick to call in sick for say, an icu rotation. but i would not just "suck it up" no matter what. who are we trying to prove this braveness to? the hospital? they don't give a rat's a$$ about you...they need a body. the other resident who will cover you? its called being a human...you help someone and they help you back.

we choose to work as hard as we want to - this is a personality issue. this doesn't just show up in residency...it also shows up when you are an attending...the choice of rounding and working until 10pm or getting your work done and going back to your family.

 

[Red Beard]

Hospitals are paid 125k per year per resident on average by the US government through Medicare funding. If the hospital chooses to have barebones staffing such that when one resident calls in sick, patient care is somehow jeopardized, is it the resident's fault or the hospital's fault? The hospital always has the option to improve the staffing by using their funds to hire moonlighters, midlevel providers, etc. so that there is still adequate coverage when a resident is sick. Don't blame your sick fellow resident for making your life harder when he or she calls in sick. You need to look at how the hospital and atendings are truly responsible for providing the manpower to take care of the patients.

This is the point a lot of people refuse to look at. Wanting/needing to call in sick wouldn't and shouldn't be a problem in the first place if the system was set up in such a way to deal with it. Looking at other aspects of medical culture that are changing--resident work hour limits, more physicians choosing part time practice and 'lifestyle specialties', etc.--its possible that this work until you drop mentality may change too.

But I'm not exactly holding my breath.



But I'm not holding my breath.

 

[yaah]

Ultimately the problem with calling in sick is that hospitals run with a lot of work from residents. When a resident on a key rotation calls out sick, someone has to cover, and rarely does anyone willingly volunteer to be that person. People do not want to be the one that results in other people having to do unsuspected extra work. But one would hope that in the proper, respectful environment, things would even out and certain people wouldn't take advantage of this. Unfortunately we live in a me-first society.

I am in a field (path) where calling out sick causes less of a burden than that of other fields, but our role is vital on many services, and when residents call in sick either someone gets pulled from a lighter rotation to cover or others just pick up the slack. It's a pain in the ass, and it does happen. However, it is almost always the same 2-3 residents who do this. When others do it, everyone knows it is not being done lightly and they will be more willing to help out. We have had residents who were scheduled to be on call develop a family emergency, and someone else takes the call. I would hope that would happen in other fields as well - clearly having appendicitis or vomiting every 2 minutes or having your spouse go to the ER with an emergent problem should result in someone covering. If people can't sack it up and help each other out, that's a poor reflection on everyone else's attitudes and fitness to be professionals.

That being said, clearly there is a fine line between calling out sick for real reasons and calling out sick for suspect reasons, and unfortunately there are a lot of people in the world who have no qualms about dumping work on other people and calling out sick when they really don't need to. Interestingly (but predictably), the ones who would do this latter behavior are also the last ones to volunteer to cover when someone else has a true crisis.

 

[snoopy brown]

People do not want to be the one that results in other people having to do unsuspected extra work. But one would hope that in the proper, respectful environment, things would even out and certain people wouldn't take advantage of this. Unfortunately we live in a me-first society.

Wrong. Again, look at your mentality. You have basically mentally shuffled anyone who takes a day off for anything less than an absolute catasrophic health event as "selfish." The problem is not (just) that hospitals depend on residents to do a lot of work. It's that they make it so that residents are spread so thin and doing so much work that one person could potentially bring down an entire service and not just in a remarkable situation but on any routine day. How stupid is that? Is there any job where that is the case?

Now any rational person would refuse to work in that situation, so enter brain conditioning. Everyone gets it drilled into their head that the patient is more important than you. And not only that, but if you would even consider taking a day off for real illness that hasn't paralyzed you, you're either weak or selfish, maybe both. Probably both.

The solution is quite simple. I've worked at minimum wage jobs that are set up better. You know what they do? They just tell people they'll pay them double to come in to cover and people do it. But residency doesn't need to do that. They just tell you to come in.

 

[TRAMD]

I am feeling better today if anyone cares, haha. I heavily weighed the pros and cons of going in yesterday or not. As I stated earlier, I HAD to go in two days ago because I didn't know when I would get to take ACLS again. I went to work sick another time because I was on call and didn't want to dump on anyone. Yesterday my responsibility was minor. My patients will be rescheduled, not transferred to another resident's schedule that day unless they are somewhat emergent issues, but scheduled appointments rarely are. We always have one or two residents in clinic who are the acute care docs for that day anyways. I am on an off-service rotation where my presence means squat (in fact, they gave me this afternoon off). I truly feel that taking a day to take care of myself and rest expediated my recovery. Also, you are not always dumping on people. I have traded call a few times with other residents for sub-emergent issues (once it benefitted me when my pregnant wife had vaginal bleeding--baby is fine, BTW). It turns out to be the same amount of work, just a different day. All-in-all I don't buy into the work until you die attitude of many physicians and am comfortable with my choice.

 

[snoopy brown]

You know that the only person who really cares about your health is whoever is on backup call. The rest of us couldn't care less

 

[TRAMD]

You know that the only person who really cares about your health is whoever is on backup call. The rest of us couldn't care less

I am haven't been on call through any of this (except pager call for my clinic patients--which I am always on) so I think only I really care.

 

[Annette]

The rule for coverage was if you covered someone, they owed you two calls- one for the one you covered and one for payback.

But this didn't work too well on the days. People on light rotations were often called in to cover the heavier ones (ICU, floors). There were also a number of months where there weren't enough interns to cover the ICU because the family medicine program decided to change the rotation to second year (MUCH better for the FP residents). Being asked to cover 15-20 ICU patients as an intern just was ludacris, but it was expected anyway. Pointing out the risks to patient safety, and well as the lack of learning, got me in big trouble. Hmmm, now that I think about it, I should have gone direct to the RRC and JCHAO instead of to my director and the hospital administration. So much for chain of command.

One senior was in the hospital with dehydration, vomiting and RUQ pain. The program director got upset when the senior asked the chief to help her find coverage. The director's remark when someone pointed out that the senior was admitted as a patient (high on dilaudid as well) was "She wasn't intubated and there are phones in the room!"

Another example was having a resident stuck in a cast. Any other employee in the hospital would have been kicked out by infection control because you just can't keep a cast clean enough. The resident got "special dispensation" from IC, and a box of extra large gloves.

 

[Faebinder]

Ya, at my program... if you are sick, you are just gonna have to walk around with an IV on a pole and Zosyn/Zofran pumped into you.

 

[snoopy brown]

The resident got "special dispensation" from IC, and a box of extra large gloves.

That's just another instance of people talking all big about the importance of their new regulations when it's inconvenient for you and then throwing it out the window when it's convenient for them. This is why I ignore just about everything IC says.

 

[Tired]

Curious response given the fact that not a single person here, including myself, has defended the system which essentially forbids calling in sick.

I'll defend it.

The arguments for calling in sick basically revolve around two trains of thought:

1) I feel too sick to work. I need to stay home to get better.
2) I'm going to make my patients sick, so I should stay home.

Here's what I say about that:

#1 - Shut up. You work in a hospital, and you know what people who are really sick look like. If you have some diarrhea and have to answer a few pages from the crapper, then do it. If you have the sniffles, I really don't care. I'm not covering your service because you don't feel good. It's internship, we don't feel good every day.

#2 - Has everyone forgotten the difference between a bacterial and viral illness? You have a f-cking cold. A cold. Seen a lot of people die of that lately? Have you admitted a lot of "Rhinovirus Sepsis" lately? And even if it is something a little stronger like influenza, put on a mask. Wow. That was tough.

Basically the best reason not to call in sick is that it makes you look like a p*ssy. And you're not a p*ssy are you?

 

[snoopy brown]

You work in a hospital, and you know what people who are really sick look like.

That line of reasoning only works if the rest of the world operates on the same rationale "either I'm in the hospital or I'm not sick." People in the hospital are really sick, yes, but that doesn't mean you have to be this sick in order to not work. As soon as they make everyone else live by the same rule I'll stop talking about it.

 

[oldbearprofessor]

#2 - Has everyone forgotten the difference between a bacterial and viral illness? You have a ...... cold. A cold. Seen a lot of people die of that lately? Have you admitted a lot of "Rhinovirus Sepsis" lately? And even if it is something a little stronger like influenza, put on a mask. Wow. That was tough.

Infants with multiple health problems, not just NICU patients, but also those with congenital heart disease among other problems, who could be in a number of hospital locations (including an ER of many hospitals), routinely become extremely sick from RSV and other viral respiratory infections. We have several otherwise stable infants die of RSV in our hospital every year and we've had several influenza deaths. Anyone working with sick infants and children, which could include a wide range of caregivers, not just those covering an NICU, should be concerned. Using a mask is inadequate to protect the children at least as far as our infection control and ID specialists have told us.

The problem is complex and I agree that a substantial responsibility falls on the attendings and the hospital for encouraging the type of "work while sick" behavior. We are stunned when residents resist being sent out of infant care areas because of the sniffles. But, when I'm on the clinical wards, I keep the chief pediatric resident on "speed dial" and I've never had them argue with me when I told them someone was going home for a URI.

Finally, in a lighter note, I would say that the most common reason I've seen for acute early AM upset stomachs among pedi residents is acute "pregnancy".