Debilitating Toothaches and Calling in Sick?

[serimeri]

So we had our orientation today with the residents regarding calling in sick and leave etc. The resident told us that the only reason we should ever call in sick is if we need an IV and even then arrangements can be made to have the IV pole attached to us so we can do our notes. He mentioned that zero tolerance would be had for anyone who called in sick for minor things.

I had a flashback just then to a time when I was 15, and I had the worlds most debilitating toothache. I literally wanted to smash my entire jaw and face with an iron. We had limited resources and no dental insurance, so my parents waited a week before sending me to the dentist for a tooth extraction. I missed a week of 10th grade, no big deal, since I made everything up. But I get scared thinking about what will happen if I ever get one of my childhood toothaches again.

Knock on wood, it has not happened in 14 years, but if it does, I will be unable to work since it will be literally like a strike of lightning. In that scenario, should I call my chief and PC immediately? Then should I check into the ER?

I'm just terrified about what will happen if my PD finds out about it and I don't get to see a dentist immediately. I still need about $10K in dental work, but I am going to hold off until I start earning or have dental insurance in place and take care of that during my vacation months.

I just want to have a plan in place in case this emergency arises. As stupid as this sounds, should I show up to the ER at my Hospital and just request an emergency dental consult there so that way nobody thinks I lied? The dentists in this town are not 24/7 so I assume they would have some sort of coverage in the ER.

I'm sure the vast majority of you think this is being paranoid...but I needed to ask since they made such a huge point about not calling in sick unless one is deathly ill.

---

Members don't see this ad.

 

[P Diddy]

So we had our orientation today with the residents regarding calling in sick and leave etc. The resident told us that the only reason we should ever call in sick is if we need an IV and even then arrangements can be made to have the IV pole attached to us so we can do our notes. He mentioned that zero tolerance would be had for anyone who called in sick for minor things.

I had a flashback just then to a time when I was 15, and I had the worlds most debilitating toothache. I literally wanted to smash my entire jaw and face with an iron. We had limited resources and no dental insurance, so my parents waited a week before sending me to the dentist for a tooth extraction. I missed a week of 10th grade, no big deal, since I made everything up. But I get scared thinking about what will happen if I ever get one of my childhood toothaches again.

Knock on wood, it has not happened in 14 years, but if it does, I will be unable to work since it will be literally like a strike of lightning. In that scenario, should I call my chief and PC immediately? Then should I check into the ER?

I'm just terrified about what will happen if my PD finds out about it and I don't get to see a dentist immediately. I still need about $10K in dental work, but I am going to hold off until I start earning or have dental insurance in place and take care of that during my vacation months.

I just want to have a plan in place in case this emergency arises. As stupid as this sounds, should I show up to the ER at my Hospital and just request an emergency dental consult there so that way nobody thinks I lied? The dentists in this town are not 24/7 so I assume they would have some sort of coverage in the ER.

I'm sure the vast majority of you think this is being paranoid...but I needed to ask since they made such a huge point about not calling in sick unless one is deathly ill.

A severe toothache can be debilitating, but in your case it is preventable. You are choosing and have chosen not to perform routine dental maintenance, or get your teeth taken care of. Is there a reason your fellow residents should suffer for your lack of foresight?

If you suffer a dental emergency without dental insurance, you may be out more than 10K, as well as the goodwill of your fellow residents. Get your teeth taken care of.

p diddy

 

[hamstergang]

I'm a little confused. If your pain gets so bad that you can't work, why would you not, for your own health and to get out of the debilitating pain, go to the ER and get a dental consult? I guess I don't understand how doing otherwise makes any sense for you regardless of being in residency.

 

[serimeri]

I would definitely try and get to the nearest dentist as soon as possible. But if I were not in a residency, and did not have a 24/7 dental clinic nearby, I would try and go in the morning or during regular hours.

I have been gradually getting work done (crowns, cleaning etc.) I just don't have $10k yet and my benefits for dental/health haven't rolled in yet.

I plan on getting work done once I have active dental insurance.

Luckily, I have been taking good care of my teeth via dental hygiene practices (very anal about it).

This thread is just a manifestation of my paranoid OCD trying to delve into what if's ....I certainly hope it never becomes a reality.

I'm just surprised that a city of 400Kplus does not have a 24/7 dental clinic...

 

[Old&InTheWay]

I would definitely try and get to the nearest dentist as soon as possible. But if I were not in a residency, and did not have a 24/7 dental clinic nearby, I would try and go in the morning or during regular hours.

I have been gradually getting work done (crowns, cleaning etc.) I just don't have $10k yet and my benefits for dental/health haven't rolled in yet.

I plan on getting work done once I have active dental insurance.

Luckily, I have been taking good care of my teeth via dental hygiene practices (very anal about it).

This thread is just a manifestation of my paranoid OCD trying to delve into what if's ....I certainly hope it never becomes a reality.

I'm just surprised that a city of 400Kplus does not have a 24/7 dental clinic...

If you literally cannot work because of the pain, you call in and get it taken care of. Maybe people are pissed off but you can probably find a way to make it up to them. Just don't go calling in sick unless you absolutely cannot function.

Also, I kind of feel like "anal" is a poor choice of adjective when describing oral hygiene.

 

[serimeri]

For whatever its worth, I have been getting my dental cleaning done regularly (out of pocket) every year, so I'm hoping I can slide past these 4 years without having that debilitating pain.

I have a pretty high pain threshold in general for otherthings luckily. Hopefully I feel that way when it's time to have kids.

 

[shoal]

Please dont go to the er. I can give you temporarily relief with a dental block and you could still work. But some of us EPs are a little peeved off at dental pain. Plus most of us dont have access to dental services anymore then you do. Be preventative and proactive.

Sent from my LG-D801 using Tapatalk

 

[Dral]

I'd wager they're trying to be extreme so that you get the picture that if you get the sniffles, you'd better not call off.

Other people have to pick up the slack for you in that case. If you are calling off a day here and there for every little head cold you get, it adds up quickly.

Trust me, you don't want to be 'that guy or gal' who calls in sick all the time. I've seen it happen...you become unpopular very quickly.

I personally got through 4 years of residency without missing a day. I was sick during that time, but I was not too sick to work. Honestly, I'd say real full blown flu is about the cut off. If you have that, you can probably stay home for a day...but that is irrelevant because you should be getting immunized yearly anyway.

Anything less, throw on a mask and get to work.

 

[Perrotfish]

You will probably be treated like an adult in the sense that people will believe you when you say you are sick. It just needs to be really, really rarely. The average resident in my class missed 1 day in 3 years, with a range of 0-3 days off for illness. If you're missing days with that frequency no one is going to care what for.

The culture of residency (and to a lesser extent of medicine in general) is incredibly toxic towards medical care and sickness. Honestly there is no good reason why we couldn't stay home sick much more often than we do, or routinely seek preventative care. Maybe its harder in surgery/OB where all the rotations are 'real', but in the IM/Peds/FP/psych about half the rotations are just electives where you're not really needed, and those rotations cover back up. Being sick just means someone misses a day a GI/ID/whatever. At least for missing a day, there shouldn't be any hardship. If the program did it right you wouldn't be working any more hours, just the same number of hours in a different place

That being said this is the culture you signed up for, and its not changing while you're a trainee, so prepare yourself to deal with it. If you think your dental work is going to keep you out for multiple days, then fix it now.

 

[serimeri]

Unfortunately no electives until 3rd year in my program.

 

[Goro]

I don't have an answer for the toothache, but I think you should be seen over your anxiety issues.

So we had our orientation today with the residents regarding calling in sick and leave etc. The resident told us that the only reason we should ever call in sick is if we need an IV and even then arrangements can be made to have the IV pole attached to us so we can do our notes. He mentioned that zero tolerance would be had for anyone who called in sick for minor things.

I had a flashback just then to a time when I was 15, and I had the worlds most debilitating toothache. I literally wanted to smash my entire jaw and face with an iron. We had limited resources and no dental insurance, so my parents waited a week before sending me to the dentist for a tooth extraction. I missed a week of 10th grade, no big deal, since I made everything up. But I get scared thinking about what will happen if I ever get one of my childhood toothaches again.

Knock on wood, it has not happened in 14 years, but if it does, I will be unable to work since it will be literally like a strike of lightning. In that scenario, should I call my chief and PC immediately? Then should I check into the ER?

I'm just terrified about what will happen if my PD finds out about it and I don't get to see a dentist immediately. I still need about $10K in dental work, but I am going to hold off until I start earning or have dental insurance in place and take care of that during my vacation months.

I just want to have a plan in place in case this emergency arises. As stupid as this sounds, should I show up to the ER at my Hospital and just request an emergency dental consult there so that way nobody thinks I lied? The dentists in this town are not 24/7 so I assume they would have some sort of coverage in the ER.

I'm sure the vast majority of you think this is being paranoid...but I needed to ask since they made such a huge point about not calling in sick unless one is deathly ill.

 

[serimeri]

I don't have an answer for the toothache, but I think you should be seen over your anxiety issues.

Any idea who I should see? Can't see anyone in the department.

I feel like I'm getting over anxious over some of the absurd threats the residents gave us. I think they are just toying with us to see if we'll crack.

 

[PMR_doc]

Oh my goodness! what specialty are you in, because whatever it is, it sounds toxic as heck! If you are sick and/or unable to work, you simply call in sick. I have called in sick, and every single one of my fellow residents has called in sick. The avg sick call in is about 3 days/yr. If your residents are such jerks, I say you are in for a rough time. And someone commented about the toxic nature of residency/medicine and taking care of ourselves - perhaps it's about time to change the negative cycle. If I'm sick I don't think twice about calling in sick. If one of my colleagues is sick, they call in sick, period. It's not a national drama. If the entire rotation/hospital somehow falls apart because one person is not there, there is a major problem with your residency program. Should you take off because you simply don't want to go in/extend vacation? No. But if you are sick, please do everyone the favor of not showing up. Not only do you put yourself at risk but you put your pts. and your colleagues at risk.

I had one time during a medicine rotation where I was visibly ill, where I was coughing up a lung. It was around noon or so - my attending says you should not have come in, finish whatever you are doing within the 1/2 hour and go home - I don't want to see you here for the rest of the day. He also bought me juice, and I got an outstanding eval at the end of the rotation also. In summary, be a good resident, but don't put your health at risk and don't come in when you are actually sick.

 

[mercaptovizadeh]

Any idea who I should see? Can't see anyone in the department.

I feel like I'm getting over anxious over some of the absurd threats the residents gave us. I think they are just toying with us to see if we'll crack.

They are not toying with you. It is THAT toxic in medicine. Doctors become uncompassionate bastards whose 10/10 is death, 9/10 is ECMO or bivad or coding someone, 8/10 is LVAD or intubation/ventilation, 7/10 is emergent dialysis/new cancer diagnosis/eclampsia, 6/10 is endocarditis and florid sepsis, etc.....

Where do you think your toothache comes on that scale? That's right, 0.

Your best bet is to get a thorough dental cleaning before you start residency, schedule your dental follow-ups on random weekdays off, and if an emergency arises you may have to go to the ED.

 

[mercaptovizadeh]

I'd wager they're trying to be extreme so that you get the picture that if you get the sniffles, you'd better not call off.

Other people have to pick up the slack for you in that case. If you are calling off a day here and there for every little head cold you get, it adds up quickly.

Trust me, you don't want to be 'that guy or gal' who calls in sick all the time. I've seen it happen...you become unpopular very quickly.

I personally got through 4 years of residency without missing a day. I was sick during that time, but I was not too sick to work. Honestly, I'd say real full blown flu is about the cut off. If you have that, you can probably stay home for a day...but that is irrelevant because you should be getting immunized yearly anyway.

Anything less, throw on a mask and get to work.

You must be in surgery. Only surgery is dumb enough to think that it's appropriate for people to take off 1 day from work for influenza. What next, 2 days for ebola and 3 for inhaled anthrax?

P.S.: the flu shot this year sucked and had poor efficacy. So I hope you will normalize your tolerance of residents with flu with the well-informed knowledge that we essentially had a dud vaccine this year.

 

[Dral]

You must be in surgery. Only surgery is dumb enough to think that it's appropriate for people to take off 1 day from work for influenza. What next, 2 days for ebola and 3 for inhaled anthrax?

P.S.: the flu shot this year sucked and had poor efficacy. So I hope you will normalize your tolerance of residents with flu with the well-informed knowledge that we essentially had a dud vaccine this year.

Surprise surprise! Dermatology! It would be cool of you to not assume what type of program I'm in and to not insinuate that surgery programs are "dumb". Thank you.

1 day is kinda an exaggeration to make a point.

Some programs are smaller and the culture of working to do your part is there...and just FYI, my program is one of the least malignant around.

The point being that programs are different in their cultures so OPs program is one that seems to have the same culture as mine. Again, not every little head cold needs a day off. That is my main point. My original post is to try to give some advice to the OP based on what I perceive as similarities between my program and theirs.

 

[Goro]

Surely there's a Psych dep't at your facility? A counseling center?

Any idea who I should see? Can't see anyone in the department.

I feel like I'm getting over anxious over some of the absurd threats the residents gave us. I think they are just toying with us to see if we'll crack.

 

[bambi]

If you are sick and go in wearing a mask like someone suggested don't the patients complain? I would be pretty concerned if I was a patient and my doctor did that.

I think sick leave can be tricky, it could be argued that if you come in sick you are putting patients and colleagues at risk and are therefore being unprofessional, but then if there is no one else to do the work that also puts patients at risk so the same could be argued.

I certainly know people that call in sick for every little cold, one not so long ago, off for a whole week with a cold when due to be on call, and the day after I saw him going off on a little trip with his girlfriend. I felt bad being sent home sick, despite the ITU senior threatening me with ECMO, in jest of course but I was pretty sick.

 

[Dral]

If you are sick and go in wearing a mask like someone suggested don't the patients complain? I would be pretty concerned if I was a patient and my doctor did that.

I think sick leave can be tricky, it could be argued that if you come in sick you are putting patients and colleagues at risk and are therefore being unprofessional, but then if there is no one else to do the work that also puts patients at risk so the same could be argued.

I certainly know people that call in sick for every little cold, one not so long ago, off for a whole week with a cold when due to be on call, and the day after I saw him going off on a little trip with his girlfriend. I felt bad being sent home sick, despite the ITU senior threatening me with ECMO, in jest of course but I was pretty sick.

The masks are quite common. Our MAs and ancillary staff have the option to not get the Influenza vaccine. However, if they choose not to, they are required to wear masks from around October until May. The patients don't seem to mind or ask about it as far as I can tell.

 

[bambi]

Are other people forced to get the flu vaccine?

I guess if the masks are the norm people don't care as they don't know any different, here it would cause a stir I'm sure.

 

[Law2Doc]

If you are sick and go in wearing a mask like someone suggested don't the patients complain? I would be pretty concerned if I was a patient and my doctor did that...

Patients are either appreciative that you are protecting them or assume it's totally normal that you are treating them like they are on droplet precautions. I've seen lots of residents wear masks and never heard of any patient complaints.

 

[Law2Doc]

I didn't use a sick day in residency but got sick my fair share. Had one call night intern year where I was puking my guts out with the flu, but it didn't really start until about midnight and at that point it didn't seem reasonable to try and wake someone up to cover for me. Lean programs tend to frown on illness because it wreaks havoc with schedules and duty hours, and you can really screw over colleagues by taking a day at an inopportune time. The whole "just call in sick" approach only works if it's a program with redundant parts or if you are on an elective where you are more a spectator than valuable asset.

 

[Dral]

Are other people forced to get the flu vaccine?

I guess if the masks are the norm people don't care as they don't know any different, here it would cause a stir I'm sure.

Yes, during vaccination season there are people that stand at the entrance to the hospital and do not let you in if you are a healthcare provider and do not have a sticker on your ID indicating you have the flu vaccine. The sticker on the ID requirement happened at my med school, the place where I did intern year, and my hospitals for residency as well (in NYC). All of them are mid-atlantic/northeast. Maybe that has something to do with it. I dunno.

Oddly enough, all MDs and the large majority of Nurses get the immunization and don't say anything otherwise (I guess because we're forced to for all intents and purposes). It seems a lot of other staff are pretty resistant to the vaccine (meaning they choose not to receive it).

 

[Raryn]

If you are sick and go in wearing a mask like someone suggested don't the patients complain? I would be pretty concerned if I was a patient and my doctor did that.

I think sick leave can be tricky, it could be argued that if you come in sick you are putting patients and colleagues at risk and are therefore being unprofessional, but then if there is no one else to do the work that also puts patients at risk so the same could be argued.

I certainly know people that call in sick for every little cold, one not so long ago, off for a whole week with a cold when due to be on call, and the day after I saw him going off on a little trip with his girlfriend. I felt bad being sent home sick, despite the ITU senior threatening me with ECMO, in jest of course but I was pretty sick.

Done it several times, never any complaints. Patients are generally appreciative or understanding if you're wearing a mask.

 

[mercaptovizadeh]

Surprise surprise! Dermatology! It would be cool of you to not assume what type of program I'm in and to not insinuate that surgery programs are "dumb". Thank you.

1 day is kinda an exaggeration to make a point.

Some programs are smaller and the culture of working to do your part is there...and just FYI, my program is one of the least malignant around.

The point being that programs are different in their cultures so OPs program is one that seems to have the same culture as mine. Again, not every little head cold needs a day off. That is my main point. My original post is to try to give some advice to the OP based on what I perceive as similarities between my program and theirs.

Do you do Mohs?

 

[Dral]

Haha. I THOUGHT about it, but no.

I was chief this year and I would always give someone the go ahead if I knew they were truly sick. Luckily it didn't come up often. I really do think it's due to the culture that is set up at my program.

People know to take it if they truly need it, but don't use them frivolously.

 

[Doctor Bagel]

Surely there's a Psych dep't at your facility? A counseling center?

I believe the op is an incoming psych resident which might explain her reluctance to see anyone there. Also this sounds like a very atypical environment for psychiatry. I hope the program turns out to be less malignant than it sounds.

 

[KnuxNole]

So we had our orientation today with the residents regarding calling in sick and leave etc. The resident told us that the only reason we should ever call in sick is if we need an IV and even then arrangements can be made to have the IV pole attached to us so we can do our notes. He mentioned that zero tolerance would be had for anyone who called in sick for minor things.

I had a flashback just then to a time when I was 15, and I had the worlds most debilitating toothache. I literally wanted to smash my entire jaw and face with an iron. We had limited resources and no dental insurance, so my parents waited a week before sending me to the dentist for a tooth extraction. I missed a week of 10th grade, no big deal, since I made everything up. But I get scared thinking about what will happen if I ever get one of my childhood toothaches again.

Knock on wood, it has not happened in 14 years, but if it does, I will be unable to work since it will be literally like a strike of lightning. In that scenario, should I call my chief and PC immediately? Then should I check into the ER?

I'm just terrified about what will happen if my PD finds out about it and I don't get to see a dentist immediately. I still need about $10K in dental work, but I am going to hold off until I start earning or have dental insurance in place and take care of that during my vacation months.

I just want to have a plan in place in case this emergency arises. As stupid as this sounds, should I show up to the ER at my Hospital and just request an emergency dental consult there so that way nobody thinks I lied? The dentists in this town are not 24/7 so I assume they would have some sort of coverage in the ER.

I'm sure the vast majority of you think this is being paranoid...but I needed to ask since they made such a huge point about not calling in sick unless one is deathly ill.

People have called in sick for a migraine, bad cold , n/v multiple times with no problems.

 

[dozitgetchahi]

They are not toying with you. It is THAT toxic in medicine. Doctors become uncompassionate bastards whose 10/10 is death, 9/10 is ECMO or bivad or coding someone, 8/10 is LVAD or intubation/ventilation, 7/10 is emergent dialysis/new cancer diagnosis/eclampsia, 6/10 is endocarditis and florid sepsis, etc.....

Where do you think your toothache comes on that scale? That's right, 0.

Your best bet is to get a thorough dental cleaning before you start residency, schedule your dental follow-ups on random weekdays off, and if an emergency arises you may have to go to the ED.

Never mind the whole concept of 'presenteeism', where people show up sick and then can't think straight/are way less effective than usual/spread disease/etc.

 

[Law2Doc]

Never mind the whole concept of 'presenteeism', where people show up sick and then can't think straight/are way less effective than usual/spread disease/etc.

First, most people who say they can't work because they are worried about not thinking straight are mentating quite well to come to that conclusion. If you are actually too sick to think straight you will be too sick to come to that conclusion. "Im so sick I can't think straight" tends to be exaggerated.

Second, " less effective than usual" is task dependent and status dependent. A skilled senior resident can be quite impaired and still accomplish most intern level tasks. An intern can still be present and babysit uncomplicated patients while only running on three cylinders.

Third, spreading disease is why many on this thread are suggesting masks and gloves. That's enough to protect us from patients with droplet precautions so it's adequate in reverse. However I would point out that a lot of flu-like symptoms are your bodies response to an illness, not the illness itself. So by the time you are feeling like crap you've often been spreading your illness for days and by the time your body has mounted a big enough response that you'd consider calling in sick, you may actually be less able to spread the illness. Mask and gloves are still a good idea, but staying home in bed might not be what's best for patient care.

 

[mercaptovizadeh]

People with cluster headaches are not infectious. They can just bring their oxygen tank with them to work.

 

[Dral]

That's right. I'll bet they'll be bringing their Oxygen to work when they're done with residency and out running a clinic when the alternative is canceling and rescheduling 25 patient appointments last minute, paying 5 staff to sit around half the day doing nothing, and paying for the overhead to keep the clinic 'open' for those staff.

 

[mercaptovizadeh]

That's right. I'll bet they'll be bringing their Oxygen to work when they're done with residency and out running a clinic when the alternative is canceling 25 patient appointments last minute and paying 5 staff to sit around half the day doing nothing, and paying for the overhead to keep the clinic 'open' for those staff.

Of course when their own mother dies they can just have the secretary write a sympathy card to dad and have sis video the funeral on her iPhone. After all, there are pimples to be seen and the show must go on...

 

[Dral]

Of course when their own mother dies they can just have the secretary write a sympathy card to dad and have sis video the funeral on her iPhone. After all, there are pimples to be seen and the show must go on...

C'mon, a headache is different than a death and you know it.

The point is at some point in our lives we have to stop 'turning in the absentee notes to the principle's office' and deal with a little inconvenience. This isn't a matter of missing long division and dodgeball in gym class...

Oops stubbed my toe. Ouch. Tough to walk. Better call in sick!!! Everyone has their threshold I guess.

My co resident broke her Femur clear through when she was half way across the country and was back to work less than a week later (despite me and co chief trying to force her to take more time)...and she is perfectly fine. There is always a line to be drawn of course, but imo it's not too difficult to have a high threshold for when to call it.

 

[KnuxNole]

If people get upset over someone calling in for a cluster headache, they might have enraging fits with people calling in for a regular headache.

 

[Law2Doc]

If people get upset over someone calling in for a cluster headache, they might have enraging fits with people calling in for a regular headache.

Yes. But again it's not the headache they have an issue with. It's having others have to cover for you, which has s domino effect on screwing up the schedule and peoples vacation and elective time and duty hours. It's not like you can just be absent and not be missed, like in med school, unless you are on a light elective or there's lots of redundancy. So if you are going to be sick it better be objectively something that's serious. It's not about a program being malignant, rather allowing your sick day would make it bad for everyone else. And that's why at a lot of programs sick days are like unicorns -- you hear about them in the employee handbook, but many of us get through residency without ever seeing one.

 

[Dral]

Yes. But again it's not the headache they have an issue with. It's having others have to cover for you, which has s domino effect on screwing up the schedule and peoples vacation and elective time and duty hours. It's not like you can just be absent and not be missed, like in med school, unless you are on a light elective or there's lots of redundancy. So if you are going to be sick it better be objectively something that's serious. It's not about a program being malignant, rather allowing your sick day would make it bad for everyone else. And that's why at a lot of programs sick days are like unicorns -- you hear about them in the employee handbook, but many of us get through residency without ever seeing one.

Exactly. As we get further along, the stakes are higher.

Like in the example I gave about a doc out in practice...of the 25 pts who need to be rescheduled, 8 took the day off. Of those, 4 were Medicaid pts who are now going to miss a whole day's pay.

Docs should of course take days for things like death in family, kid breaks their arm, serious personal illness (basically imo, something that requires the doc themselves to be seeing another healthcare professional), or something bad enough that they can't even really get out of bed, but others feel the repercussions of those days off. So it better be worth it.

 

[Law2Doc]

Exactly. As we get further along, the stakes are higher.

Like in the example I gave about a doc out in practice...of the 25 pts who need to be rescheduled, 8 took the day off. Of those, 4 were Medicaid pts who are now going to miss a whole day's pay.

Docs should of course take days for things like death in family, kid breaks their arm, serious personal illness (basically imo, something that requires the doc themselves to be seeing another healthcare professional), or something bad enough that they can't even really get out of bed, but others feel the repercussions of those days off. So it better be worth it.

There's also the difference in level of training. If you are out in practice if you want to deal with the ire of patients and loss of business, that's on you. As a resident the pain gets felt by your colleagues. So you have more leeway with the former.

 

[Dral]

That is true...plus the staff love getting paid for not having to work as hard in the example I gave. Heh

 

[KnuxNole]

Yes. But again it's not the headache they have an issue with. It's having others have to cover for you, which has s domino effect on screwing up the schedule and peoples vacation and elective time and duty hours. It's not like you can just be absent and not be missed, like in med school, unless you are on a light elective or there's lots of redundancy. So if you are going to be sick it better be objectively something that's serious. It's not about a program being malignant, rather allowing your sick day would make it bad for everyone else. And that's why at a lot of programs sick days are like unicorns -- you hear about them in the employee handbook, but many of us get through residency without ever seeing one.

That's a good point. I've taken one sick day in 2 years, but that was from a near emergency. There are peeps that have taken a sick day every other month, but it is what it is, to be fair, a lot of our rotations, people can still function without us, so perhaps it gives some more leeway...

 

[Doctor Bagel]

A reminder again that the culture around sick days is dependent on your specialty. The op is in psychiatry, not surgery or even internal medicine. I finished a psychiatry residency at a program that's supposedly tougher than normal, and I and most people I worked with called in sick at some point. I wouldn't say sick days were unicorns. Certainly you were more likely to work through things if you were on call or on a busy service, but stories about people coming in the round with an IV in their arm for fluids just don't happen in fields like psychiatry (unless you're in a way outside of the norm type of program).

 

[koikisi]

A reminder again that the culture around sick days is dependent on your specialty. The op is in psychiatry, not surgery or even internal medicine. I finished a psychiatry residency at a program that's supposedly tougher than normal, and I and most people I worked with called in sick at some point. I wouldn't say sick days were unicorns. Certainly you were more likely to work through things if you were on call or on a busy service, but stories about people coming in the round with an IV in their arm for fluids just don't happen in fields like psychiatry (unless you're in a way outside of the norm type of program).

Yes, and there are way outside the norm Psychiatry programs, in fact, there are some psychiatry programs that have disgruntled malignant personalities as faculty who switched from medicine and surgery to psych, which has led to these tough harsh programs.

 

[Law2Doc]

Yes, and there are way outside the norm Psychiatry programs, in fact, there are some psychiatry programs that have disgruntled malignant personalities as faculty who switched from medicine and surgery to psych, which has led to these tough harsh programs.

Not being expected to use sick days does not equate to "malignant". (Not sure if you were saying this but you sort of hinted at it). To some extent it reinforces that you are a valuable member of the team. Some of the happiest residents I've met in the hospital work in fields where the hours are often long and sick days are frowned upon. But they are valued team members training to do what they enjoy and treated respectfully by their bosses. Some of the most unhappy residents in the hospital I've met actually had much lighter hours and could get away with a sick day or two. Working 80 hours a week doing what you love and being treated as a future colleague by your bosses trumps working 65 hours a week but being treated like crap and hating what you are doing every second of the day. The latter is more likely to fit into the malignant category. During intern year I actually felt sorry for quite a few people who were clearly suffering even though their hours were comparatively lighter.

 

[mercaptovizadeh]

Again, this is not a competition, people in residency are biologically human (as far as I am aware?), they do get sick, and sometimes that does require them to take time off from work. It's not very common since most in residency are young and generally healthy, but it happens.

 

[Crayola227]

Oh my goodness! what specialty are you in, because whatever it is, it sounds toxic as heck! If you are sick and/or unable to work, you simply call in sick. I have called in sick, and every single one of my fellow residents has called in sick. The avg sick call in is about 3 days/yr. If your residents are such jerks, I say you are in for a rough time. And someone commented about the toxic nature of residency/medicine and taking care of ourselves - perhaps it's about time to change the negative cycle. If I'm sick I don't think twice about calling in sick. If one of my colleagues is sick, they call in sick, period. It's not a national drama. If the entire rotation/hospital somehow falls apart because one person is not there, there is a major problem with your residency program. Should you take off because you simply don't want to go in/extend vacation? No. But if you are sick, please do everyone the favor of not showing up. Not only do you put yourself at risk but you put your pts. and your colleagues at risk.

I had one time during a medicine rotation where I was visibly ill, where I was coughing up a lung. It was around noon or so - my attending says you should not have come in, finish whatever you are doing within the 1/2 hour and go home - I don't want to see you here for the rest of the day. He also bought me juice, and I got an outstanding eval at the end of the rotation also. In summary, be a good resident, but don't put your health at risk and don't come in when you are actually sick.

PMR doc. Enough said. I mean that as a compliment to your specialty and wherever you practice.

To the OP, you are not whack for being freaked out about this. If your program is telling you this, they mean it. That being said, the world will not end if you have to call in sick 1 day, even in the most evil program there is. Whenever you call in sick, someone is suffering more in your place. That's OK depending on the circumstances and your relationship with the inconvenienced and how you pay that back.

If you have bad teeth, don't tell anyone at the program (you saw the reaction you got here on the board, you are trying to be proactive but you will be blamed instead), better to hide and do whatever you can to get as much dental work done in your "spare" time. If such a horrific toothache erupts, OD on APAP & the strongest NSAIDs you can get, gargle lidocaine endlessly, and bite your cheeks till they bleed to work through it. Find out if toradol or tramadol on the job is considered practicing under the influence or not, if that's not kosher don't do it. You can't take any narcs then go to work that's for sure. It's worth pissing off the ED people for a dental block if that means not pissing off your program by missing a day at work. You will earn more respect attempting to do your own dental block in the workroom than missing a day.

When a program says you can take a day if you're sick it's no big deal, maybe they mean it, I'm still suspicious. A lot of times they just pay lip service to it but it's BS, but some programs it's for real.
When a program out and out says what yours did, don't f*ck around. Maybe they're just trying to scare you, but even if that's the case you have to still have to wonder at how it's going to go down at the kind of program that takes pains to scare you so much. Avoid a sick day and cross your fingers someone else calls one in so you can see how it's received, because you don't want to ask what happens if someone takes a sick day because then they'll think you might be planning one and then if you do call in sick then it's confirmed.

It's hilarious because people will tell you and me that we're being paranoid, but it's not paranoia when they *really* are out to get you, and your program just said they were. You can't take the chance if they're serious.

 

[mercaptovizadeh]

Not being expected to use sick days does not equate to "malignant". (Not sure if you were saying this but you sort of hinted at it). To some extent it reinforces that you are a valuable member of the team. Some of the happiest residents I've met in the hospital work in fields where the hours are often long and sick days are frowned upon. But they are valued team members training to do what they enjoy and treated respectfully by their bosses. Some of the most unhappy residents in the hospital I've met actually had much lighter hours and could get away with a sick day or two. Working 80 hours a week doing what you love and being treated as a future colleague by your bosses trumps working 65 hours a week but being treated like crap and hating what you are doing every second of the day. The latter is more likely to fit into the malignant category. During intern year I actually felt sorry for quite a few people who were clearly suffering even though their hours were comparatively lighter.

It is a problem when you connect being ill with value to the team or happiness in residency. You are making a logical leap that has no basis whatsoever. If a program cannot sustain one of its residents taking off - on average - 1-2 sick days per year (obviously not all on the same day) for things that make it very difficult or impossible to work (flu, viral gastro with numerous episodes of vomiting and diarrhea just before/during work, not to mention something much more serious...) - that program is poorly managed by the higher ups. It means they lack wisdom and foresight in how the world works, that they have no back up plan, and it makes me worry that they have no back up plan for when their diagnostic train comes to an abrupt halt or things go to hell in the OR. It also means they are not well prepared for what to do if someone dares to go into preterm labor (how dare she, she should have aborted it a long time ago, doesn't she know the schedule!?!?) or if someone develops appendicitis (the gall!) and perfs - as at least 3 PGY1/2 residents at my institution had appendicitis just this year alone, 1 of whom perforated. I know you think that people with appendicitis and preterm labor are lazy good-for-nothing residents who hate their jobs, but sometimes you just can't give them mag sulfate and shove the crowning head back into the uterus until vacation, and usually it isn't acceptable to let (make?) them work until they perf and then just give them antibiotics.

 

[Doctor Bob]

It's early in the morning... not sure if this is a serious post or not.

If such a horrific toothache erupts, OD on APAP & the strongest NSAIDs you can get, gargle lidocaine endlessly, and bite your cheeks till they bleed to work through it. Find out if toradol or tramadol on the job is considered practicing under the influence or not, if that's not kosher don't do it. You can't take any narcs then go to work that's for sure.

With the realignment of tramadol to a higher DEA tier, there's no using that and going to work.

1) Don't OD on tylenol or NSAIDs. There's no guarantee you'll get time off for your liver or kidney transplant.
2) Don't gargle lidocaine all day. There's no guarantee you'll get time off for your seizure or cardiac arrest.
3) Don't bite your cheeks till they bleed. There's no guarantee you'll get time off for your hemorrhagic shock or your facial reconstruction after the wound gets infected and leads to extensive facial gangrene.

It's worth pissing off the ED people for a dental block if that means not pissing off your program by missing a day at work.

No it's not

You will earn more respect attempting to do your own dental block in the workroom than missing a day.

People will be talking about it in the hospital for years to come. "Did you hear about the resident who killed himself in the workroom? Yea, looks like he tried to do his own dental block and shot the lidocaine right into his carotid."

 

[Law2Doc]

It is a problem when you connect being ill with value to the team or happiness in residency. You are making a logical leap that has no basis whatsoever. If a program cannot sustain one of its residents taking off - on average - 1-2 sick days per year (obviously not all on the same day) for things that make it very difficult or impossible to work (flu, viral gastro with numerous episodes of vomiting and diarrhea just before/during work, not to mention something much more serious...) - that program is poorly managed by the higher ups. It means they lack wisdom and foresight in how the world works, that they have no back up plan, and it makes me worry that they have no back up plan for when their diagnostic train comes to an abrupt halt or things go to hell in the OR. It also means they are not well prepared for what to do if someone dares to go into preterm labor (how dare she, she should have aborted it a long time ago, doesn't she know the schedule!?!?) or if someone develops appendicitis (the gall!) and perfs - as at least 3 PGY1/2 residents at my institution had appendicitis just this year alone, 1 of whom perforated. I know you think that people with appendicitis and preterm labor are lazy good-for-nothing residents who hate their jobs, but sometimes you just can't give them mag sulfate and shove the crowning head back into the uterus until vacation, and usually it isn't acceptable to let (make?) them work until they perf and then just give them antibiotics.

Your flowery exaggeration aside, I think you need to realize that some places are extremely lean in structure -- they simply don't have the manpower to let people off without screwing up other people's electives, duty hours and the like. Programs dont get to choose how many residents they get -- a program needs to be allocated spots, and then the hospital has to fund them. And there are fixed obligations like numbers of weeks of ICU that some residnts need that limits how often you can pull people. The PD can say "I need more interns" until he's blue in the face but that doesn't make it happen and doesn't make him a bad manager when it doesn't. Most lean programs need the PD and chiefs to work magic filling a lot of holes with very few pegs. If you need six people each maxing out duty hours to cover all the slots you need to cover, you can't get by with five. If someone calls in sick, then someone goes over hours that week, or you end up calling someone back from their elective (or worse, vacation). So yes it's a very big deal in such a setting if someone has an unexpected illness. The going into labor issue they'd try to work around by forcing that person to use their electives or vacation strategically, so that person ideally isn't on the call schedule those couple of weeks, but yeah, if the timing doesn't work out, a lot of people are impacted. Usually you see attendings and seniors pitching in, but that's not always a debt junior residents want to incur lightly -- they will always collect with interest. So this has very little to do with management or wisdom or planning -- if you only have so many pieces to work with you simply don't get to have much of a backup plan.

 

[Crayola227]

It's early in the morning... not sure if this is a serious post or not.

With the realignment of tramadol to a higher DEA tier, there's no using that and going to work.

1) Don't OD on tylenol or NSAIDs. There's no guarantee you'll get time off for your liver or kidney transplant.
2) Don't gargle lidocaine all day. There's no guarantee you'll get time off for your seizure or cardiac arrest.
3) Don't bite your cheeks till they bleed. There's no guarantee you'll get time off for your hemorrhagic shock or your facial reconstruction after the wound gets infected and leads to extensive facial gangrene.

No it's not

People will be talking about it in the hospital for years to come. "Did you hear about the resident who killed himself in the workroom? Yea, looks like he tried to do his own dental block and shot the lidocaine right into his carotid."

I'm exaggerating a bit. J/k.

Thanks for the heads up on tramadol (I was wondering about it because a pharmacist at my hospital said they let her go to work on it, but obviously that's a different story...) so question answered.

And I see that you are continuing the joke w/ 1),2), and 3).

Really I just mean do what we all do to maximize non-narc tx of pain: take the maximum amount of APAP you can safely, the maximum amount of NSAID you can safely, and keep in mind that higher doses can be used acutely in the short term safely than what would be a recommended daily dose for someone with chronic pain who might be on a given dose for years. Don't gargle lidocaine, but I know there's that OTC stuff for teething babies that you can probably use, it doesn't help much, but it helps some. I've strapped ice packs to various parts of my body when I was in front of the computer for stretches of time writing notes in the workroom. I know I can strap ice to my head and type notes. As far as biting your cheeks, in reality there are less harmful techniques for distracting yourself from pain, such clenching and relaxing your fists or other muscle group, snapping a rubber band on your wrist. Some of these things sound lame (to patients and to us) but when you're in pain and you have a job to do...it's worth throwing the kitchen sink (safely?) at yourself.

And as far as the ED, I should have said "it's worth pissing off the ED department at a hospital you DON'T work at to get a dental block so you don't miss a day". You know, even with all the preventative dental care in the world, the pain of a root canal can come on sudden onset, crowns just fall the **** out, etc. My friend during surg rotation had his root canal pain start on a Friday and there was no dentist he could see until Monday, and he had to work the whole weekend. He toughed it out and went to the ED after work Sat and explained why he was there, sudden onset of dental pain that couldn't be predicted or dealt with at home or at a dental office, and he needed a block to get him through work Sunday until he could go home swallow some narcs and see the dentist Monday. They were pretty understanding. Everyone's that's done residency knows that sometimes we have to use stopgap solutions to get us through work until the next day off. But yeah, it's always better to seek medical care outside of your own institution.

 

[Smurfette]

Just because tramadol changed DEA categories doesn't mean someone can't work while taking it. Afterall, ritalin and adderall are in a more restricted category than tramadol, and we don't prevent patients on those medications from working even though they are schedule 2.