Calling in sick

[madtowngirl]

I can't imagine calling in sick unless I was "SICU-sick". But there is one thing I'm scared of having, and that's a GI bug on an operative day. I watched my chief scrub out of a case multiple times to sprint to the bathroom while I was a med student, and I'm terrified of having that happen to me.

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[TRAMD]

I can't imagine calling in sick unless I was "SICU-sick". But there is one thing I'm scared of having, and that's a GI bug on an operative day. I watched my chief scrub out of a case multiple times to sprint to the bathroom while I was a med student, and I'm terrified of having that happen to me.

Why wouldn't he/she call for help instead of exposing the patient to prolonged unnecessary anesthesia? I guess ego is more important than patient care.

 

[madtowngirl]

The attending was there operating too; it wasn't like her scrubbing out slowed the case down a whole lot. And pretty much every case a resident does puts a patient under "prolonged anesthesia."

 

[RTrain]

Why wouldn't he/she call for help instead of exposing the patient to prolonged unnecessary anesthesia? I guess ego is more important than patient care.

Not trying to be argumentative at all, but I think one of the main points here is that those who don't call in sick for "minor" things like gastroenteritis or flu-like illness don't consider the practice to be ego-driven at all. It's driven by a sense of responsibility to our colleagues and patients. If the chief resident described above had called in sick, either the patient who needed the operation would have had to wait for it, or someone else would have been taken away from their duties and their own patients to perform it (and surgical chiefs aren't a dime a dozen, it would likely have been a senior or junior resident who was not as qualified to do the procedure). Patient care would indeed have suffered.

If I had an ego problem, I figure I would believe that since I am the center of the universe, I can take a day off when I want to. But since do not, I know that I am no more or less important than anyone else, and I need to be in my place when I'm supposed to be there unless there is a truly unimpeachable reason why not.

 

[TRAMD]

The attending was there operating too; it wasn't like her scrubbing out slowed the case down a whole lot. And pretty much every case a resident does puts a patient under "prolonged anesthesia."

Ah, gotcha.

 

[TRAMD]

Not trying to be argumentative at all, but I think one of the main points here is that those who don't call in sick for "minor" things like gastroenteritis or flu-like illness don't consider the practice to be ego-driven at all. It's driven by a sense of responsibility to our colleagues and patients. If the chief resident described above had called in sick, either the patient who needed the operation would have had to wait for it, or someone else would have been taken away from their duties and their own patients to perform it (and surgical chiefs aren't a dime a dozen, it would likely have been a senior or junior resident who was not as qualified to do the procedure). Patient care would indeed have suffered.

If I had an ego problem, I figure I would believe that since I am the center of the universe, I can take a day off when I want to. But since do not, I know that I am no more or less important than anyone else, and I need to be in my place when I'm supposed to be there unless there is a truly unimpeachable reason why not.

I feel that sense of responsibility when I cover for another resident that I know is sick and is better off staying home.

I will admit, however, that surgery is a different world that I don't understand. Perhaps "bravado", not "ego" was the word I was looking for.

 

[RTrain]

I feel that sense of responsibility when I cover for another resident that I know is sick and is better off staying home.

That's a very kind way to feel, I am impressed.

 

[Winged Scapula]

Thanks for clarifying Tramd. I am feeling cranky enough that I was getting ready to ask why its always "ego" when surgeons do things others disagree with.

 

[Castro Viejo]

I will admit, however, that surgery is a different world that I don't understand.

Bingo!

 

[nykka3]

So what if you have a contagious bacterial or viral illness should you still not call in sick? Just wondering what your thoughts are since I will be a resident later this year.

 

[Castro Viejo]

So what if you have a contagious bacterial or viral illness should you still not call in sick?

Like gonorrhea?

 

[Tired]

So what if you have a contagious bacterial or viral illness should you still not call in sick? Just wondering what your thoughts are since I will be a resident later this year.

I have yet to see a patient die from a cold.

I have yet to contract a bacterial illness. If I ever do, it will probably be acute diarrhea. I wash my hands.

 

[RTrain]

So what if you have a contagious bacterial or viral illness should you still not call in sick?

That's what we're saying, yes. I use a mask if I'm coughing, and I always wash my hands going into and out of any room anyway.

 

[Winged Scapula]

So what if you have a contagious bacterial or viral illness should you still not call in sick? Just wondering what your thoughts are since I will be a resident later this year.

Pretty much.

If you are that sick, you will most often be sent home or be removed from direct patient duties.

Although as Tired notes, in most cases, the patient will not be catching anything from you as long as you practice good handwashing techniques. Exceptions would be Heme-Onc patients, NICU preemies and other immunocompromised patients. In those cases, I would expect that your team would realize the potential danger you represent.

 

[carrigallen]

With neutropenic patients you can wear gloves, gown, and droplet mask and wash your hands (Unless you have active TB or whooping cough). Immunocompromised patients are usually receiving prophylactic antibiotics anyway, so your case of the Mondays probably won't be transmitted readily anyway. Also hangovers are not contagious.

 

[Winged Scapula]

With neutropenic patients you can wear gloves, gown, and droplet mask and wash your hands (Unless you have active TB or whooping cough). Immunocompromised patients are usually receiving prophylactic antibiotics anyway, so your case of the Mondays probably won't be transmitted readily anyway. Also hangovers are not contagious.

Who are these residents that actually have time and energy to go out and get drunk?

 

[Blade28]

Who are these residents that actually have time and energy to go out and get drunk?

What? It's easy!

In any given week (168 hours):

90 hours at work (conservatively)
4 hours of sleep a night = 28 hours/week
1 hour commute time each day = 7 hours/week

That leaves 43 hours per week, or over 6 hours per day, for meals and beverages! And sometimes it's so much easier to drink your calories via spirits and draft beers.

Mmm...

 

[Winged Scapula]

What? It's easy!

In any given week (168 hours):

90 hours at work (conservatively)
4 hours of sleep a night = 28 hours/week
1 hour commute time each day = 7 hours/week

That leaves 43 hours per week, or over 6 hours per day, for meals and beverages! And sometimes it's so much easier to drink your calories via spirits and draft beers.

Mmm...

I preferred to use my 43 extra hours per week (or, in the old days, 26 hours) to do things other than drink.

 

[Blade28]

I preferred to use my 43 extra hours per week (or, in the old days, 26 hours) to do things other than drink.

Touche!

 

[Castro Viejo]

I preferred to use my 43 extra hours per week (or, in the old days, 26 hours) to do things other than drink.

Hmmm... At just a little over seven minutes per week (all in one session, of course), what the hell are you doing with the other 42 hours and 53 minutes?

 

[Winged Scapula]

Hmmm... At just a little over seven minutes per week (all in one session, of course), what the hell are you doing with the other 42 hours and 53 minutes?

Its called foreplay Castro! You should learn it...your fiancee will be grateful.

(you and your "seven minutes")

 

[Faebinder]

Its called foreplay Castro! You should learn it...your fiancee will be grateful.

(you and your "seven minutes")

Hands don't require foreplay... Castro saves money and time in addition to keeping the lotion industry floating.

[YOUTUBE]http://youtube.com/watch?v=eWEjvCRPrCo[/YOUTUBE]

 

[Castro Viejo]

Its called foreplay Castro! You should learn it...your fiancee will be grateful.

(you and your "seven minutes")

Foreplay's stupid. KY is king.

The best never rest (from reading Schwartz).

 

[Tired]

Its called foreplay Castro! You should learn it...your fiancee will be grateful.

(you and your "seven minutes")

If you have time for foreplay, you're not working hard enough.

 

[Winged Scapula]

Ok, back to original topic...

my partner and I were discussing this because we have noticed a tendency amongst our office staff, especially those who are salaried instead of hourly wage earners, to call in sick when we think they look fine.

Long term employees so not likely to be a function of hating to work with mean surgeons, but another example of the fact that there are just certain types of people for whom a little sniffle or sore throat seems to be reason not to go to work.

 

[Doowai]

In a 3 year program it seems like PGY2 is the year to use sick days - it seems like it would just look bad to be sick your intern year, and your senior year you have some teaching responsibilities. So it seems like year 2 is the one to be sick

 

[Winged Scapula]

Sick days? Please tell me of these things called "sick days".

 

[Rogue_Leader]

While interviewing for IM residencies, most (if not all) programs have a jeopardy rotation where residents have a few weeks where they do cushy electives (or vacation) with the expectation that you may be called into cover a ward or unit resident who called in sick. Most of them are based on the honor system that you don't call in unless you're 3 steps from death, but some of them had the caveat that you had to call the jeopardy resident yourself to explain that you're sick and they have to cover for you. Apparently, this cuts down on the number of people taking advantage of the system. But I did hear of some people abusing it, like a resident who took 2 weeks off for "paternity leave", even though that wasn't a benefit in his contract.

 

[TRAMD]

While interviewing for IM residencies, most (if not all) programs have a jeopardy rotation where residents have a few weeks where they do cushy electives (or vacation) with the expectation that you may be called into cover a ward or unit resident who called in sick. Most of them are based on the honor system that you don't call in unless you're 3 steps from death, but some of them had the caveat that you had to call the jeopardy resident yourself to explain that you're sick and they have to cover for you. Apparently, this cuts down on the number of people taking advantage of the system. But I did hear of some people abusing it, like a resident who took 2 weeks off for "paternity leave", even though that wasn't a benefit in his contract.

I took two weeks off for paternity leave. It came out of my PPL (payed personal leave) and I requested it months in advance. I didn't think of this as an "abuse".

 

[Sweet Tea]

I have (another) URI. I have a fever, I'm coughing, my throat is killing me, my sinuses might explode, and I'm about to guzzle some nyquil and go to bed. But I'm post-call today, and on call again tomorrow. No, I'm not calling out sick, but to be honest I'd like to. Showing up for call may be the right thing to do, it may be the wrong thing to do, but it's what I'm doing because I don't have much choice in the matter. *shrugs*

 

[elwademd]

. But I did hear of some people abusing it, like a resident who took 2 weeks off for "paternity leave", even though that wasn't a benefit in his contract.

in accordance with the family medical leave act, it does not have to be spelled out in the contract. whether or not the resident is paid during this time period is a separate issue, but if you need it, your residency can not stop you from taking time off to care for a newborn child, sick parent, sick grandparent, etc.

http://www.dol.gov/esa/whd/fmla/


but given that most residents are too young or naive to know the difference, the powers that be may tell the resident that he or she can't, and the resident is none the wiser.

yes, i understand that residency is like no other job, but some issues that wouldn't necessarily be a big deal at any other job become huge issues in residency.

 

[Tired]

but given that most residents are too young or naive to know the difference, the powers that be may tell the resident that he or she can't, and the resident is none the wiser.

More likely (since everyone knows about FMLA) they tell them they will get held back in their training. As I understand it, nothing in FMLA prevents that from happening.

 

[elwademd]

More likely (since everyone knows about FMLA) they tell them they will get held back in their training. As I understand it, nothing in FMLA prevents that from happening.

well, if your residency is kind, and you don't overdo it, you could use vacation time for fmla issues. i know a few residents who have done it (post pregnancy), but then again i'm at an institution with smaller residencies where it's a little easier than it likely would be at a larger institution.

 

[CommunityED]

I've ended up sick three times, and called in sick once.

1) I ate a Chipotle burrito, proceeded to anaphylax and ended up a patient in my residency's ER. I was working (as a PGY 2) in the medical bay, started having severe shortness of breath, tripoding and wheeze... my co-resident (PGY 3) looked at me, said, "You look terrible... come up front to the shock rooms!" When all was said and done, I'd had 3 rounds of epi, 2L of NS, 60 mg of SoluMedrol, Zantac and Benadryl. An epi drip was sitting at the bedside next to the intubation stuff. I swear to God, I was looking at my attending, who was starting to fondle the ETT, wheezing, "Keep that away from me! I'll be fine! You try to tube me and I'll kill you!"
2) I anaphylaxed again after eating rice and beans at the NICU teaching conference. I told my attending I was going to the ER, stopped by our ER and jabbed an EpiPen in my thigh, then went next door to the adult EC and grabbed steroids, Zantac and Benadryl. Backup was already coming into the NICU to take my call, but I figured I'd already be up all night from the epi and the 'roids, so I might as well take my own call. Dumb, dumb move.
3) I had already been diagnosed with pneumonia and given antibiotics by my actual PCP. Then I developed right sided chest pain, shaking chills and shortness of breath. I couldn't even get up the stairs in my townhouse. I called my boss, called my PCP (who sent me to the ER), called in backup and went to the damn ER. I truly thought I was sick - what ER doc goes to the ER? And that, ladies and gents, was the only time I took a sick day.

I too am an ER doc...

Went to my home ED as a PGY 4 resident with 24 hours of the worst HA of my life (after being at home puking and taking some loeftover vicodin from my wife's pregnancy).

Of course I got admitted for 3 days with meningitis.

 

[Doowai]

Saturday I went to the gym feeling very very very weak. I could not do one dip. Recently I did 72 consecutive dips, and did 10 dips with 135 LBS harnessed on. I could not do one. Monday I had a pretty high fever (104) - I had not taken it, they took it at the doctors office when I went in for a presurgical clearance examination. I felt like someone had been punching and kicking me all over. Its been a decade since I was this sick. Darn flu

My son had a sinus infection and was given a z-pak prescription. I was laying on the floor, covered in blankets, when my wife told me. I could not for the life of me think of what the z stood for, that is how obtunded I was.

Wednesday it was all as clear as a bell, although I was still running a fever. Monday I was able to go to the doctors appointment, go get my chest x-ray. I could not get my blood work. I started to go to the lab and thought - I have to get bloodwork done, I better eat. I should have known they wanted me to be fasting, but my mind just was not working clearly. I also went to get fingerprinted for the training permit, and filled the forms out completely wrong. I mentally was misfiring in a major way.

The point being, I know programs expect us to work sick, but it scares me to think what sorts of mistakes I might make in that state. It literally took me several days to begin to feel I was improving.

 

[surgeon2b forev]

I think Tired has a point... if you only have a cold.

But when you have influenze, that's a different story. That virus can knock you on your you know what, and it's potentially deadly (like, not theoretically, seroiusly) to a lot of people in the hospital. And you can't just solve that issue by wearing a mask and gloves all day, although it does minimize transmission.

Any ID fellows with input?

 

[Tired]

"surgeon2b forev" = pre-Pharmacy?

 

[Blade28]

"surgeon2b forev" = pre-Pharmacy?

He needs to update his status - he's an MS-IV.

 

[jl lin]

K, I'm simply lurking, but honestly a severe migraine is like nothing you can fully discribe or function with. I've had the worse back-labor for macro babies. Had surgeries with complications. . .all kinds of things. But if you get a killer migraine, it's impossible to function for surgery, rounding or tying your shoes for that matter.

There's a reason people with serious migraines get referred to pain clinics. Fortunately I haven't had more than say ten true migraines in my life. Suffice it say, the H/A was so horrible, my BP was 220/140. This is, um, way far from my baseline. Point is, if severe enough, they can be delibilitating beyond anything. It's like being in one of the worst kinds of all-consuming tortue chambers. They can be mad serious. So when they happen, you can't take care of pts. Hell you can't even really see or hear them b/c of the pain. If I had to live with that on a weekly basis, I don't know if I'd keep going. They can be that bad.

 

[kralwok]

I called in sick once. I had severe low back pain and couldn't stand up/walk. I was on an outpatient rotation so it didn't affect anyone. Had I been on inpatient I probably would have gone if I could have gotten in the car (though honestly, they probably would have sent me home b/c I just couldn't function). The next day I showed up to work and the attending was like "why are you here? go home!". So I went home and luckily had the weekend to recover. Thank god this happened while I was on outpatient.
I have never called in sick when I was actually sick, but luckily I never got really really sick as a resident. It is such a shame that residents are expected to work through illness and expose everyone in the hospital to their infections.

 

[mwest]

It's not that much of a big deal- when you are sick and cannot give your 100% then you take sick leave. Period. It doesn't even have to be infectious like all of us seem to be suggesting here. Anything that keeps you from mentally/physically functioning to your capacity counts.
We don't need to have the guilt baggage also because at our program you switch calls/clinic with whoever covering for you which is pretty fair.

 

[SouthernSurgeon]

K, I'm simply lurking, but honestly a severe migraine is like nothing you can fully discribe or function with. I've had the worse back-labor for macro babies. Had surgeries with complications. . .all kinds of things. But if you get a killer migraine, it's impossible to function for surgery, rounding or tying your shoes for that matter.

There's a reason people with serious migraines get referred to pain clinics. Fortunately I haven't had more than say ten true migraines in my life. Suffice it say, the H/A was so horrible, my BP was 220/140. This is, um, way far from my baseline. Point is, if severe enough, they can be delibilitating beyond anything. It's like being in one of the worst kinds of all-consuming tortue chambers. They can be mad serious. So when they happen, you can't take care of pts. Hell you can't even really see or hear them b/c of the pain. If I had to live with that on a weekly basis, I don't know if I'd keep going. They can be that bad.

Why did this merit pulling up a 2 year old thread?

 

[Apollyon]

Why did this merit pulling up a 2 year old thread?

When the signature is longer than the post, one must take that into consideration.

Then again, when the signature extolling the USMC does not point to marines.com or www.usmc.mil, one must also take that into consideration.

 

[bluealiendoctor]

Sick days? Please tell me of these things called "sick days".

Come on Winged, ease up on the 'I had to walk to work uphill in snow both ways' comments.

 

[elr1983]

I think surgery is different....a friend of mine broke her arm walking in to work one day (slipped on the ice). She went to the ER for x-rays and it ended up needing a closed reduction in the ER. Several hours (and several doses of morphine) later she was discharged and went home rather than going upstairs to evening round with the team. Our attending was not happy. Oh, and it wasn't a matter of him not knowing the situation....the other members of the team were keeping the chief resident/attending well informed.

How do you guys feel about people missing work for funerals/other family emergencies? I got called in just before christmas because another resident's grandma died and our program was totally fine with it and encouraged her to not worry about anything other than being with her family during this difficult time. I'm not in surgery, though...

 

[Rogue Synapse]

Come on Winged, ease up on the 'I had to walk to work uphill in snow both ways' comments.

Let's all yell at the WS from two years in the past.

 

[pillowhead]

I think surgery is different....a friend of mine broke her arm walking in to work one day (slipped on the ice). She went to the ER for x-rays and it ended up needing a closed reduction in the ER. Several hours (and several doses of morphine) later she was discharged and went home rather than going upstairs to evening round with the team. Our attending was not happy. Oh, and it wasn't a matter of him not knowing the situation....the other members of the team were keeping the chief resident/attending well informed.

That is absolutely ridiculous. I never understand how we as physicians can treat our colleagues who become patients that way. I mean, if it was me as an orthopedic surgeon or emergeny medicine physician, I would be appalled if my patient-physician wanted to start caring for other patients immediately after a procedure and/or multiple rounds of opioids or benzos. Any bozo should recognize how unsafe that is for everyone involved.

 

[elr1983]

I know, ridiculous, right? The argument from the surgeons is that we, as med students, don't make decisions, sign orders, etc, and so we don't put any patients in danger if we're impaired. This is the same argument they used to not let us go home post call.

 

[treesap]

I'm glad someone resurrected this thread because I need a place to vent!

The problem in a small program is that if someone calls in sick, someone else has to cover. It hadn't been a problem until recently, when 3 or 4 people were calling in sick a week. Over the last 3 years, I've been called in so many times I can't even count, sometimes for weeks at a time.

I guess I wouldn't be so upset if they were on death's door. But a virus??? You have a COLD and you're calling in sick to the ICU? The sick call guy has been called in so many times that he's over his 80 hours and I (the senior resident) just have to "tough it out" on my own.

The worst offenders are those that have no job prospects after residency, ie they have no reason to want to graduate "on time". For those of us that have an inflexible deadline (fellowship, job) it is in our best interest to show up and work through it.

I have a few colleagues that work their butts off... if they called in sick, I'd bend over backwards to help them. But the others really don't seem to care they've inconvenienced anyone else. This bothers me the most...who ARE these people? Is this how you get ahead, by screwing over your colleagues?

Part of me is jealous that they get away with this. I LIKE being a hardworking person, but almost wish I had some of this devil-may-care attitude. I'm sure it would be healthier in the long run and gnaw at me less.

Grrr!

 

[jl lin]

Why did this merit pulling up a 2 year old thread?

IDN, I was reading through the tread and saw someone post something that basically brushed off migraines as a lame thing and not something for which one should miss call.

Kind of annoyed me a bit; b/c it's not necessarily based in reality. If a person has not had a 8 or 10 out of 10 migraine, they have absolutely no freaking idea what they are talking about. Knowing how they can be, if my surgeon had one at this level and proceeded to operate on me, I'm be mad as hell. When I tell you you really can't see or focus, believe it. They CAN be that bad. I refused an OB b/c he was too sick and miserable and overly busy and was just being a bastard. Sure it wasn't all his fault. I can understand that people were popping in labor like there was no tomorrow; but after he examined me and I got a sense of what was going on with him, I say, Hell no. Don't touch me anymore, period. Luckily the OB that was mostly following me and who was one heck of a mensch came it for the C-section--it was a transverse presentation at that point, and hell if I was going to play with it. Patients can often sense when their nurses or doctors are seriously not up-to-par for whatever reason. So the hosital can save itself unnecessary complaints and law suits if it gets a little more sensible about forcing people to work when they seriously can't work up to par. You are no superman, period. If you can't work up to par, stay the hell away from me as a patient, period.

Also, anyone OKing that someone should return to work after less than 48 hours or so abdominal surgery, such as an appy, needs to have his or her head examined.

This is bad form--bad practice--and just a bad example to patients and others as well. It's hypocritical.

So, though it's an old thread, I still see this mentality and it bugs the life out of me. Sure there are always JO's that can take advantage and stick it to their fellow colleagues. But it's illogical to based such determinations on that. If there is a trends with someone being a slacker azz, deal with it on a case-by-case basis, but don't make other hospital staff, patients, and the individual resident pay an unreasonable price for the JO's of the world.


Oh. . .and I don't know why this thread wasn't archived? But when I read the one comment that included the bit with migraines as something as minor as hell, it pizzed me off, along with the one about pushing the resident to take call shortly after an appy--or doing rounds with IV polls. Come on. And what the hell does this say to patients? Physicians are hypocrites; b/c they won't or "can't" take care of themselves.

It's illogical and just plain idiotic.