Calling in sick

[jl lin]

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

Uh? It's not that long. It's just that the font is bigger. I've seen some longer. Don't worry about it. I'm sure your post was respectful, productive, and necessary. Not. It's was meant as an unnecessary smack. If you move here as some other agent "moniker" and have an issue, you know what? That's your problem, seriously. But don't just be nasty for the hell of it and try to come off as someone without an agenda. Most decent human beings are too reasonable in their thinking for that. Try using some respect and be civil.

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.

Uh? . . .Again. . . Hadn't had one marine person take umbrage to that.

Ah. . well. . some people. Takes all kinds.

BTW Personality Plus, US Marine Corp was underscored. The software read it as otherwise.

Nasty people in the world for sure--they don't even get why they can't be civil and respectful.

 

[Winged Scapula]

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

Regardless of when that comment was made, it is/was true...but yeah, this is a 2 year old thread.

We were not allowed sick days in my residency and although the hospital offered "personal days", surgical residents were made to sell them back as part of the contract.

You can choose to believe me or not (it appears that you do not), but I am not exaggerating nor is my residency that far long ago that I have a distorted memory of it (ie, the "we walked uphill both ways in the snow" comment).

The fact is that programs like this exist and still do. Much of surgical "education" lies in service. If you are gone, then someone else picks up the slack and they are generally not happy about it. As noted above, surgery training programs are different by and large. You do not call in sick.

If yours allows you sick days and you are not expected to come in when ill, then more power to you. I will not pretend that was my experience to make everyone feel better or to lie to students about my program. I have little to no interest in some sort of e-measuring stick about who had it harder during residency.

 

[bluealiendoctor]

Winged, I'm not sure what made you think I don't believe you. There is no argument whatsoever as to your residency being more rigorous than those today. Everybody knows this and that was my point. It is however all relative. My grandfather would say your residency was a cake walk. I doubt that you were forced to wash your attending clothes with a washboard, or build a new barn during the late night hours before going in for surgery rounds. I also didn't know you were a surgeon. That alone puts your residency above any other field out there and again, everybody knows that. I am well aware that programs still exist that favor service far beyond education. It seems surgery and obgyn are usually the culprit. Changes are made usually with good intent. It is not always appropriate to assume the 'old days were better'. If we refused change, then women wouldn't be voting, public bathrooms would be segregated and we wouldn't even have female doctors. Medicine requires changes as well. It is much more common today to have people beginning their medical career already having a family to raise. To say you have to put your career before your family might seem noble to old schoolers, but we are trying to get around that. People should be able to apply their passion and goodwill to people without having to abandon their spouse and/or children. I don't think this is a weakness, but a strength. Again, I completely accept that your residency was much more strenuous than mine. I can't imagine anybody arguing against that....well, except my grandfather.

 

[Winged Scapula]

Winged, I'm not sure what made you think I don't believe you.

Because the phrase "walking both ways to school uphill in the snow" is *commonly* used to claim or imply that the other is exaggerating their experiences.

There is no argument whatsoever as to your residency being more rigorous than those today. Everybody knows this and that was my point. It is however all relative. My grandfather would say your residency was a cake walk. I doubt that you were forced to wash your attending clothes with a washboard, or build a new barn during the late night hours before going in for surgery rounds. I also didn't know you were a surgeon. That alone puts your residency above any other field out there and again, everybody knows that. I am well aware that programs still exist that favor service far beyond education. It seems surgery and obgyn are usually the culprit. Changes are made usually with good intent. It is not always appropriate to assume the 'old days were better'. If we refused change, then women wouldn't be voting, public bathrooms would be segregated and we wouldn't even have female doctors. Medicine requires changes as well. It is much more common today to have people beginning their medical career already having a family to raise. To say you have to put your career before your family might seem noble to old schoolers, but we are trying to get around that. People should be able to apply their passion and goodwill to people without having to abandon their spouse and/or children. I don't think this is a weakness, but a strength. Again, I completely accept that your residency was much more strenuous than mine. I can't imagine anybody arguing against that....well, except my grandfather.

My point was not that my residency was harder than yours - as I noted, I'm not interested in an electronic measuring stick. However, I take issue with users who claim I am exaggerating or that it couldn't have been that bad. Unless they were there at the same time and place, they have no business stating as much. But I don't claim the old days were better, at least not in terms of service over education. We may disagree about reduction in work hours and whether or not its beneficial, but I don't derogate the new ways simply because they're new.

 

[bluealiendoctor]

Because the phrase "walking both ways to school uphill in the snow" is *commonly* used to claim or imply that the other is exaggerating their experiences.



My point was not that my residency was harder than yours - as I noted, I'm not interested in an electronic measuring stick. However, I take issue with users who claim I am exaggerating or that it couldn't have been that bad. Unless they were there at the same time and place, they have no business stating as much. But I don't claim the old days were better, at least not in terms of service over education. We may disagree about reduction in work hours and whether or not its beneficial, but I don't derogate the new ways simply because they're new.

Well said Winged. I don't think a reduction in work hours has anything to do with what the ACGME focuses on i.e. sleep/rest. I think it simply makes residents happier which can in itself have a profound benefit in overall performance. My phrase was a bit misleading, I agree. I not only don't feel that the rigors of past residencies are exagerated, but I also would never expect you to exaggerate. Based on your past advice/comments, it would seem very unlike you.

 

[WholeLottaGame7]

I think that surgical resident who was scrubbing out to run to the bathroom for their GI illness was lying about being a resident. A REAL surgical resident would have inserted a rectal tube prior to surgery. Sheesh, kids these days, no work ethic...

/sarcasm

I'll second the "tailoring it to the rotation" nature of sick days. I took my first sick day in medical school last week as an MS4 due to a nasty GI bug. It was during a FM "procedures" selective, which basically involves me doing a lot of shadowing interspersed with seeing some clinic patients and doing some "procedures" like shave biopsies, etc. Do I have any responsibilities? No. Will anyone even remember my name after my half-day of working with them? No. Did that stop the program secretary from warning me I might fail if I miss too many days (need 14 clinical days for the month, was scheduled for 17 before my day off)? No. I'm sure she's never been sick, either. Funny how everybody's illness comes into question but your own...

Contrast that to 3rd year on my peds surg rotation, when I had a nasty fever and heart palpitations (wtf, viral myocarditis?), finished my short call at 11p, changed out of scrubs and went down the ED (to avoid any confusion), hung out there til 4a, went home and showered/ate breakfast, back at the hospital at 5a to pre-round. Did I have any responsibilities then? As a medical student, I would still say no. But, we occasionally we made life easier on the interns, and although it's not like medical students are ever key cogs in patient care, the team mentality of that rotation definitely persevered and I didn't want to let anyone down.

Was it the right decision, or will it be in residency? I dunno.

A lot of good examples have been brought up, though:
- NICU/heme-onc/BMT/other immunocompromised
- if you need narcotics (post-surgical, for realz, you might as well come in drunk)
- if you warrant an admit to the hospital
- births/deaths (or life-threatening).

I recognize some of the harder-core of you might not agree with the last one, but that's OK, because if you don't, you're a heartless bastard and nobody loves you anyway.

 

[michaelrack]

- births/deaths (or life-threatening).

.

Your own death is considered a perfectly acceptable reason for a resident to miss work by most PD's and chief residents

 

[deleted87716]

Your own death is considered a perfectly acceptable reason for a resident to miss work by most PD's and chief residents

You'll likely have to give them a copy of your death certificate, though. Plus, you can only call in dead once. They won't buy it a second time. 😉

 

[Winged Scapula]

Calling in dead is only acceptable if the resident were coded.

DNR/DNI is for the weak and lazy. 😉

 

[Laryngophed]

Calling in dead is only acceptable if the resident were coded.

DNR/DNI is for the weak and lazy. 😉

So, should all residents have a defibrillator implanted on the first day of orientation so as to minimize interruption of care?

 

[Winged Scapula]

So, should all residents have a defibrillator implanted on the first day of orientation so as to minimize interruption of care?

Not a bad idea. Include a Foley and NGT and you've got yourself a good plan. No excuses anymore!

 

[docB]

I don't think being dead will cut it. I know from watching ER (waaaaaay back in the early years) that if you are a surg intern and you off yourself by jumping in front of a train mean old Dr. Benton will keep ranting about how lazy you are and paging you until he realizes he's paging the beeper clipped to the belt of the mangled trauma code he's working on.

 

[Law2Doc]

I don't think being dead will cut it. I know from watching ER (waaaaaay back in the early years) that if you are a surg intern and you off yourself by jumping in front of a train mean old Dr. Benton will keep ranting about how lazy you are and paging you until he realizes he's paging the beeper clipped to the belt of the mangled trauma code he's working on.

Yes, but in all fairness that person still reported to the hospital.

 

[michaelrack]

Not a bad idea. Include a Foley and NGT and you've got yourself a good plan. No excuses anymore!

You forgot a rectal tube.

 

[Winged Scapula]

You forgot a rectal tube.

Great minds think alike.😀

I *did* think about it, but since I was posting between cases, I didn't have time to go back and edit and then forgot about it.

 

[WholeLottaGame7]

Yes, but in all fairness that person still reported to the hospital.

That is the ultimate gunner move right there. Talk about setting the bar high, now the PD or chair has something to hang over the heads of all future residents: "Oh yeah, well X came in to the hospital AFTER HE WAS DEAD. What's your excuse?"

 

[doctorhouse]

a

 

[fab4fan]

You'll likely have to give them a copy of your death certificate, though. Plus, you can only call in dead once. They won't buy it a second time. 😉

Bullcrap. Everyone knows doctors are God and can do an end-run around this trifle.

 

[CherryTree1305]

Just to add my unwanted two cents - it isn't just residency issues. It is the entire hospital attitude and has been at all the various ones I've worked in over the past 30+ years (yes, I'm one of those horrible RN's - but NOT a DNP.) You just DON"T call in sick. (And I spent those years working in an NICU!) Only once was I ever sent home "sick" and that was because one of those evil vent. cords jumped out and grabbed my foot, tripped me and I went down, breaking my nose, splitting the skin on the nose and bleeding all over the floor - then I got excused for TWO whole days, came back looking like a raccoon and hands so swollen I couldn't even put gloves on to do proper universal precautions. But I was at work. As a nurse, we don't have the option of taking call from the little girls room, instead you stay with your patient until you can't bear it any longer, call to your co-worker, race to the restroom, do what needs to be done, scrub your hands & extremely pale face, race back to the NICU, do another 3 minute scrub in, and fly back to the bedside until the next go-round. Makes for a long day and makes one really appreciate your co-workers.

 

[Cerberus]

Hah, sick days? We technically have sick days in our contract (i think) but calling in means someone has to cover for us and then we have to pay it back to them at a later date.

 

[docB]

Hah, sick days? We technically have sick days in our contract (i think) but calling in means someone has to cover for us and then we have to pay it back to them at a later date.

This doesn't change out of residency. My EM group has a call schedule for sick calls and we pay ourselves to take the call. If you use the sick call you don't get paid for the shift of course but you also have to take a call in the next two months for free.

Most practices in every specialty have some formal or informal, favor bank style set up for call. For office based specialties you either have to reschedule you patients or have them seen by someone else.

Medicine isn't like other jobs where you can just put things on hold for a day.

 

[Cerberus]

This doesn't change out of residency. My EM group has a call schedule for sick calls and we pay ourselves to take the call. If you use the sick call you don't get paid for the shift of course but you also have to take a call in the next two months for free.

Most practices in every specialty have some formal or informal, favor bank style set up for call. For office based specialties you either have to reschedule you patients or have them seen by someone else.

Medicine isn't like other jobs where you can just put things on hold for a day.

Right and if I come in for someone, I would expect it to be paid back to me (as a resident or attending). I called in once during intern year (got gastro from the little germ bags in the pedsed), usually I just suck it up and come in though.

 

[Janedoedoctor]

As a nurse, we don't have the option of taking call from the little girls room, instead you stay with your patient until you can't bear it any longer, call to your co-worker, race to the restroom, do what needs to be done, scrub your hands & extremely pale face, race back to the NICU, do another 3 minute scrub in, and fly back to the bedside until the next go-round. Makes for a long day and makes one really appreciate your co-workers.

This definitely sounds like a safe, sensible way to prevent spreading your GI bugs to the extremely vulnerable, preterm neonates.

I can't wrap my head around the idea that there are floor managers/head nurses out there with so little common sense that they allow this kind of thing to happen.

Why is it so hard for people in healthcare to understand that we are only human, and that inevitably, at some point, our bodies are going to fail us in one way or another. Why do we feel this masochistic need to torture ourselves far beyond what would be considered reasonable and/or safe in other high stakes industries, eg aviation or nuclear industry?

It must be some kind of god complex. Patients and we ourselves would be a lot better of without it.

 

[Arcan57]

This definitely sounds like a safe, sensible way to prevent spreading your GI bugs to the extremely vulnerable, preterm neonates.

I can't wrap my head around the idea that there are floor managers/head nurses out there with so little common sense that they allow this kind of thing to happen.

Why is it so hard for people in healthcare to understand that we are only human, and that inevitably, at some point, our bodies are going to fail us in one way or another. Why do we feel this masochistic need to torture ourselves far beyond what would be considered reasonable and/or safe in other high stakes industries, eg aviation or nuclear industry?

It must be some kind of god complex. Patients and we ourselves would be a lot better of without it.

It's not so much a god complex as systematic lack of redundancy. There are extraordinarily few hospitals that have any sort of overflow capacity. Staffing levels are maintained to max out the workload of every employee. This is good in that it makes the hospital more financially sound, but it also means that there's often no coverage if one of the nurses calls in. If you're working with 3 other nurses at 1:8 and one calls in sick you're up to almost 1:11 which in most situations is completely unsafe. So do you put the patients and your fellow nurses at risk due to too high a workload, or put them at risk due to whatever virus you're carrying? Sometimes it's easy to decide which risk is greatest (appy, severe gastro w/ active vomiting on on end - seasonal allergies on the other), sometimes it's tough (migraine, URI w/ fever).

None of the factors influencing the "we don't get sick" mentality are going away, and with tightening reimbursement the pressure is going to increase on nurses and ancillary staff. While firing someone for a medical problem is legally frown upon, people that call in frequently tend to be brought up often when deciding who stays employed. For the solo practitioner, they often aren't replaceable and don't have good options when they are sick. I don't know of any solo or small practice that could afford to have an extra doc just to cover. So it's not "look how macho I am" but "I don't have a choice except to abandon my patients or suck it up".

 

[Law2Doc]

I think that this mentatlity is starting to change somewhat...

if it is changing, I think many of us have seen no such evidence yet. Certainly not in residency. The culture in many specialties is to show up if you can possibly struggle your way through the day. That goes double for an overnight or weekend where it really inconveniences someone else if they have to come cover for you. Bad coughs, runny nose, muscle aches, headaches don't keep residents home like they might other professionals. You stick on gloves and a mask and the patients will be fine.

 

[docB]

This definitely sounds like a safe, sensible way to prevent spreading your GI bugs to the extremely vulnerable, preterm neonates.

I can't wrap my head around the idea that there are floor managers/head nurses out there with so little common sense that they allow this kind of thing to happen.

Why is it so hard for people in healthcare to understand that we are only human, and that inevitably, at some point, our bodies are going to fail us in one way or another. Why do we feel this masochistic need to torture ourselves far beyond what would be considered reasonable and/or safe in other high stakes industries, eg aviation or nuclear industry?

It must be some kind of god complex. Patients and we ourselves would be a lot better of without it.

I agree with Arcan. This isn't due to some God complex, it's the system. If I don't work I don't get paid, in fact, I have to pay someone else to cover my shift. That nurse in NICU, you say the charge nurse should send her home. What if she is begging to stay because she has to make rent. No one is doing this because we like it. There are forces at work that just make it happen.

 

[RadOncDoc21]

I can't speak for all institutions but at the institution where I train and insitutions where friends train there is a changing sentiment. In my residency program, residents are able to and do call in sick when they are not well. If they are out other residents help out or attendings increase their work load regardless of whether it's a Friday, weekend, holiday, etc. I'm in oncology and we see a fair number of patients who are immunosuppressed, etc. and would be remiss if I were to put them at further risk. Also, if a program doesn't provide you the ability to take off when you are sick, to me that is a sign of a lack of respect for the individual and I would not recommend that friends/colleagues train at programs like that. It's one thing to call in for a hang nail but if you are truly ill, it is what it is, you take the time, you get better and you come back. If a colleague is sick, I don' demand compensation time back for covering and vice versa. There is a certain amount of respect and trust amongst those in our department and we help each other out.

I completely agree. Especially when you're dealing with patients who are immunocompromised and nothing worse then catching the flu from a co worker who should have stayed home.

-R

 

[docB]

That is horrible rationale for coming in when sick, it is certainly reality but it is the job of those superivising residents/attending physicians/nurses etc. to ensure that this does not happen. If you are working in the ER and seeing a patient with multiple comorbidities who could be tipped over the edge by catching the influenza you have, you are doing a disservice to the patient. As a physician, I would hope you were more concerned about first doing no harm and then about missing a pay day. You are also putting your colleagues at risk and putting them in the same predicament. I agree with staffing the way it is that it is difficult to call in but in the long run calling in for a day or two is far better than the potential problems you can cause. That's why we have back up/emergency call in. I'm certainly not in ER, general sugery, etc. but train in a residency program that understands we get sick. If I'm sick for a day or two, either my co-residents help out or the attending picks up the slack.

There are a lot of problems in healthcare. This is a very minor one comparatively and it isn't likely to be solved as it would require money. I also think that the exposure patients have to all of the other bugs in the hospital, clinic, waiting room, life are more concerning than their exposure to healthcare workers. And even then all the resistant stuff we pick up over the years, MRSA, VRE, etc. is worse than the day to day colds.

 

[Law2Doc]

... Also, if a program doesn't provide you the ability to take off when you are sick, to me that is a sign of a lack of respect for the individual and I would not recommend that friends/colleagues train at programs like that. It's one thing to call in for a hang nail but if you are truly ill, it is what it is, you take the time, you get better and you come back. If a colleague is sick, I don' demand compensation time back for covering and vice versa. There is a certain amount of respect and trust amongst those in our department and we help each other out.

it's less about respect and more about culture. There are many specialties where the culture is to tough it out. Not just at the resident level, but fellows and attendings as well. Since it's specialty wide, you can't really not recommend not to train at a given program, but instead would have to forego an entire given field. Which is fine -- if sick days are that important to you it wouldn't have been a good fit for you anyhow. The fact that you aren't demanding someone to return the favor of taking your shift perhaps reflects that you have less onerous call in oncology than some fields.

 

[Law2Doc]

... I also think that the exposure patients have to all of the other bugs in the hospital, clinic, waiting room, life are more concerning than their exposure to healthcare workers. And even then all the resistant stuff we pick up over the years, MRSA, VRE, etc. is worse than the day to day colds.

absolutely. A healthy doctor wearing a white coat probably spreads more bad bugs than a sick drippy one in fresh scrubs. And its probably nothing compared to what the various food service people track around the hospital daily, since they go into every room. The "don't give the patients your cold" notion kind of highlights the hypocrisy.

 

[Arcan57]

There are obviously risks to the patient from a physician but why increase that risk? Maybe you're not worried about colds, but what about influenza. The patients I treat are pretty susceptible to influenza as they often have multicomorbidities, are older, and may be immunosuppressed. Based on the published data, there is a small number of patients that die from the flu every year and very often it is the aforementioned patients. Why increase their risk, even it is only a small amount.

You're a resident, you're viewing this from a resident's perspective, and that's fine. Residency is the most redundant portion of the healthcare delivery system. In many cases a missing resident can be compensated for without endangering patients. As I mentioned before, that redundancy doesn't exist in many cases outside of academics. If community doctor X doesn't come to work because of a URI, then none of community doctor X's patients get care that day (or they are shunted to the ED where they will receive expensive and possibly unnecessary care).

 

[Law2Doc]

You're a resident, you're viewing this from a resident's perspective, and that's fine. Residency is the most redundant portion of the healthcare delivery system. In many cases a missing resident can be compensated for without endangering patients. As I mentioned before, that redundancy doesn't exist in many cases outside of academics. If community doctor X doesn't come to work because of a URI, then none of community doctor X's patients get care that day (or they are shunted to the ED where they will receive expensive and possibly unnecessary care).

I agree with your last two sentences. I would suggest that residents aren't nearly as redundant components at the smaller programs as they are at the bigger ones.

 

[Arcan57]

I agree with your last two sentences. I would suggest that residents aren't nearly as redundant components at the smaller programs as they are at the bigger ones.

I'll give you that, but every resident is theoretically supervised by an attending. So there's still more redundancy there than in the majority of health care.

 

[NotAProgDirector]

That is horrible rationale for coming in when sick, it is certainly reality but it is the job of those superivising residents/attending physicians/nurses etc. to ensure that this does not happen. If you are working in the ER and seeing a patient with multiple comorbidities who could be tipped over the edge by catching the influenza you have, you are doing a disservice to the patient. As a physician, I would hope you were more concerned about first doing no harm and then about missing a pay day. You are also putting your colleagues at risk and putting them in the same predicament. I agree with staffing the way it is that it is difficult to call in but in the long run calling in for a day or two is far better than the potential problems you can cause. That's why we have back up/emergency call in. I'm certainly not in ER, general sugery, etc. but train in a residency program that understands we get sick. If I'm sick for a day or two, either my co-residents help out or the attending picks up the slack.

I do agree with this, but speaking from experience, a system like this fails once you have someone who abuses it. We have had residents who tend to call in sick when they have just a mild cold, and others that seem ready to remove their own appendix while rounding to avoid missing time. One resident who calls in sick all the time can easily kill the morale of a program. We had one resident who was a single mom, and called in whenever one of her children was ill and couldn't go to school. We had to come up with a plan where the number of sick days is tracked, and that it's kept reasonable and fair for everyone.

But, we do have a coverage system

 

[QofQuimica]

I do agree with this, but speaking from experience, a system like this fails once you have someone who abuses it. We have had residents who tend to call in sick when they have just a mild cold, and others that seem ready to remove their own appendix while rounding to avoid missing time. One resident who calls in sick all the time can easily kill the morale of a program. We had one resident who was a single mom, and called in whenever one of her children was ill and couldn't go to school. We had to come up with a plan where the number of sick days is tracked, and that it's kept reasonable and fair for everyone.

Very true. That's why I like the system we have where people who call in sick are required to pay back the missed time to the sick call resident. It's only humane to be able to take a day or two off when you're legitimately sick. But at the same time, you have to be accountable to your fellow residents and not take time off if you don't really need it. And let's not get started on the subject of single parents who expect everyone else to suffer on a regular basis because they aren't responsible enough to set up backup childcare plans.

 

[medicinesux]

Having gone from one extreme to another, I have more sick days now than I know what to do with. Though I am free to use them I still feel guilty calling out (I attribute this as a relic to my days in medicine) if I feel a scratch developing in my throat or if I am feeling just a tad wee under the weather. All I have to do is roll over in my bed in the morning and push a button on the computer to call in my absence. Sure beats calling in as a resident and feeling as if you were on trial to justify why you can't come in that day. God, if it was that easy to call out sick as a resident I would have stopped climbing out of bed by July 5th of my intern year!
I wish I could let some of the poor souls here borrow the days I racked up. Even though I've used 5 "sick/personal" days in just the past 3 months, I still could call out everyday for the next 3 weeks and still not have to payback a penny. But then again why would I ever do that when I have the next 2 weeks off for the holidays??? Just last week, a coworker called out sick to go on a cruise.....get this.....for the WHOLE WEEK! No one batted an eye! Can you imagine how that would go down working in the hospital?! By the way, I NEVER called out sick once my entire four years of residency. Not Once!..... for many of the reasons already stated above! I felt the pain of getting excessive work dumped on me when a coresident called out. I could never bring myself to not report to the hospital. Gotta love when your cointern calls out sick on a Saturday and you have to round on your 12 and their 12 patients. And not to discover this until you walk in at 6 in the morning with the attending coming in at 8! Or better yet, getting pulled off your cush radiology elective to cover the ICU for 2 weeks. My stomach twists in knots just thinking about those dark days again.

 

[Groove]

Called in sick on a few occassions in my previous career, but never as a physician and I've had some pretty sick days. I just don't believe in it. You have too many people depending on you. Virtually every member of your team "feels" it when they have to pick up your slack. I'm not saying it's a healthy or good policy for a resident or patients, but I think the field of medicine tends to take a more militaristic approach and as someone said "just walk it off" mentality. I was febrile, horrible bronchiolitis/bronchitis/laryngitis, lost my voice for 2 weeks and had to whisper orders to nurses but was on SICU that month as an intern. You just can't call in sick and dump 6 patients on your fellow residents. Plus, are you really going to feel THAT much better in 24 hours to where you are "now" capable of working? I just don't believe in calling in sick unless I'm literally about to die. No sick days in 3.5 years so far during residency, but I've been pretty sick several times.

 

[Doctor Bagel]

I do agree with this, but speaking from experience, a system like this fails once you have someone who abuses it. We have had residents who tend to call in sick when they have just a mild cold, and others that seem ready to remove their own appendix while rounding to avoid missing time. One resident who calls in sick all the time can easily kill the morale of a program. We had one resident who was a single mom, and called in whenever one of her children was ill and couldn't go to school. We had to come up with a plan where the number of sick days is tracked, and that it's kept reasonable and fair for everyone.

But, we do have a coverage system

You can't stop supporting residents keeping themselves healthy by some outlier who abuses the system. Since we log our hours for virtually everything we do, our sick days are tracked. Surely, you can figure out if something is up from that tracking and go from there. Of course that still leaves the administration in a difficult situation because the resident's health information is protected. What do you do to keep things fair?

At my program, payback wouldn't work because our jeopardy/backup system is covered by 3rd and 4th year residents. Our call schedule is almost entirely covered by 1st and 2nd years, meaning that the people covering call aren't regularly scheduled in the call pool. But it's really not been a problem because I don't think anybody in recent years has abused the system. Calling in sick for call is pretty much a huge deal that I think most of us would be very reluctant to do.

 

[45408]

I'll give you that, but every resident is theoretically supervised by an attending. So there's still more redundancy there than in the majority of health care.

Sort of. Our attendings will often have a full day of clinic or meetings, while we see traumas, consults, and do floor work. There's no way they could do both, and I'm pretty sure a good percentage of my attendings couldn't actually discharge a patient without our help.

 

[Arcan57]

Sort of. Our attendings will often have a full day of clinic or meetings, while we see traumas, consults, and do floor work. There's no way they could do both, and I'm pretty sure a good percentage of my attendings couldn't actually discharge a patient without our help.

But out in the community, the surgeons I deal with are doing all of the above. I'll give you that they may be breaking ACGME rules (less the 80hr work week and more the 30 hrs of patient care) to do so.

 

[VA Hopeful Dr]

But out in the community, the surgeons I deal with are doing all of the above. I'll give you that they may be breaking ACGME rules (less the 80hr work week and more the 30 hrs of patient care) to do so.

Yeah, but those are private surgeons. If you've been solely at a teaching hospital for 20 years, I bet a lot of your paperwork/scut skills have atrophied. Also, and this might just be my experience, at private hospitals the staff (SW and discharge planning especially) seem a little more on the ball than at teaching hospitals.

 

[gstrub]

Last weekend I ate something horrible and had blow it out your ass gastroenteritis all afternoon Sunday. I texted my chief (I am a surgical intern) that night and told him such. He told me not to come in. I said F that I am a bad ass surgeon. I woke up, puked, put scrubs on, sharted, thought better of the whole thing, and texted him and said maybe you're right. I spent every other 30 minutes on Monday on the toilet. I would have been mess in the hospital and would have likely ended up with an IV had I gone in. I still feel bad about having my co-residents pick up my slack (which is really just clinic and scut on Mondays and wasn't so bad as they don't usually have an intern on this service), but I still am upset about it. What can you do though? I honestly would have been the sickest person in clinic. So I am just going to say that if you physically can't avoid the toilet for more than 30 minutes and look like a sweaty ghost, there's no reason you should be taking care of patients that day.

 

[Law2Doc]

Last weekend I ate something horrible and had blow it out your ass gastroenteritis all afternoon Sunday. I texted my chief (I am a surgical intern) that night and told him such. He told me not to come in. I said F that I am a bad ass surgeon. I woke up, puked, put scrubs on, sharted, thought better of the whole thing, and texted him and said maybe you're right. I spent every other 30 minutes on Monday on the toilet. I would have been mess in the hospital and would have likely ended up with an IV had I gone in. I still feel bad about having my co-residents pick up my slack (which is really just clinic and scut on Mondays and wasn't so bad as they don't usually have an intern on this service), but I still am upset about it. What can you do though? I honestly would have been the sickest person in clinic. So I am just going to say that if you physically can't avoid the toilet for more than 30 minutes and look like a sweaty ghost, there's no reason you should be taking care of patients that day.

I've spent an overnight night on the wards puking my guts out every 20 minutes, and someone else with the same bug was seen the next day doing rounds with an IV pole. Its not ideal, but in smaller residencies, it's not uncommon for the whole group to either be over hours, post-call, or have some variation of the same bug at the same time. Sometimes calling in sick isn't always optional even if it were condoned. Often you don't know you are sick until a few hours into your shift, and there isn't the time or available bodies to get a replacement anyhow. So you muscle through. It helps your street cred. And you don't owe anyone a shift, and get a post call day to recover far enough into the virus that you might actually have time to recover.

Plus if you are going to totally trash a bathroom, it's better to do it at one that's not at your home.

 

[member0007]

The sick day (limited number of days) versus interview days/conference days/personal days etc.

If the resident is on a resident dependent service, then someone needs to cover. I have a personal problem with people who think that sick days needs to paid back to someone specific etc. I think having to cover for a resident who is out sick is part of the job and what I get paid to do.

However, the personal time, interview time, conferences are totally different in that they are foreseeable. These are important but if you can't get coverage, you should be prepared to forfeit them. I am sick and tired of residents who make up some crappy poster and then goes on these week long and expensive shin digs, even when they can't get coverage. I am tired of being harassed by residents who want to find coverage for their pal. This is an example of old school cronyism and very unprofessional.

I want to propose that residents should schedule conferences during vacations or resident independent services, and give up on the idea of having to stand next to their poster for an hr as reason enough to have to attend a conference, especially, if they can't find coverage.

 

[Law2Doc]

The sick day (limited number of days) versus interview days/conference days/personal days etc.

If the resident is on a resident dependent service, then someone needs to cover. I have a personal problem with people who think that sick days needs to paid back to someone specific etc. I think having to cover for a resident who is out sick is part of the job and what I get paid to do.

However, the personal time, interview time, conferences are totally different in that they are foreseeable. These are important but if you can't get coverage, you should be prepared to forfeit them. I am sick and tired of residents who make up some crappy poster and then goes on these week long and expensive shin digs, even when they can't get coverage. I am tired of being harassed by chief residents who want to find coverage for their pal. This is an example of old school cronyism and very unprofessional.

I want to propose that residents should schedule conferences during vacations or resident independent services, and give up on the idea of having to stand next to their poster for an hr as reason enough to have to attend a conference, especially, if they can't find coverage.

First, it's not individuals who think the sick days need to be paid back, it's usually a longstanding rule within programs that is set up that way -- that if someone has to come in on the weekend or an overnight to cover your shift, you cover one of theirs. The notion that my weekend plans can be ruined because you have a bug and you don't feel it necessary to pay it back is pretty bizarre. (mind you, all this assumes sick days are even an option, which at a number of programs described in this thread, it is not).

As for conferences, in general the programs get a lot of mileage out of being able to say that x% of people get to present something at a national meeting. More than you think -- those "crappy posters" are actually a big deal. It looks great for the PD when recruiting new residents, it enhances fellowship matching for the folks that do them ( which again helps the program) and it gives the HR folks stuff to publish in the department and hospital wide newsletters. Since this kind of stuff actually matters to academic programs, particularly in some specialties and at academic institutions, they encourage folks to take this initiative, and forcing people to use up their vacation days would not be a good way to foster this. I think it sounds like you picked an academic minded program but don't have that mindset, so your gripes with conference presentation time are really going to fall on deaf ears. I don't think many at such institutions are going to back your "proposal". Best advice -- if you can't beat 'em, join 'em. Crank out a couple of posters a year. It will help your CV, and you won't feel taken advantage of.

As for interviews, if we are talking about fellowships, again it's in the programs best interests to work with you to get something good, not cut off your legs by making you use up all your vacation for this. If we are talking about prelims going on interviews, or folks looking to change programs, then yeah, I guess I agree you have to squeeze this in on your own time -- it doesn't really benefit your program in any real way.

 

[Law2Doc]

This is pretty much BS in my opinion. If you are puking or ****ting your brains out, don't come to work. I don't care how small a program you are in, you are a resident, not a martyr. By using that BS logic, you potentially hurt your patients, hospital staff, and other colleagues. Guess the "street cred" is more important than actually doing the right thing. I have seen this situation before and what was done was straight forward, the attending came in and covered the service over night and the intern and resident went home an recovered.

Not all programs have the same attitude as you are calling common sense, obviously. To call an attending in to cover a residents shift simply is unheard of at a lot of places. Actually in a lot of non medical jobs (eg law firms) if a senior person had to come in and do work for an underling that can hurt the underling professionally - you can't bail in the middle of a deal no matter how sick you get. So while you feel it is BS, and maybe it is, that doesn't change the fact that at many places, the culture is such that calling in an attending would be BS/not an option. It really has nothing to do with "doing the right thing".

And as I mentioned above, it's not always a question of coming into work -- in longer shifts you can already be at work when the illness comes on. Then it becomes a question of whether a middle of the night replacement would even be feasible. At smaller programs the answer is often no. And you are better off in the hospital in the vicinity of a bathroom than trying to make a commute home anyhow.

 

[Law2Doc]

...
As for your personal vacation, conferences, interviews, if you end up having to cover because a colleague went to a conference my advice would be to do some research and go to one of your own. Every department has there own policies but ours is that if you do research and go to a conference you have to prepare a manuscript. The work required to do all that on top of resident work is a lot so I don't begrude someone who goes on a trip.Also, if your department wants research done, that stupid poster supports that endeavor.
Same thing goes for fellowship/ job interviews, I want my colleagues to be successful so more power to them going on interviews.

agreed.

 

[wholeheartedly]

This is pretty much BS in my opinion. If you are puking or ****ting your brains out, don't come to work. I don't care how small a program you are in, you are a resident, not a martyr. By using that BS logic, you potentially hurt your patients, hospital staff, and other colleagues. Guess the "street cred" is more important than actually doing the right thing. I have seen this situation before and what was done was straight forward, the attending came in and covered the service over night and the intern and resident went home an recovered.

I agree with this completely. Most people aren't aware of the downstream effects of coming to work sick like that. I guarantee when you're puking your guts out, while you might think about it a tiny bit, you're not focussing much on what you're touching or how not to spread it. You're in just scrape by survival mode til you get back home to bed. You also can't be sure of what you have, might be a GI virus, might be E. coli, or you might've picked up C diff from one of your patients and that's not a minor issue . What you assume to be a minor self-limiting infection might not be, especially for your patients.

One place I worked we had a bunch of people that kept coming in sick and passing it on to everyone else. It was in a clinical lab and everyone spent most of the day in gloves and PPE stuff, but some of those GI viruses have an infectious dose of only 10 viral particles. Don't wash your hands well enough in the bathroom and off to the next person it goes. They've done studies where those particles were found on surfaces 20 feet away and still viable after someone vomits.

It just kept spreading through the group and finally my supervisor basically said 'stay home or else' he said that he'd rather work two people short and cover their spots himself for a day or two and break the cycle than have half the staff out because somebody tried to prove they were tough.

So yeah, it might put your program in a pinch for you stay home a day or two, but that's a much smaller problem for them than having it cycle through a bunch of staff. Never mind the risk for patients.

 

[Law2Doc]

...

So yeah, it might put your program in a pinch for you stay home a day or two, but that's a much smaller problem for them than having it cycle through a bunch of staff...

absolutely but that's a decision for the program to make, not the resident unilaterally. If the program sends a resident home that's fine.

 

[Substance]

Not all programs have the same attitude as you are calling common sense, obviously. To call an attending in to cover a residents shift simply is unheard of at a lot of places. Actually in a lot of non medical jobs (eg law firms) if a senior person had to come in and do work for an underling that can hurt the underling professionally - you can't bail in the middle of a deal no matter how sick you get. So while you feel it is BS, and maybe it is, that doesn't change the fact that at many places, the culture is such that calling in an attending would be BS/not an option. It really has nothing to do with "doing the right thing".

And as I mentioned above, it's not always a question of coming into work -- in longer shifts you can already be at work when the illness comes on. Then it becomes a question of whether a middle of the night replacement would even be feasible. At smaller programs the answer is often no. And you are better off in the hospital in the vicinity of a bathroom than trying to make a commute home anyhow.

Why does it seem that people who went into ROAD or other very highly sought after, super competitive fields are more lenient and humane when it comes to the medical careers of their colleagues and successors than those in noncompetitive fields like IM or OB or FM? That's just been my experience, and it seems to play out on this forum too.