Can I refuse to see patients who have a cold?

[bisell26]

I have a huge pet peeve, when you are sick, you need to be home and not going around to your Psychiatry appointments blowing your virus all over the place. Do any of these patients know that they can just re-schedule? I feel like doctors need to have some rights as well. Why should I subject myself to someone who is contagious when I don't have to? I have an infant at home that I need to take care of, and it is just infuriating to me when people bring their kids in for a routine med follow up appointment for Ritalin. I just want to scream and tell them to get the hell out of my office.

Oh and another thing, I have bad Asthma, and I absolutely can't stand the patients who reek of cigarette smoke or Cannabis. It's just insulting that I have to completely air out my office. I feel like I should be able to refuse to see these patients on accord of my own health needs.

It's not like it's life or death when they are coming in for their routine med management appointments.

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[Bartelby]

You probably can, but if someone has taken time off work to make it to a once-in-three-months appointment with you it seems harsh to turn them away for a sniffle. We also work with populations who are more prone to illness. I think seeing people with colds just comes with the territory.

Something like a flu (where it clearly is not a drug reaction or other acute issue requiring more prompt attention) seems more appropriate to turn away.

 

[PikminOC]

Wait until you shill for rvu's. You won't be asking these questions.

 

[Old&InTheWay]

Has this always been a pet peeve, or is it worse with a new baby at home? It’s hard taking care of sick kids (time off work, up at night, etc). But it is also pretty hard to avoid people with colds if you live and work in the world in the winter, especially if you work with kids.

That said, if you have a policy that allows for people to cancel appointments on the day of the appointment without penalty, let people know. I’m sure some of them will take you up on it.

 

[birchswing]

I have seen doctors working while sick, so it goes each way. I mean think if a doctor took off for a cold (not that they shouldn't), but that's a big wrecking ball in the schedule. When I've had to reschedule with my psychiatrist it's usually means having to wait another month. And she wants to see me often even though we rarely change meds. I know if I called in saying I had a cold, they would want me to come in.

I think it comes down to contagious viruses in the winter season just being the worst. I tell my PCP that I just will not see him in the winter months (which he doesn't mind, I'm sure). I guess my health anxiety that leads me to see him is overruled by my anxiety over getting cold/flu. I avoid that environment at all costs. I avoid urgent cares. My autonomic system is already off, and even a small cold virus gives me worse tachycardia—let alone the flu.

One thing I see that is terrible is these urgent cares popping up that are specifically advertising for people who have a cold or the flu to come in! What are they going to do except turn the Urgent Care into ground zero for a bigger outbreak (or give them some very sketchy flu anti-viral—IMO). I know some people need to be hospitalized from flu complications, but why are these places encouraging people with viruses that will run their course to come to a centralized location where there are other people who might have ailments that actually have a fix? I guess I know why; it makes for good business. But when I have been places like that in the past and it looks like a developing country clinic with all these people languishing in the waiting room, I always wonder why they would rather be there rather than at home in bed. Actually I might know the answer to that to—employers who require notes from doctors, which is just insanity. Viruses are so common that a doctor verifying it with a note is like a doctor verifying that a patient poops.

 

[Bearrie]

I have a huge pet peeve, when you are sick, you need to be home and not going around to your Psychiatry appointments blowing your virus all over the place. Do any of these patients know that they can just re-schedule? I feel like doctors need to have some rights as well. Why should I subject myself to someone who is contagious when I don't have to? I have an infant at home that I need to take care of, and it is just infuriating to me when people bring their kids in for a routine med follow up appointment for Ritalin. I just want to scream and tell them to get the hell out of my office.

Oh and another thing, I have bad Asthma, and I absolutely can't stand the patients who reek of cigarette smoke or Cannabis. It's just insulting that I have to completely air out my office. I feel like I should be able to refuse to see these patients on accord of my own health needs.

It's not like it's life or death when they are coming in for their routine med management appointments.

I suppose it matters what type of practice setting you are in. I see most of my patients weekly for psychotherapy and don’t have many patients on medication. I understand and waive fees if they cancel once because they’re sick. If I were responsible for someone recently discharged on clozapine, then I’d probably say yes you must see.

 

[wolfvgang22]

We have masks by the door and ask patients who are ill to put one on. I don't shake their hand if they are apparently ill, and use hand sanitizer like crazy. If the patient is very ill we reschedule (i.e.; patient walks in and says "I was just diagnosed with the flu, heh heh" or "I've been told I have tuberculosis".) Hospital culture in general cares less about hospital staff than patients, so I always frame limiting contact with ill patients as a safety issue for other patients, not me.

As you know, these folks are contagious before they even show symptoms. So it is a job hazard.

Regarding malodorous patients, that is also just a job hazard. I had a patient with schizophrenia and alcohol use disorder a few months ago who defecated on the furniture in my office. Other patients would vacate the building before he arrived indoors because his hygiene was so poor. I actually wrote him a prescription to bathe and hospitalized him twice, but it made no difference because he would drink and was non-adherent to meds. Since it was summer I started seeing him on a shaded quiet bench outdoors. The social worker was mildly outraged and said I was harming his dignity. I said he was infringing on the right of others not to smell feces, vomit, tobacco, and body odor the rest of the day. He died a week later from complications related to alcohol dependence.

Don't even get me started on patients who come and sit all day in the waiting room drinking coffee, watching TV, and napping, only to tell me at their 3pm appointment they have a massive bed bug or lice infestation. I've had to have my office treated 3 times this year for bed bugs left behind by patients. I swear, one morning I unlocked my office door to find a large bed bug sitting across from my desk in the chair, legs crossed. He said "You're late. You think your time is more important than mine, eh doc? How was the golf?"

 

[WisNeuro]

We have masks by the door and ask patients who are ill to put one on. I don't shake their hand if they are apparently ill, and use hand sanitizer like crazy. If the patient is very ill we reschedule (i.e.; patient walks in and says "I was just diagnosed with the flu, heh heh" or "I've been told I have tuberculosis".) Hospital culture in general cares less about hospital staff than patients, so I always frame limiting contact with ill patients as a safety issue for other patients, not me.

As you know, these folks are contagious before they even show symptoms. So it is a job hazard.

Regarding malodorous patients, that is also just a job hazard. I had a patient with schizophrenia and alcohol use disorder a few months ago who defecated on the furniture in my office. Other patients would vacate the building before he arrived indoors because his hygiene was so poor. I actually wrote him a prescription to bathe and hospitalized him twice, but it made no difference because he would drink and was non-adherent to meds. Since it was summer I started seeing him on a shaded quiet bench outdoors. The social worker was mildly outraged and said I was harming his dignity. I said he was infringing on the right of others not to smell feces, vomit, tobacco, and body odor the rest of the day. He died a week later from complications related to alcohol dependence.

Don't even get me started on patients who come and sit all day in the waiting room drinking coffee, watching TV, and napping, only to tell me at their 3pm appointment they have a massive bed bug or lice infestation. I've had to have my office treated 3 times this year for bed bugs left behind by patients. I swear, one morning I unlocked my office door to find a large bed bug sitting across from my desk in the chair, legs crossed. He said "You're late. You think your time is more important than mine, eh doc? How was the golf?"

We just replaced all of the furniture with hard plastic furniture so we could just have housekeeping hose it down and disinfect if need be. Regarding the malodorous ones, I used to do some work on spinal cord units, with many deep, infected pressure ulcers. Those have quite the strong odor. Ever since then, I've always kept some Vaporub in my office, couple nostrils full of that usually does the trick for short periods of time.

 

[Merely]

We have masks by the door and ask patients who are ill to put one on. I don't shake their hand if they are apparently ill, and use hand sanitizer like crazy. If the patient is very ill we reschedule (i.e.; patient walks in and says "I was just diagnosed with the flu, heh heh" or "I've been told I have tuberculosis".) Hospital culture in general cares less about hospital staff than patients, so I always frame limiting contact with ill patients as a safety issue for other patients, not me.

As you know, these folks are contagious before they even show symptoms. So it is a job hazard.

Regarding malodorous patients, that is also just a job hazard. I had a patient with schizophrenia and alcohol use disorder a few months ago who defecated on the furniture in my office. Other patients would vacate the building before he arrived indoors because his hygiene was so poor. I actually wrote him a prescription to bathe and hospitalized him twice, but it made no difference because he would drink and was non-adherent to meds. Since it was summer I started seeing him on a shaded quiet bench outdoors. The social worker was mildly outraged and said I was harming his dignity. I said he was infringing on the right of others not to smell feces, vomit, tobacco, and body odor the rest of the day. He died a week later from complications related to alcohol dependence.

Don't even get me started on patients who come and sit all day in the waiting room drinking coffee, watching TV, and napping, only to tell me at their 3pm appointment they have a massive bed bug or lice infestation. I've had to have my office treated 3 times this year for bed bugs left behind by patients. I swear, one morning I unlocked my office door to find a large bed bug sitting across from my desk in the chair, legs crossed. He said "You're late. You think your time is more important than mine, eh doc? How was the golf?"

I guess this is why some people limit their pp to suburban depression and anxiety lol

 

[wolfvgang22]

I guess this is why some people limit their pp to suburban depression and anxiety lol

Partly. A big part is it can be frustrating and demoralizing treating only chronically ill, lower income people with lots of limiting social factors who naturally do not respond as well to treatment. At the same time, these people are the ones who need us the most. I think a mix of more and less sick patients is best.

 

[NITRAS]

You are a psychiatrist. . . you don't have to touch them.

Wash your hands, and keep an appropriate distance. Tell your staff to do the same.

 

[SourceOfDenial]

A thread about a doctor who gets upset seeing people who are sick. Love it.

 

[FrustratedFamDoc]

A thread about a doctor who gets upset seeing people who are sick. Love it.

Was about to post literally this. The undertone of disdain is deafening. It says more to me when patients keep regular follow ups when ill than those who cancel or no show for nothing. You're first few years out of residency you'll probably catch everything, at least twice, anyway. Goes with the territory.

 

[wolfvgang22]

A thread about a doctor who gets upset seeing people who are sick. Love it.

It's ok to vent sometimes to colleagues. Doctors are human and have the same concerns as everyone else, plus tough professional concerns. Let's not attack anyone for being human.

Being concerned about ones own health and having feelings of disgust or disdain is normal. Ignoring and not addressing these feelings in the context of compassion for both patients and oneself leads to burnout and other problems. A balanced, realistic outlook is necessary, just as we tell our patients.

 

[clausewitz2]

Partly. A big part is it can be frustrating and demoralizing treating only chronically ill, lower income people with lots of limiting social factors who naturally do not respond as well to treatment. At the same time, these people are the ones who need us the most. I think a mix of more and less sick patients is best.

Man, I feel like if someone could actually recruit and sustain a strictly bipolar I clinic, you would get exactly this sort of mix, as you would range from homeless alcoholics on disability right up to high-powered lawyers and college professors with just about every level of impairment and social functioning in between.

 

[whopper]

Depends on your employer.

I have become much more vigilant over getting sick cause getting sick and taking a day off is more than a $1000 loss for me/day.
I am washing hands during cold season now on the order of when I did IM, being almost after seeing every patient.

 

[SourceOfDenial]

It's ok to vent sometimes to colleagues. Doctors are human and have the same concerns as everyone else, plus tough professional concerns. Let's not attack anyone for being human.

Being concerned about ones own health and having feelings of disgust or disdain is normal. Ignoring and not addressing these feelings in the context of compassion for both patients and oneself leads to burnout and other problems. A balanced, realistic outlook is necessary, just as we tell our patients.

I'd argue that venting about patient populations on a public facing forum isn't really addressing this in a framework of compassion for self or others, but that's me.

My standard barometer is, would I say this to the patient? If the answer is no, or I hesitate, I look at what I'm thinking, feeling, and change the language.

 

[clausewitz2]

My standard barometer is, would I say this to the patient? If the answer is no, or I hesitate, I look at what I'm thinking, feeling, and change the language.

I don't know that that is always the right call.

Hate in the Counter-Transference

 

[Merely]

I'd argue that venting about patient populations on a public facing forum isn't really addressing this in a framework of compassion for self or others, but that's me.

My standard barometer is, would I say this to the patient? If the answer is no, or I hesitate, I look at what I'm thinking, feeling, and change the language.

Are you saying it would be fine if the forum was doctor only? Or are you suggesting we should always pretend everything is rainbows and sunshine’s?

 

[SourceOfDenial]

I don't know that that is always the right call.

Hate in the Counter-Transference

Big difference between processing emotions with a supervisor, doing your own self work and venting on a forum. Also, I hear trainees frequently use counter transference as an excuse for intolerance. Different things.

To your earlier post, many places have a dedicated bipolar clinic and it looks exactly as you describe.

Are you saying it would be fine if the forum was doctor only? Or are you suggesting we should always pretend everything is rainbows and sunshine’s?

No, but there are ways to say what the thread originator meant without being derogatory towards patients. True, maybe the person really hates smokers, but maybe they are concerned with their health. If it's the latter, then simply say, 'I have asthma and kids, I worry patients come to my clinic feeling ill. What can I do to keep myself and family safe?'

That reads very different.

 

[clausewitz2]

Big difference between processing emotions with a supervisor, doing your own self work and venting on a forum. Also, I hear trainees frequently use counter transference as an excuse for intolerance. Different things.

To your earlier post, many places have a dedicated bipolar clinic and it looks exactly as you describe.



No, but there are ways to say what the thread originator meant without being derogatory towards patients. True, maybe the person really hates smokers, but maybe they are concerned with their health. If it's the latter, then simply say, 'I have asthma and kids, I worry patients come to my clinic feeling ill. What can I do to keep myself and family safe?'

That reads very different.

I tend to agree with you re: thinking about how we say things and not mistaking intolerance for useful self-reflection, but sometimes you have to own up to frankly homicidal urges directed towards some patients. I'm with you on making sure we don't cross the line into actually saying things that suggest those feelings are 100% justified.

Sadly our adult bipolar folks are split up between our SMI, mood, and dual diagnosis clinics so no dice.

 

[jericurls]

I have a huge pet peeve, when you are sick, you need to be home and not going around to your Psychiatry appointments blowing your virus all over the place. Do any of these patients know that they can just re-schedule? I feel like doctors need to have some rights as well. Why should I subject myself to someone who is contagious when I don't have to? I have an infant at home that I need to take care of, and it is just infuriating to me when people bring their kids in for a routine med follow up appointment for Ritalin. I just want to scream and tell them to get the hell out of my office.

Oh and another thing, I have bad Asthma, and I absolutely can't stand the patients who reek of cigarette smoke or Cannabis. It's just insulting that I have to completely air out my office. I feel like I should be able to refuse to see these patients on accord of my own health needs.

It's not like it's life or death when they are coming in for their routine med management appointments.

This is sad and I suggest that you seek help for yourself first before you take on any more patients. Please do not externalize this as if it's anyone else's fault for your fear of contracting viral illness.

If you have such a fear, then why did you choose to become a doctor at the first place? Every profession is at risk of transmittable illnesses. Is it ethical for a surgeon to refuse to exam a patient post op for fear of feces? Is it ethical for a hospital neurologist to refuse to see patients with suspected meningitis? What about an ER doctor excluding any patient with possible Hep or HIV?

Your fear of contracting a respiratory viral illnesss seems so excessive that you would benefit from your own therapy in my opinion.

 

[aim-agm]

This is sad and I suggest that you seek help for yourself first before you take on any more patients. Please do not externalize this as if it's anyone else's fault for your fear of contracting viral illness.

If you have such a fear, then why did you choose to become a doctor at the first place? Every profession is at risk of transmittable illnesses. Is it ethical for a surgeon to refuse to exam a patient post op for fear of feces? Is it ethical for a hospital neurologist to refuse to see patients with suspected meningitis? What about an ER doctor excluding any patient with possible Hep or HIV?

Your fear of contracting a respiratory viral illnesss seems so excessive that you would benefit from your own therapy in my opinion.

They have an infant. They do not want to get the infant ill, nor for that matter become ill themselves. They are distressed by being in situations where they are put at risk of illness by others. They are expressing their distress and soliciting the opinions of their peers.

Nothing in the above is ethically questionable nor an indication of need for psychotherapy.

 

[Salpingo]

I have a huge pet peeve, when you are sick, you need to be home and not going around to your Psychiatry appointments blowing your virus all over the place. Do any of these patients know that they can just re-schedule? I feel like doctors need to have some rights as well. Why should I subject myself to someone who is contagious when I don't have to? I have an infant at home that I need to take care of, and it is just infuriating to me when people bring their kids in for a routine med follow up appointment for Ritalin. I just want to scream and tell them to get the hell out of my office.

Oh and another thing, I have bad Asthma, and I absolutely can't stand the patients who reek of cigarette smoke or Cannabis. It's just insulting that I have to completely air out my office. I feel like I should be able to refuse to see these patients on accord of my own health needs.

It's not like it's life or death when they are coming in for their routine med management appointments.

Not sure what you wanted to get out of this thread, but, yeah, if something bad happened to your patient, legally you could be held accountable for patient abandonment if your reason for not seeing them was smell or a URI. You may feel threatened, but I think most of us have had to deal with cases where the patient literally threatened our lives but we felt morally obliged to help, so thats probably where the standard of care lies.

If you're in a cash-based, private practice, you have more leeway to do things by phone. If you need to go through insurance, I'd check to see if your patients are covered and are able to do telepsychiatry (most states require insurance reimburse at the same rate as in-person), with clear guidelines when you expect them to use it. If you're in residency, your body doesn't belong to you for X number of years, so sorry, but it gets better (in seriousness, I'm hoping your program director would want to hear if you're feeling burnt out, but also know realistically about the demands of these clinics).

I think most of us are picking up on the deeper subtext, which is that you're disgusted by at least a few of your patients, feel they are inconsiderate and intruding on your space and your personal wellbeing. If you're asking if its OK to FEEL like screaming at your patients, sure (especially if you have an infant at home). If you're asking if its OK to ACTUALLY scream at your patient... I hope you're getting some sleep.

 

[bisell26]

For those people that are being critical of me, I have an infant child at home so I am extra paranoid. If my son gets sick, then that means I have to take sick time off to care for him. If I get sick enough to where I can't function, I have to call in sick. Who do you think is going to see the patient's that were scheduled to see me? . It means a resident will have to see them and that is frowned upon in my program. So that is why I am paranoid about getting sick.

Also, the truly urgent ones, I can understand. But if you have are contagious, you can call the front desk and re-schedule. There is no penalty to do so. We are forbidden from charging Medi-Cal patient's for no-shows and cancellations. Some of the med management appointments can be postponed.

 

[Salpingo]

Regarding malodorous patients, that is also just a job hazard. I had a patient with schizophrenia and alcohol use disorder a few months ago who defecated on the furniture in my office. Other patients would vacate the building before he arrived indoors because his hygiene was so poor. I actually wrote him a prescription to bathe and hospitalized him twice, but it made no difference because he would drink and was non-adherent to meds. Since it was summer I started seeing him on a shaded quiet bench outdoors. The social worker was mildly outraged and said I was harming his dignity. I said he was infringing on the right of others not to smell feces, vomit, tobacco, and body odor the rest of the day. He died a week later from complications related to alcohol dependence.

Sounds like a tough case - I think between the non-adherence and the defecation you had grounds for discharging from the clinic, but it sounds like you went beyond to do your best to help.

 

[bisell26]

For those of you with kids on here, when your child is sick with something that is potentially contagious, do you encourage him/her to go to school no matter what and infect other kids?

 

[birchswing]

For those people that are being critical of me, I have an infant child at home so I am extra paranoid. If my son gets sick, then that means I have to take sick time off to care for him. If I get sick enough to where I can't function, I have to call in sick. Who do you think is going to see the patient's that were scheduled to see me? . It means a resident will have to see them and that is frowned upon in my program. So that is why I am paranoid about getting sick.

Also, the truly urgent ones, I can understand. But if you have are contagious, you can call the front desk and re-schedule. There is no penalty to do so. We are forbidden from charging Medi-Cal patient's for no-shows and cancellations. Some of the med management appointments can be postponed.

I thought you said your son was at home. You said you'd have to take time off to care for him if he's sick. Who cares for him now?

 

[Salpingo]

For those of you with kids on here, when your child is sick with something that is potentially contagious, do you encourage him/her to go to school no matter what and infect other kids?

No, but I would probably encourage them to go to their doctor's appointment.

I think your original point is that you were upset that your patients were inconsiderate of you (and by extension, your family), the same way I would be annoyed at another parent for sending their contagious kid to school. What you're hearing here is that people don't view their doctor the same way they do school, for a number of reasons. You could certainly ask a patient to reschedule, but you're hearing thats not going to be well-received, by your patients, your peers, or your supervisors.

The challenge of psychiatry is that we deal with patients who are often very obnoxious. Actually, most people are obnoxious, but our patients are the ones who are coming to address their obnoxious problems, which includes possibly poor social skills, limited capacity to mentalize, executive dysfunction, low energy/mood, substance use etc. It sucks and hard to realize when you're exhausted, but consider that you only see them for a few minutes every month while they have to live with themselves every moment in between.

 

[Salpingo]

Was about to post literally this. The undertone of disdain is deafening. It says more to me when patients keep regular follow ups when ill than those who cancel or no show for nothing. You're first few years out of residency you'll probably catch everything, at least twice, anyway. Goes with the territory.

I definitely didn't realize while I was in the midst of residency how important those appointments were to some patients, and it wasn't until the end when we were saying goodbye that it became evident. It often seemed to come out of nowhere, the ones who seemed to have minimal insight, appearing totally indifferent or profoundly treatment refractory that I assumed they were coming more out of habit than interest (of course, they always came). Then at our last meeting they would open up -- some expressing pride, some sadness, a few openly upset and hostile (the inpatient units typically anticipated transition time as a potential uptick in admission). What could be another routine med check where we feel that we're just hitting a refill could be a huge part of a person's week, month or life.

 

[Old&InTheWay]

For those of you with kids on here, when your child is sick with something that is potentially contagious, do you encourage him/her to go to school no matter what and infect other kids?

If one of my kids has a cold, but isn’t feeling terrible, I send them to school (just as I would go to work). I keep them home if they have a fever or are vomiting. The fact is, when we are sick, we are often contagious before and after we have symptoms. Kids at school/day care get sick a lot no matter what you do to try to prevent it. And they’ll bring it home and get you sick. It can be really stressful, and I imagine even more so while in residency. But this part of parenting gets way better as they get a little older (first few winters in preschool can be rough). How old is your child?

 

[futuredo32]

Unless you have a job where you don't work with the public at all you take a chance of being exposed to illness. I understand that you have asthma and a child. I took care of my Grandma as a resident and med student and I was terrified I would bring home something that would make her sick or kill her. I also recall as a resident and med student it was expected that we went to our rotation regardless of how sick we personally were. I smoke myself and I use febreeze to mask the odor. If the odor truly offends you maybe private practice where you refused to see people who smoked anything? I have one patient who has finally taken his first shower in six years, seriously. I always schedule him as my last appointment and use a can of febreeze and spend an hour with the door to the outside open to air out my office after he comes.

And you are likely to come into contact with sick people at stores restaurants, etc.

I got REALLY sick during my first rotation, pediatrics, and since then my immune system is crazy strong.

But as physicians I think the patient comes first.

 

[futuredo32]

I definitely didn't realize while I was in the midst of residency how important those appointments were to some patients, and it wasn't until the end when we were saying goodbye that it became evident. It often seemed to come out of nowhere, the ones who seemed to have minimal insight, appearing totally indifferent or profoundly treatment refractory that I assumed they were coming more out of habit than interest (of course, they always came). Then at our last meeting they would open up -- some expressing pride, some sadness, a few openly upset and hostile (the inpatient units typically anticipated transition time as a potential uptick in admission). What could be another routine med check where we feel that we're just hitting a refill could be a huge part of a person's week, month or life.

THIS.

 

[Merely]

Hypothetical question: if you get to select your own patients couldn’t you simply do an intake on a patient then if you don’t like them for whatever reason (annoying,poor hygiene, etc) you could simply refer them to someone else and never see them again because you’re “not a good match”? This would avoid all the issues discussed in this thread for the most part I think

 

[erg923]

For those of you with kids on here, when your child is sick with something that is potentially contagious, do you encourage him/her to go to school no matter what and infect other kids?

Yes. Unless they have a fever. Its not realistic to think that you are going to effect the spread of the common cold in a school or work setting. It happens every year, and it will continue to happen no matter what you do.

My frank advice here would be to man up. No one likes to be sick, but if its just the sniffles, you'll live. I mean, presumably, you became a physician to treat sick people, so all this is a bit bizarre if you ask me.

 

[VA Hopeful Dr]

If one of my kids has a cold, but isn’t feeling terrible, I send them to school (just as I would go to work). I keep them home if they have a fever or are vomiting. The fact is, when we are sick, we are often contagious before and after we have symptoms. Kids at school/day care get sick a lot no matter what you do to try to prevent it. And they’ll bring it home and get you sick. It can be really stressful, and I imagine even more so while in residency. But this part of parenting gets way better as they get a little older (first few winters in preschool can be rough). How old is you child(ren)?

Yep. If you keep your kid home every time they get the sniffles, the truant officer is going to be paying you a visit come 1st grade.

 

[ridethecliche]

People literally go to the doctor when they're sick. Take the same precautions as one does in FM/IM/Peds and continue to live.

Folks working in ID, neuro, etc also have kids and continue to work and see patients through it all.

 

[erg923]

Yep. If you keep your kid home every time they get the sniffles, the truant officer is going to be paying you a visit come 1st grade.

 

[Ironspy]

My kids have the sniffles 2-4 months straight each winter. People are most contagious 1-2 days prior to viral symptoms. If there's no fever/vomiting they go to school. If I kept my kids home from school anytime they could potentially be contagious I'd be unemployed and they'd be illiterate.

 

[FrustratedFamDoc]

I definitely didn't realize while I was in the midst of residency how important those appointments were to some patients, and it wasn't until the end when we were saying goodbye that it became evident. It often seemed to come out of nowhere, the ones who seemed to have minimal insight, appearing totally indifferent or profoundly treatment refractory that I assumed they were coming more out of habit than interest (of course, they always came). Then at our last meeting they would open up -- some expressing pride, some sadness, a few openly upset and hostile (the inpatient units typically anticipated transition time as a potential uptick in admission). What could be another routine med check where we feel that we're just hitting a refill could be a huge part of a person's week, month or life.

I'm primary care so a little bit different, but share all of what you have said.

For many of our patients, we are literally, the ONLY positive and encouraging voice they may hear in their lives. Those that dwell in their circle are often hopeless, depressed and filled with despair. The cycle has a way of perpetuating. Their negative energy is contagious, but positive can be too. The office visit with us offers an escape where they can at least come up for air.

 

[Armadillos]

If your worried about it I would keep separate hand sanitizers in your office for both you and the patient. If someone seems sick you can wear a mask. However if a reasonable patient calls in and tells me they are feeling kind of sick and wondering if they can get refills to last until a rescheduled appointment I’m doing that 100% of the time.

 

[bisell26]

If your worried about it I would keep separate hand sanitizers in your office for both you and the patient. If someone seems sick you can wear a mask. However if a reasonable patient calls in and tells me they are feeling kind of sick and wondering if they can get refills to last until a rescheduled appointment I’m doing that 100% of the time.

I have no problem with a crisis patient coming in when they are sick.

What I have a problem with is the ones that have a fever, are sneezing and coughing up the wire, just for a refill of their Zoloft. We could have done that over the phone and I could have given you a refill without any problem.

 

[bisell26]

I thought you said your son was at home. You said you'd have to take time off to care for him if he's sick. Who cares for him now?

I have arranged childcare for him while I'm at work. But when he is sick, I obviously won't be able to send him there, thus, requiring me to stay home with him.

 

[birchswing]

I have no problem with a crisis patient coming in when they are sick.

What I have a problem with is the ones that have a fever, are sneezing and coughing up the wire, just for a refill of their Zoloft. We could have done that over the phone and I could have given you a refill without any problem.

As a patient, I must say that option sounds amazing. Do your patients know about it? You might have a run on patients pretending to be sick just for that option.

 

[birchswing]

I have arranged childcare for him while I'm at work. But when he is sick, I obviously won't be able to send him there, thus, requiring me to stay home with him.

Ahh, gotcha. I was assuming another parent or grandparent at home already.

I don't have children, but knowing people who do have children they seem to get sick quite often from being in a daycare environment. I'm not sure if everyone is as scrupulous as you at not sending sick children to daycare.

 

[bisell26]

We have masks by the door and ask patients who are ill to put one on. I don't shake their hand if they are apparently ill, and use hand sanitizer like crazy. If the patient is very ill we reschedule (i.e.; patient walks in and says "I was just diagnosed with the flu, heh heh" or "I've been told I have tuberculosis".) Hospital culture in general cares less about hospital staff than patients, so I always frame limiting contact with ill patients as a safety issue for other patients, not me.

As you know, these folks are contagious before they even show symptoms. So it is a job hazard.

Regarding malodorous patients, that is also just a job hazard. I had a patient with schizophrenia and alcohol use disorder a few months ago who defecated on the furniture in my office. Other patients would vacate the building before he arrived indoors because his hygiene was so poor. I actually wrote him a prescription to bathe and hospitalized him twice, but it made no difference because he would drink and was non-adherent to meds. Since it was summer I started seeing him on a shaded quiet bench outdoors. The social worker was mildly outraged and said I was harming his dignity. I said he was infringing on the right of others not to smell feces, vomit, tobacco, and body odor the rest of the day. He died a week later from complications related to alcohol dependence.

Don't even get me started on patients who come and sit all day in the waiting room drinking coffee, watching TV, and napping, only to tell me at their 3pm appointment they have a massive bed bug or lice infestation. I've had to have my office treated 3 times this year for bed bugs left behind by patients. I swear, one morning I unlocked my office door to find a large bed bug sitting across from my desk in the chair, legs crossed. He said "You're late. You think your time is more important than mine, eh doc? How was the golf?"

I guess I can ask my office staff to get masks for the patient's.

 

[bisell26]

Unless you have a job where you don't work with the public at all you take a chance of being exposed to illness. I understand that you have asthma and a child. I took care of my Grandma as a resident and med student and I was terrified I would bring home something that would make her sick or kill her. I also recall as a resident and med student it was expected that we went to our rotation regardless of how sick we personally were. I smoke myself and I use febreeze to mask the odor. If the odor truly offends you maybe private practice where you refused to see people who smoked anything? I have one patient who has finally taken his first shower in six years, seriously. I always schedule him as my last appointment and use a can of febreeze and spend an hour with the door to the outside open to air out my office after he comes.

And you are likely to come into contact with sick people at stores restaurants, etc.

I got REALLY sick during my first rotation, pediatrics, and since then my immune system is crazy strong.

But as physicians I think the patient comes first.

Not taking a shower for 6 years, are you exaggerating? Isn't that grave disability? How is this person able to function/live by themselves

 

[jericurls]

Being paranoid of getting your infant sick is not a good reason for refusing to see patients.

Especially from a psychodynamic framework in my opinion. Basically you are telling the patient "don't ever come see me unless you are well". The transference alone can ruin their progress.
To think that you are not allowed to see your doctor because you have a sniffle is BEYOND absurd.

Besides, we are not talking about highly contagious illnesses such as gastro. Common cold can be easily transmitted even by taking a subway ride if you don't practice good hand hyigene.

Why did you even post the thread? To gain sympathy for your unreaonsable fear? I know I might sound harsh but deep down you know you need to correct your unwarranted fear.

 

[futuredo32]

Not taking a shower for 6 years, are you exaggerating? Isn't that grave disability? How is this person able to function/live by themselves

Truth. I inherited him. He finally showered once but "didn't get all the layers off". He is on disability. He's married. The only time he leaves his home is every 3 months to see me. He is so physically deconditioned he is gasping for air after a few breaths. I have begged him to see a Pcp. He usually no shows 2 or 3 times before he comes and I charge full fee. He needs medical care more than psych. I can't force him to see a Pcp. I spend hours with him at every visit and this is actually the most progress he has made. Can't add an SGA because he won't get labs. Guessing the sick role is appealing.

 

[clausewitz2]

Truth. I inherited him. He finally showered once but "didn't get all the layers off". He is on disability. He's married. The only time he leaves his home is every 3 months to see me. He is so physically deconditioned he is gasping for air after a few breaths. I have begged him to see a Pcp. He usually no shows 2 or 3 times before he comes and I charge full fee. He needs medical care more than psych. I can't force him to see a Pcp. I spend hours with him at every visit and this is actually the most progress he has made. Can't add an SGA because he won't get labs. Guessing the sick role is appealing.

You realize giving him hours and hours at every visit is directly reinforcing that sick role, right?