Culture of medicine and time off

[samac]

I’m wondering if this is just something personally engrained in me or if others can relate.

I’m in my last year of psychiatry residency, recently had abdominal pain, vomiting and went to the ED. Had elevated LFTs, bili, lipase, WBC. Ended up with a 3 day hospital stay, ERCP with 2 stents placed and a cholecystectomy.

I’ve taken no FMLA or extended time off my entire residency and asked for 2 weeks to recoup which ended up being granted.
I’m 3 days out and feeling so incredibly guilty. I have the insight to realize I shouldn’t feel that way. I’m all outpatient so other than covering refills it’s not like I’m screwing someone else over.

This just lead me to wonder do others in medicine think they would feel similarly guilty and this is a suck it up and work cultural problem in medicine? Or am I just way too anal retentive and need to unwind sometimes?

What’s your thoughts? How do you think you’d feel?

---

Members don't see this ad.

 

[Crayola227]

Personally I do lay this at the feet of medical culture. It alone can do it. We can't rule it out. Maybe some of it is your work ethic. Either way I think you should cut yourself slack.

Especially having surgery. You're human. Despite being a doctor, you're allowed to be a patient too, sometimes .

 

[Crayola227]

When my parent died in med school I felt bad having 3 days off. And I can tell you right now outside of what I consider the shame culture of medicine, like if it was college or some other job, I wouldn't have felt bad taking that time off in the slightest. I think it can be very occupation dependent for some people.

Gosh, samac, I miss you guys and playing WW with yall. Too busy until my toddler goes to school I think.

I hope you recover well! Try to enjoy the time as much as you can.

 

[DrMetal]

too anal retentive and need to unwind sometimes?

This. We're way too anal and don't know how to unwind.

You had a serious medical issue (the vast majority of people with n/v/abd pain, don't get admitted for 3 days, +ERCP, +stents). So you should definitely take time off, and make sure you get good outpatient follow up (the more concerning question might be, why did a young person have such a significant biliary obstruction? That might require further outpatient workup). If a stone, get your gallbladder removed. I've seen young people get septic from refusing or not tending to this, thinking they were 'Ok' and good to go.

Then enjoy life next year as an attending Psychiatrist. You can make buku money, you guys have the golden ticket right now (and spend said money).

 

[Smurfette]

This. We're way too anal and don't know how to unwind.

You had a serious medical issue (the vast majority of people with n/v/abd pain, don't get admitted for 3 days, +ERCP, +stents). So you should definitely take time off, and make sure you get good outpatient follow up (the more concerning question might be, why did a young person have such a significant biliary obstruction? That might require further outpatient workup). If a stone, get your gallbladder removed. I've seen young people get septic from refusing or not tending to this, thinking they were 'Ok' and good to go.

Then enjoy life next year as an attending Psychiatrist. You can make buku money, you guys have the golden ticket right now (and spend said money).

It was gallstone pancreatitis based on the description and they said they had a cholecystectomy

But yeah, in medicine we are the first people to not follow our own advice and tend to return to work with minimal to no time off. I feel guilty taking time off or having to cancel patients. That being said, I also think the fact that most physicians I know (including myself) get no paid sick days nor productivity goal adjustments to compensate for time off doesn't help foster a "take off to take care of yourself" type of culture.

 

[DrMetal]

It was gallstone pancreatitis based on the description and they said they had a cholecystectomy

Reading comprehension has never been my strong suit. Equations make much more better sense to me than words.

 

[VA Hopeful Dr]

It was gallstone pancreatitis based on the description and they said they had a cholecystectomy

But yeah, in medicine we are the first people to not follow our own advice and tend to return to work with minimal to no time off. I feel guilty taking time off or having to cancel patients. That being said, I also think the fact that most physicians I know (including myself) get no paid sick days nor productivity goal adjustments to compensate for time off doesn't help foster a "take off to take care of yourself" type of culture.

I was that way until I had COVID. I ended up coming back too soon for how I felt and it was a mess. We're talking had to prop myself up on the walls between rooms from dizziness and slept through my entire lunch. After that, I stopped feeling guilty about sick days.

My wife took a day off after she tore her calf muscle as she couldn't walk without crutches. The next several days despite a very obvious limp, some of her patients made snotty remarks about having to reschedule their appointments. She doesn't feel bad about sick days anymore either.

Now we're not surgeons and I know historically y'all's culture has been even more "tough it out your patients need you" then medicine as a whole so I'm sure that doesn't help.

 

[shaggybill]

If I wouldn't feel bad about writing a patient out of work for it, then I don't feel bad about taking time off for it myself. This whole notion that doctors somehow qualify as superhuman or don't need the same kind of accommodations that we grant our patients is toxic. Probably stems from the days of "if you aren't working 100 hours a week every week in residency then you aren't getting trained properly."

 

[clausewitz2]

If I wouldn't feel bad about writing a patient out of work for it, then I don't feel bad about taking time off for it myself. This whole notion that doctors somehow qualify as superhuman or don't need the same kind of accommodations that we grant our patients is toxic. Probably stems from the days of "if you aren't working 100 hours a week every week in residency then you aren't getting trained properly."

This is one way to try to maintain the emotional distance that makes the job doable, even if it has really deleterious consequences. "The patients are the ones with diseases, not me. They are the ones who need treatment, not me. I am outside of that category, doesn't apply, nope nope, nothing to do with me personally."

 

[samac]

Personally I do lay this at the feet of medical culture. It alone can do it. We can't rule it out. Maybe some of it is your work ethic. Either way I think you should cut yourself slack.

Especially having surgery. You're human. Despite being a doctor, you're allowed to be a patient too, sometimes .

When my parent died in med school I felt bad having 3 days off. And I can tell you right now outside of what I consider the shame culture of medicine, like if it was college or some other job, I wouldn't have felt bad taking that time off in the slightest. I think it can be very occupation dependent for some people.

Gosh, samac, I miss you guys and playing WW with yall. Too busy until my toddler goes to school I think.

I hope you recover well! Try to enjoy the time as much as you can.

Oh cray that’s rough with your parent. It’s crazy the guilt we can feel.
We haven’t been playing much recently! I was sent forward in a new championship and had to drop out of the final game secondary to this. Also feel kind of bad about that, look forward to playing again in the future.

It was gallstone pancreatitis based on the description and they said they had a cholecystectomy

But yeah, in medicine we are the first people to not follow our own advice and tend to return to work with minimal to no time off. I feel guilty taking time off or having to cancel patients. That being said, I also think the fact that most physicians I know (including myself) get no paid sick days nor productivity goal adjustments to compensate for time off doesn't help foster a "take off to take care of yourself" type of culture.

I think the rescheduling patients is big for me, I’m pretty much scheduled out until late May at the end of residency here and I feel like I’m screwing some of them over, but ultimately I can’t give them great care right now anyway.

 

[operaman]

Yeah this one is tough for me. I’ll take planned time off no problem, but canceling something last minute is really tough. I’m booked solid for months with a list of unscheduled referrals more than 1600 people long. Taking a day off means 25+ patients now get rescheduled for some time 4-6 months from now, many of whom have already waited that long for an appointment. I know it’s hard on my staff who have to make all the calls and deal with all the angry people. So I tend to push through unless I’m so bad off it’s impossible to work.

 

[clausewitz2]

Yeah this one is tough for me. I’ll take planned time off no problem, but canceling something last minute is really tough. I’m booked solid for months with a list of unscheduled referrals more than 1600 people long. Taking a day off means 25+ patients now get rescheduled for some time 4-6 months from now, many of whom have already waited that long for an appointment. I know it’s hard on my staff who have to make all the calls and deal with all the angry people. So I tend to push through unless I’m so bad off it’s impossible to work.

The good news is as a psychiatrist when they become an attending OP, if they choose to, can pursue a practice setting where there is enough flex and unscheduled time to fit people in who need to be shifted a bit. They can also get away with a smaller panel than pretty much any other specialty. Then again, it is in precisely those settings where they will be least likely to have staff who can deal with it for them. I do not know how y'all do it, though, and I can only imagine it's even possible because you don't necessarily need to be, like, fully emotionally present in the same way to do perfectly good work the way we do.

 

[operaman]

The good news is as a psychiatrist when they become an attending OP, if they choose to, can pursue a practice setting where there is enough flex and unscheduled time to fit people in who need to be shifted a bit. They can also get away with a smaller panel than pretty much any other specialty. Then again, it is in precisely those settings where they will be least likely to have staff who can deal with it for them. I do not know how y'all do it, though, and I can only imagine it's even possible because you don't necessarily need to be, like, fully emotionally present in the same way to do perfectly good work the way we do.

Yeah I’m definitely not really emotionally present when working while sick. Thankfully I can still function fairly well and manage what comes in - so much is procedural and can be done on autopilot. I’ve also found that the more dire the situation, the easier the decision making gets. Patient codes? Start acls. Big obstructing airway tumor and can’t breathe? Trach. Stable patient with tumor in office? Biopsy.

Most of the situations that require high level thinking in my field can usually wait a little bit.

 

[smq123]

It is not just medical culture. It is corporate medical culture.

There is no leeway in the system - not enough clinicians, and too many patients to see. If I cancel a day of clinic, there is literally no where else to put those patients for another 2-3 months. Anything urgent will have to be shoved onto a colleague's schedule, and they probably don't have time in their schedule for these kind of add-ons. There's no breathing room and no grace for last minute adjustments.

 

[comp1]

This is in no way unique or particular to medicine. High achieving people are going to feel this in any occupation. It's honestly why they are high achieving. Don't expect to be able to switch occupations and have this change. However, it doesn't work long term for the individual and super long term for the organization. It's appropriate and even normal for residency given its structure, but beyond that, you'll want to look for jobs that have built in cushions to reduce the external pressure (internal is for you to work on in therapy). Reducing this external pressure is actually very challenging as a manager because you WILL sometimes have people at work, being paid, doing nothing. No job can be perfectly stretched out to cover various ups and downs in need. To the bean counters, this looks like horrific waste, but over time it's not. Over time, it's really the only way you prevent burn out. There's a nursing rule that you need to always overstaff by at least 20% to account for call outs, vacancies, vacations, etc. Physician managers could do well to also follow this.

 

[samac]

Yeah this one is tough for me. I’ll take planned time off no problem, but canceling something last minute is really tough. I’m booked solid for months with a list of unscheduled referrals more than 1600 people long. Taking a day off means 25+ patients now get rescheduled for some time 4-6 months from now, many of whom have already waited that long for an appointment. I know it’s hard on my staff who have to make all the calls and deal with all the angry people. So I tend to push through unless I’m so bad off it’s impossible to work.

Also nearing the end of my residency I’m at the transition of care point so a lot of people are having their last appointment with me without the conversation with sucks and I know the front desk is getting the brunt of that frustration.

The good news is as a psychiatrist when they become an attending OP, if they choose to, can pursue a practice setting where there is enough flex and unscheduled time to fit people in who need to be shifted a bit. They can also get away with a smaller panel than pretty much any other specialty. Then again, it is in precisely those settings where they will be least likely to have staff who can deal with it for them. I do not know how y'all do it, though, and I can only imagine it's even possible because you don't necessarily need to be, like, fully emotionally present in the same way to do perfectly good work the way we do.

I’m signed for an inpatient gig, which people will have to cover me when I’m off but at least it’s not trying to shuffle whole panels around.

 

[comp1]

Yeah, if this is an issue significant enough to you to post about it on SDN, I think choosing inpatient is a great choice and if you can find literal shift work, even better.

 

[anonperson]

I’m wondering if this is just something personally engrained in me or if others can relate.

I’m in my last year of psychiatry residency, recently had abdominal pain, vomiting and went to the ED. Had elevated LFTs, bili, lipase, WBC. Ended up with a 3 day hospital stay, ERCP with 2 stents placed and a cholecystectomy.

I’ve taken no FMLA or extended time off my entire residency and asked for 2 weeks to recoup which ended up being granted.
I’m 3 days out and feeling so incredibly guilty. I have the insight to realize I shouldn’t feel that way. I’m all outpatient so other than covering refills it’s not like I’m screwing someone else over.

This just lead me to wonder do others in medicine think they would feel similarly guilty and this is a suck it up and work cultural problem in medicine? Or am I just way too anal retentive and need to unwind sometimes?

What’s your thoughts? How do you think you’d feel?

You're anal retentive and need to unwind.

I'm an attending in practice. I operate and see patients. Similar to others, I have patients booked out for surgery several months and for clinic.

I hardly call out sick. If it's a URTI, then I just mask up and work. I don't mind and patients have been fine with it.

I've basically called out unexpectedly due to deaths in the family and when my dad had a CABG.

I don't feel guilty because I will always accommodate patients otherwise. Since I'm in a FQHC, not uncommon for patients to be a bit late due to transportation issues etc. Will see them regardless. Will usually take on difficult cases etc.

Some people really abuse the system and will call out if they have a hangnail. I strive to not be that type of person. Since I know I am not, I don't sweat it if I have to call out for these types of family issues.

 

[samac]

Yeah, if this is an issue significant enough to you to post about it on SDN, I think choosing inpatient is a great choice and if you can find literal shift work, even better.

Shift work in psychiatry is really rare but would be my dream tbh

 

[mistafab]

Shift work in psychiatry is really rare but would be my dream tbh

Does not have to be a dream. I’m doing ED/Consult day only shifts (no calls, no nights) after graduating.

 

[Stagg737]

We haven’t been playing much recently! I was sent forward in a new championship and had to drop out of the final game secondary to this. Also feel kind of bad about that, look forward to playing again in the future.

What?!? How dare you sully the SDN name! Jk, obviously, sorry it had to happen during the tournament and hope you're feeling better!

This just lead me to wonder do others in medicine think they would feel similarly guilty and this is a suck it up and work cultural problem in medicine? Or am I just way too anal retentive and need to unwind sometimes?

What’s your thoughts? How do you think you’d feel?

Imo, it's a bit of both. No doubt that the culture of medicine and society as a whole, especially medical training, instills some feelings that doctors need to do more and be more as examples of pillars for patients, society, etc. Imo, there's some truth to that but the extent to which it's conveyed and expected is not healthy and often unrealistic.

That being said, I also know you well enough that you're putting more guilt on yourself than you need to. You'd be feeling some of this with these patients regardless of whether you'd be able to see them one more time or not, it's just intensified more now that you won't see some of them again. That's okay to a certain extent, but give yourself some grace. You're moving on either way, it's the same plan for them just with a road-bump, don't let yourself get too hung up on guilt or feelings related to countertransference. Consider it a good learning exercise. Depending on the patient I may have felt somewhat similarly (thanks OCPD traits), but those feelings don't change the reality of the situation. Recognize that and do a little reframing, it can be quite helpful.

 

[fellow12321]

It’s looked down on but I did it a lot. During residency and even fellowship I’ve rigged the schedule to give myself as much time off as possible. I’m all for more hours if it leads to better learning and training but if you’re doing nothing with those extra hours you may as well just be chilling at home.