Getting sick and rotations

[pianola]

I woke up Saturday morning with a terrible cold and I haven't been able to shake it. Right now I'm doing research in a lab (this is my last week doing research at this lab) so I came in to work today (Monday). I'm not sure how long I'm going to end up staying, though.

Anyway, I was wondering: What are the guidelines about getting sick during rotations (which I haven't started yet)? Obviously I wouldn't want to make the patients sicker (esp immunocompromised ones), but I don't want to be a quitter. Also I would imagine that missing several days (to a week?) of a 2 week or 4 week rotation wouldn't do great things for your grades.

It may seem like common sense to stay home when you're sick, but right now I sort of feel like I'm in that gray area where *I* could work through it, but patients might not appreciate it...

Haha, in other words: "how sick is sick?"

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[Perrotfish]

I woke up Saturday morning with a terrible cold and I haven't been able to shake it. Right now I'm doing research in a lab (this is my last week doing research at this lab) so I came in to work today (Monday). I'm not sure how long I'm going to end up staying, though.

Anyway, I was wondering: What are the guidelines about getting sick during rotations (which I haven't started yet)? Obviously I wouldn't want to make the patients sicker (esp immunocompromised ones), but I don't want to be a quitter. Also I would imagine that missing several days (to a week?) of a 2 week or 4 week rotation wouldn't do great things for your grades.

It may seem like common sense to stay home when you're sick, but right now I sort of feel like I'm in that gray area where *I* could work through it, but patients might not appreciate it...

Haha, in other words: "how sick is sick?"

Depends on the rotation. If you're doing an elective in psych a bad cold probably means you will probably take a couple of sick days. On the other hand if you're on a core medicine or surgery rotation the basic rule of thumb is that, one way or another, you need to be in the hospital.

 

[cpants]

I woke up Saturday morning with a terrible cold and I haven't been able to shake it. Right now I'm doing research in a lab (this is my last week doing research at this lab) so I came in to work today (Monday). I'm not sure how long I'm going to end up staying, though.

Anyway, I was wondering: What are the guidelines about getting sick during rotations (which I haven't started yet)? Obviously I wouldn't want to make the patients sicker (esp immunocompromised ones), but I don't want to be a quitter. Also I would imagine that missing several days (to a week?) of a 2 week or 4 week rotation wouldn't do great things for your grades.

It may seem like common sense to stay home when you're sick, but right now I sort of feel like I'm in that gray area where *I* could work through it, but patients might not appreciate it...

Haha, in other words: "how sick is sick?"

The guidelines are school specific, and unfortunately most schools are not too liberal with sick time. They will tell you you shouldn't come in when sick, but their policies are set up so that there is significant disincentive to staying home. In general, any days off from rotations for any reason will require a documented excuse and need to be made up, likely on weekends or during vacation time. Some nicer schools have set it up so that students get 1-2 excused days during each rotation so that they can be sick or attend a funeral without penalty.

If you are in a gray area, you will probably be working. That's not the best thing for patients, students, or staff, but it's the reality. One strategy which is somewhat risky, but which I have used, is not to inform the course director if you need to be off. Call the resident or off-site attending directly. They generally don't care if you can't make it, and will encourage you to stay home if sick. You thereby avoid the makeup days and administrative hoops. Again, use at your own risk.

 

[psipsina]

At my school the official policy was 2 days off per rotation, more than that requires a doctors note and will have to be made up later. Some rotations were explicitly clear that you could not call out "don't call out sick unless you need to be hospitalized, in which case come in anyways". Sometimes its more about sensing the culture of the program. If all your residents are sick too and showing up every day they aren't going to take too kindly to you taking a few days off for the same thing. I definitely worked sick during third year. Let me tell you snot accumulating in your OR mask is just plain nasty but all my snifflin didn't get me out of my 15 hour days. A few times I asked to leave early to go get a script I needed which seemed well received as long as I pulled my weight in the AM and was clearly so ill that some medication was indicated. The only days off I got were 1) getting the swine flu + superimposed pneumonia (that bought me three whole days!) and 2) an enterovirus where apparently I looked so rough the ob-gyns sent me home when they saw me in the am writing my patient notes.

 

[Jolie South]

At my school the official policy was 2 days off per rotation, more than that requires a doctors note and will have to be made up later. Some rotations were explicitly clear that you could not call out "don't call out sick unless you need to be hospitalized, in which case come in anyways". Sometimes its more about sensing the culture of the program. If all your residents are sick too and showing up every day they aren't going to take too kindly to you taking a few days off for the same thing. I definitely worked sick during third year. Let me tell you snot accumulating in your OR mask is just plain nasty but all my snifflin didn't get me out of my 15 hour days. A few times I asked to leave early to go get a script I needed which seemed well received as long as I pulled my weight in the AM and was clearly so ill that some medication was indicated. The only days off I got were 1) getting the swine flu + superimposed pneumonia (that bought me three whole days!) and 2) an enterovirus where apparently I looked so rough the ob-gyns sent me home when they saw me in the am writing my patient notes.

I think it varies from rotation to rotation. You're allowed 2 days of excused absences per month at my institution. You're technically supposed to talk with the clerkship coordinator and get an ok from your team. I usually just work it out with my team. This might bite me in the ass one day, but it's been ok so far.

If it's a crippling illness (i.e. dysentery, food poisoning, or the like), a call to a chief/attending very early in the morning might be acceptable. I don't think a cold is a reason to not show up and do your AM work. Get there and hope they take pity on you and let you leave.

 

[Depakote]

Get there and hope they take pity on you and let you leave.

That pretty much sums up being sick during your clinical rotations.

 

[ShyRem]

We were flat out told "Don't get sick. EVER." The policy on time off was "you don't get any." That being said, I showed up to a rotation, my attending took one look at me and told me to go home and not come back for 4 days on family med. I was pretty darn sick. I honestly don't remember 3 of those 4 days. Those were the only days off I took.

Some of my classmates just wouldn't show up, would show up late, or go home early. I still can't believe they passed. I was working harder on peds than one of my housemates on surgery and int med. My clinical grades showed it; he still ended up top four in class based solely on written exam grades.

 

[engineeredout]

Have to say I was wondering about this too. I managed to catch the flu in the middle of july and was wondering if I was on rotations how I would go about things. Not that I wouldn't want to show up and do the job, but if you really shouldn't be there for the patient's sake.

 

[psipsina]

Have to say I was wondering about this too. I managed to catch the flu in the middle of july and was wondering if I was on rotations how I would go about things. Not that I wouldn't want to show up and do the job, but if you really shouldn't be there for the patient's sake.

You should wash constantly and wear a mask when in contact with patients. Theoretically you can prevent the spread of respiratory droplets with some vigilance. The problem of course is when you're uber sick and working an 80 hour week you ain't so vigilant. You are however expected to show up in most cases and let the residents/attending decide to take pity on you and send you home if they so choose. Many of them won't.

 

[shantster]

I've been quite worried about this with my Peds rotation being in February and hearing from people that the worst they've ever gotten sick was on their Peds rotations in med school. It's particularly a concern to me because I was diagnosed with Lupus almost 2 months ago and have been on lovely immunosuppressive drugs so I'm very likely to get sick. In this situation, should I alert my resident at the beginning of the rotation so he/she understands that me getting sick is likely and a bit more serious because it might not be a normal infection? I'm planning on masking up on anyone that has a cough and sterilizing the stethoscope constantly, but I have a feeling that I'm still going to get sick.

 

[mumd2011]

I know at my school that you only have a certain amount of allotted absences per rotation and then cumulative for the year. That being said, the only rotation where I found that people just will not accept that you are sick is surgery. For the most part, the other rotations were pretty understanding. I did avoid notifying the clerkship director if at all possible. I found it much easier (and, less likely I would have to make it up) if I discussed it with my senior resident (this will likely not work for surgery). For instance, I worked with a private pediatrics physician for 2 weeks during my pediatrics rotation-I think I got just about every GI bug that went around during that time. I just made sure to call as soon as I could (either night before or before clinic started that day) to let them know, he was very cool about it as most of them understand that this is our first exposure to a lot of viral/bacterial infections and can't help being sick.

Now, I know at my school the rules if you get the flu/swine flu are different. We are required to be out for a certain number of days (that we can't be penalized for) if we have documented flu. This is probably because of the risk to the patients.

Use your head. It is not beneficial for you to be there if you are running to the bathroom every 5 minutes, have a high fever, etc. because you aren't a productive member of the team.