Sick during clinicals?

[J ROD]

While you are rotating through clinicals, what happens if you get sick and can't come in? Is it a big deal? Just curious as to what the drill is because everyone gets sick. Thanks for the insight to those that reply.

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[Koko]

The response you get is highly dependent on the people you're working with. At the hospitals I rotated at, you could miss due to illness, but it was frowned upon and some residents and attendings could make your life unpleasant as a consequence.

Try to stay healthy. 😉

 

[funkless]

Take this for what it's worth (I start M3 in a month and am basing this solely on word of mouth), but I hear that sick days are rarely a problem, but only if:

1. You're contagious; i.e., are a significant risk to your patients
2. You *ask* your attending and your chief resident
3. You've arranged for coverage prior to asking for leave

I imagine that it depends largely on the service and on the illness itself. I.e., if you contract some transmissible alien death flu the day before you begin your NICU rotation, you'll likely be asked to stay far away (preferably across state lines). But if you're doing outpatient peds and you have gastroenteritis, you'll probably be expected to show up, since apparently Peds = diarrhea; just be sure to wash your hands. (Inpatient peds is another story.)

Maybe someone with actual clinical experience can affirm/refute this...

 

[kaos]

Well obviously if you have something like pinkeye or c diff diarrhea or ebola, you'll won't be allowed to come in to the hospital. 🙄 😛

 

[PLK7905]

Take this for what it's worth (I start M3 in a month and am basing this solely on word of mouth), but I hear that sick days are rarely a problem, but only if:

1. You're contagious; i.e., are a significant risk to your patients
2. You *ask* your attending and your chief resident
3. You've arranged for coverage prior to asking for leave

I imagine that it depends largely on the service and on the illness itself. I.e., if you contract some transmissible alien death flu the day before you begin your NICU rotation, you'll likely be asked to stay far away (preferably across state lines). But if you're doing outpatient peds and you have gastroenteritis, you'll probably be expected to show up, since apparently Peds = diarrhea; just be sure to wash your hands. (Inpatient peds is another story.)

Maybe someone with actual clinical experience can affirm/refute this...

I agree with all of this, except why in the world would a med student need to arrange for coverage?

As a med student, (except for MAYBE on your sub I), you are really not very important for patient care, so it's not really going to inconvenience anyone if you are not there. That doesn't mean that people will be happy about you taking a sick day though. It really just depends on who you are working with. I would say that, in general, if you are really feeling too sick to work, call your cheif or attending. If you are sick, but can still work (which is usually the case with most illnesses), wear a mask if its respiratory and wash your hands alot, and suck it up. Of course, if you are working with immunosuppressed patients (esp if they are neutropenic), don't go near them if you aren't feeling well.

Edit to add: Yes, if you are highly contagious, don't come in!

 

[njbmd]

While you are rotating through clinicals, what happens if you get sick and can't come in? Is it a big deal? Just curious as to what the drill is because everyone gets sick. Thanks for the insight to those that reply.

Hi there,
If you are sick, call your resident and do not come in. You risk infecting the rest of the team and your patients. My criterion for staying home is fever. If you have a fever above 100.4F then stay home otherwise, I expect you to come in.

To avoid getting the "kiddie crud": Wash your hands and put a gown/gloves on before picking up the little people. Use gloves if you change a diaper or wipe a runny nose. During RSV season, wear a mask in addition to wearing gloves/gown.

For big people: Wash your hands between patients and clean the head of your stethoscope with anti-germicidal cleaner (Clorox wipes or Lysol wipes) not an alcohol wipe.

Do not remove a dressing or change a bandage without gloves. Wash your hands before and after touching any part of any patient.

Use gloves to draw blood, pick up tubes of blood, or pick up anything that belongs to any patient. Wash your hands after you remove the gloves.

Do not touch your face while you are in the hospital unless you wash your hands before and wash your hands after.

Cover scrubs with a clean labcoat when you leave the OR and wash your labcoat/jacket twice weekly.

If you follow the above, you can stay healthier.

njbmd 🙂

 

[CANES2006]

If you just have the common flu bug, my advice is to suck it up. Residents and attendings will look down upon you if you stay home because of that.

 

[jojo14]

If you are constantly vomiting, I think that would be criteria to stay home too.
I think I had a flu bug/food poisoning this past Jan when I was doing ob and I "couldn't suck it up," if you will. I was throwing up every hour for awhile and couldn't walk without feeling really weak. I just contacted the site director and it was no big deal. I felt horrible the next day but at least I wasn't projectile vomiting anymore.

 

[loveumms]

You can call in sick, especially during third year if you truly are sick. Use common sense and remember you are there for your patients (along with education). Many of the patients already have weakened immune systems and don't need some med student giving them another bug/virus.

If you only have the sniffles then you need to go in and be aware of who you have contact with. Personally I have worked with residents who think a fever is not grounds for staying home, saying "take a Tylenol and get your butt in here" .. luckily I never got sick on that rotation but if I did I would have called out b/c its more important to me that I don't get my patients sicker then getting a good eval from the resident. Furthermore, I am not any good to anyone (patients or the team) if I am really sick since my work would be sub par and I would probably end up sicker. But, that is just me.

 

[Hurricane]

I missed one day as a third year because my hubby gave me a box of sugar-free chocolates for valentines day and I ate the whole thing in one sitting. Apparently they sweeten those things with mannitol which acts as an osmotic laxative, and the next morning I was so dehydrated that I passed out cold when I got up to brush my teeth. So I called in sick and they were fine with it. I left out the part about the chocolates though

I think as long as it doesn't become a regular thing, people understand. When I was on IM, my intern was always sick with some head cold type thing, and the other residents really grumbled about it. During my month rotation, she missed 2 calls, and the residents who had to take her sick call were hopping mad.

And I second the advice given above. If you remember nothing else, remember these two things: 1) Wash your hands a lot. Like you have OCD. 2) Never touch your face. That will go a long way towards keeping you healthy.

 

[lynx]

How about coldsores?

 

[Samoa]

It pisses me off when my classmates come in sick. I think it's unprofessional to care more about your image than you care about your patients' and colleagues' health.

But I realize I'm probably in a small minority on this.

If you're truly not replaceable even for a day, then alright, come in, and do what you can to protect the rest of us from your germs. But from what I've seen so far, there's NOBODY whose work can't be covered for a day or two.

 

[fab4fan]

It pisses me off when my classmates come in sick. I think it's unprofessional to care more about your image than you care about your patients' and colleagues' health.

But I realize I'm probably in a small minority on this.

If you're truly not replaceable even for a day, then alright, come in, and do what you can to protect the rest of us from your germs. But from what I've seen so far, there's NOBODY whose work can't be covered for a day or two.

So true. This whole idea of "suck it up/come in on your death bed" does wonders for nosocomial infection rates and spreading bugs among hospital staff. Not to mention that if you truly are ill, you're not going to be working up to par. No one is going to give you a medal for coming in sick, and if you wind up making an error that harms a pt., no one will say, "Well, that's OK...you were sick."

 

[21JumpStreet]

I agree with the last two responses. Coming in sick is just spreading germs. If you feel really sick you are not productive to anyone including oneself.

Someone at our med school just goes early to her doctor and gets a letter of excuse. The personal physician than states that if they have a problem with this they may call him. And that he is not releasing this person on to the wards or clinical site until better.

 

[pillowhead]

It really depends on the rotation. I was pretty sick on my first rotation of the year--Surgery--and come hell or high water, I had to be there at 5:00am 6 mornings a week and stay till the end. Unless you had a very high fever or were literally vomitting or having diarrhea on the hour every hour, there was no way you could take a day off.

I've been sick on my Psych rotation. I went in, opened my mouth and out came my raspy voice and everyone was like "Go home. Leave. Why are you here?" I just took the one day off and slept all day which was very much appreciated. Honestly, if you feel like total crap, you're not helping anyone by showing up. You'll just spread it to the rest of the team and the patients. But if a resident or attending insists you show up, what are you going to do? Argue with them?

 

[Samoa]

And see, surgery is the rotation where you most need to stay home if your sick. Unless you're wearing a TB respirator in the OR, operating on a patient when you're sick, or even scrubbing in, is just asking for a wound infection. I've seen it happen.

 

[RuralMedicine]

To avoid getting the "kiddie crud": Wash your hands and put a gown/gloves on before picking up the little people. Use gloves if you change a diaper or wipe a runny nose. During RSV season, wear a mask in addition to wearing gloves/gown.

For big people: Wash your hands between patients and clean the head of your stethoscope with anti-germicidal cleaner (Clorox wipes or Lysol wipes) not an alcohol wipe.
njbmd 🙂

Actually RSV only requires barrier/contact isolation. However, that mask can be helpful for Influenza, Adenovirus, and Parainfluenzae of course. Handwashing is always good 😉

 

[21JumpStreet]

It really depends on the rotation. I was pretty sick on my first rotation of the year--Surgery--and come hell or high water, I had to be there at 5:00am 6 mornings a week and stay till the end. Unless you had a very high fever or were literally vomitting or having diarrhea on the hour every hour, there was no way you could take a day off.

I've been sick on my Psych rotation. I went in, opened my mouth and out came my raspy voice and everyone was like "Go home. Leave. Why are you here?" I just took the one day off and slept all day which was very much appreciated. Honestly, if you feel like total crap, you're not helping anyone by showing up. You'll just spread it to the rest of the team and the patients. But if a resident or attending insists you show up, what are you going to do? Argue with them?

Refer them nicely to your personal physician. It worked for this lady. The personal physician's attitude was "you are my patient first" before a med student.

 

[Adcadet]

On surgery I developed hematuria one morning and was cleared to see my doc in the afternoon, and was diagnosed with a kidney stone. The next day I was in pain requiring oral narcotics and my chief resident told me to stay home. The next day my attendings were cool about letting me know I could leave if I needed to. So much for all surgeons being jerks. 🙂

 

[sophiejane]

Medical students thinking they are not replaceable is hilarious. What, is the hospital going to fall apart if you aren't there to be the 3rd person in a row to examine Mrs. Jones today?

Come on. If you are truly sick, stay home and get well or risk infecting others or missing even more of of your rotation. Bring a doctor's note when you return and no one can argue with you.

 

[xaelia]

Hmm...maybe I don't go to one of those "cutthroat" medical schools, so I'm sure my experience could be different, but I've missed a day of outpatient pediatrics and a day of psychiatry due to misc. head colds that kept me awake all night to the point where it was like 5AM, I hadn't slept yet, and I was half-snowed from Nyquil. No big deal.

A couple caveats:
1. If you're on an inpatient medicine or surgery month, and your classmates have to pick up the slack, you owe 'em when you get back or they'll just be pissed at you. Especially if you miss more than one day on a rotation like that.
2. Your residents and attendings are going to be pretty minimally impacted by your absence. Medical students, particularly 3rd year, rarely can do enough, capably enough, such that itt doesn't require oversight and you're really missed. Sure, maybe if you're gunning for honors and you get sick a couple times, you might be jeopardizing your capability of getting top clinical evaluations, but you're not going to fail unless you don't report yourself as out due to illness to your clerkship coordinator.
3. You, the student, are paying for medical school. You are paying for the opportunity to educate yourself and train yourself so that you can pass the licensing exams and become a competent doctor. If you're not going to learn anything from a day where you're so zombified that you can't do any good, or you're contagious enough you could bring down your team or infect your patients, just do the smart thing and stay home. Sleep, eat, watch TV, read over some notes, go to the health center and get antibiotics, etc. Don't worry about it. Medical school isn't meant to weed out the weak by Draconian adherence to some kind of attendance quota.

 

[funkless]

On surgery I developed hematuria one morning and was cleared to see my doc in the afternoon, and was diagnosed with a kidney stone. The next day I was in pain requiring oral narcotics and my chief resident told me to stay home. The next day my attendings were cool about letting me know I could leave if I needed to. So much for all surgeons being jerks. 🙂

Renal colic will bring out the 'sympathy pains' in even the coldest of hearts. Ouch.

 

[cavaor]

I dont know if this is typical for most places, but where I'm at...we have been specifically told that unless we are in the hospital we are expected to show to our clinical obligations. Its completely ridiculous given the fact you certainly dont give a good impression to patients when you are sick much less have the potential to innoculate your patients. If we are unable to show, then we are expected to work with fellow rotation students to switch schedules/get someone to cover our responsibilities.

 

[THP]

I'm starting 3rd year soon and this sort of concerns me. I never used to get sick but ever since my daughter started going to day care it seems like I get sick at least once a month.

 

[oudoc08]

3. You, the student, are paying for medical school. You are paying for the opportunity to educate yourself and train yourself so that you can pass the licensing exams and become a competent doctor. If you're not going to learn anything from a day where you're so zombified that you can't do any good, or you're contagious enough you could bring down your team or infect your patients, just do the smart thing and stay home. Sleep, eat, watch TV, read over some notes, go to the health center and get antibiotics, etc. Don't worry about it. Medical school isn't meant to weed out the weak by Draconian adherence to some kind of attendance quota.

My thoughts exactly. I'm not quite to 3rd yr yet, but my view is that medical school is not a job. You are paying for the opportunity to learn, they are not paying you to be there. Get over the fear of your superiors, and look at the big picture. Yes you have to play the game, but have some self-respect. Your health and the safety of your patients outweighs some prick surgeon's demands of self-righteous "I did it, so you have to".

 

[automaton]

don't get sick

 

[DOtobe]

The upside is, once you start your rotations, your immune system turns into an immune system of steel. Mine did, and I only missed one day during my two years on rotations (due to a gastro that knocked me down for a day). So missing rotations becomes less of an issue once you are in the hospital more often and exposed to more and more germs.

But if you are sick, do not go to the hospital! Pts are sick already, we don't want to expose them to more infections. The hospital won't come crashing down if you miss a day.

 

[LanceArmstrong]

While you are rotating through clinicals, what happens if you get sick and can't come in? Is it a big deal? Just curious as to what the drill is because everyone gets sick. Thanks for the insight to those that reply.

You know what they do to sick horses on the farm... it's called "putting them down" 😱

 

[Samoa]

You know what they do to sick horses on the farm... it's called "putting them down" 😱

That being one of the crucial distinctions between animals and humans...

 

[Pinki]

I had menigitis 3 weeks ago while on IM inpatient rotation - I woke up at 3 am with classic nuchal rigidity, nauseating HA, photophobia, fever. I schlepped myself to the ED (at a different hospital, mind you!) and once I got the LP back that showed high lymphocytes, I paged my resident and attending from the ED letting them know I was being admitted.

I was hospitalized for 2 days, and out another 3 days with a post LP HA. I also called my dean of students and asked him to relay the message to the academic department chair, the point being, I wanted to make sure I had as many allies as possible (and I got flowers from my dean, to boot!)

EVERYONE at the hospital and my school were totally, completely and absolutely cool with my absence and believe me, being gone made no difference in my grade (got an honors eval). The academic chair of the hospital where I was rotating is an ID specialist, and he couldn't believe I was back taking call in less than a week - but I did take it easy on my return for a few days, asking my attending if I could sit down during bedside rounds, etc.

If you're sick, you're sick. Personally, I wouldn't call in unless I had a troublesome GI bug (as in, running to the john every 10 minutes) or unless I was hospitalized - as the case was.

 

[gunit07]

If you are constantly vomiting, I think that would be criteria to stay home too.
.

on peds, i actually vomitted once during morning report and once during rounds. needless to say, i had to go home. (especially since one of my patients was totally immunocompromised.)
my evaluation from my intern: "Student left early once because of illness. Other students noticed the absence and thought it unfair to them."
and she checked yes for the box for "does this student's conduct need further review?"
(keep in mind that the attendings and senior resident wrote great evals.)

maybe i should have just puked on her?

and i love how the other students thought it was unfair to them... did they want to be sick too??? it's not like they had to go see my patients or write my notes for me. jerks!

but that was peds.

i actually called in sick once on gen med and they were soooo nice about it 🙂 and actually cared the next day when i came in - not about the missed time, but about my health. best team ever🙂

it totally does depend on your team. on neuro, the sub-i had to leave a couple hours early one day to go pick up his girlfriend from the airport, and he still got honors🙂

 

[carrigallen]

And see, surgery is the rotation where you most need to stay home if your sick.

Yep. Nothing like snot continously running out your nose, tickling your nasal philtrum and then pooling behind your mask while scrubbed in as the retractor during a 5-hr Whipple. 😳

 

[xaelia]

There's a girl at my school who has been taking coumadin for a few months, and she periodically uses it to take off early from clinic, short call, etc. She calls it "pulling the coumadin card." Crappy. I was on a 1-month psych rotation with her, and she missed like 3 days for various personal reasons.

Some people, I'm not sure if they're cut out for it....

 

[Adcadet]

There's a girl at my school who has been taking coumadin for a few months, and she periodically uses it to take off early from clinic, short call, etc. She calls it "pulling the coumadin card." Crappy. I was on a 1-month psych rotation with her, and she missed like 3 days for various personal reasons.

Some people, I'm not sure if they're cut out for it....

Wow, that almost sounds like academic dishonesty to me.

 

[SurgeryChef]

on peds, i actually vomitted once during morning report and once during rounds. needless to say, i had to go home. (especially since one of my patients was totally immunocompromised.)
my evaluation from my intern: "Student left early once because of illness. Other students noticed the absence and thought it unfair to them."
and she checked yes for the box for "does this student's conduct need further review?"
(keep in mind that the attendings and senior resident wrote great evals.)

maybe i should have just puked on her?

and i love how the other students thought it was unfair to them... did they want to be sick too??? it's not like they had to go see my patients or write my notes for me. jerks!

but that was peds.

i actually called in sick once on gen med and they were soooo nice about it 🙂 and actually cared the next day when i came in - not about the missed time, but about my health. best team ever🙂

it totally does depend on your team. on neuro, the sub-i had to leave a couple hours early one day to go pick up his girlfriend from the airport, and he still got honors🙂

I have to say this is the most ridiculous thing i've heard all week. Your intern is psycho.

That's all.

 

[Hurricane]

Yeah, that intern is ridiculous.

Our AI director is ridiculous too: We're all required to do two medicine AIs, and the woman in charge is a real nazi about missing time. Partly because she thinks the internal medicine AI is the most important component of your entire medical education, and partly because the hospital actually requires the AIs to function. (At least that's what she says whenever there is a proposal to cut the requirement down from two AIs to one.)

Anyway, last year this girl was pregnant and had a couple episodes of orthostatic hypotension/passing out, after which her senior resident sent her home. The AI director found out about it, tracked the student down, and told her she needed to "deal with it" or she would fail the rotation.

 

[beary]

There's a girl at my school who has been taking coumadin for a few months, and she periodically uses it to take off early from clinic, short call, etc. She calls it "pulling the coumadin card." Crappy. I was on a 1-month psych rotation with her, and she missed like 3 days for various personal reasons.

Why on earth would anybody need to miss work for taking coumadin? I used to take coumadin and it didn't make me sick or anything. Maybe if you were like bleeding out and had to go to the ER or something. 🙄

 

[loveumms]

Why on earth would anybody need to miss work for taking coumadin? I used to take coumadin and it didn't make me sick or anything. Maybe if you were like bleeding out and had to go to the ER or something. 🙄

Only thing I could think of is maybe to get her blood drawn - still pretty lame excuse!

 

[xaelia]

She'd say she didn't have her pills with her, and that she needed to go home and take her scheduled dose.

...

She did fail Step 1 the first time she took it. She's not an All-Star to begin with.

 

[beary]

I threw up twice on rounds this morning and my resident MADE me go home. She said she didn't want to get it, or have the rest of the team get sick. Which I totally agree with.

 

[njbmd]

There's a girl at my school who has been taking coumadin for a few months, and she periodically uses it to take off early from clinic, short call, etc. She calls it "pulling the coumadin card." Crappy. I was on a 1-month psych rotation with her, and she missed like 3 days for various personal reasons.

Some people, I'm not sure if they're cut out for it....

Hi there,
Whatever someone else in your class does to miss time is THEIR loss. She like you, is paying for this instruction and it's her loss. There are always going to be people who "play" this and "play" that but your education is in your hands. She had three days less of instruction than you did. Consider yourself fortunate that you are not in her shoes and keep moving forward. It's your medical education and you have one chance to get everything you can. When you are out there in residency or practice, what one another student did or did not do, will not matter. It's all about how good YOU are.

njbmd 🙂

 

[mfleur]

I'm on ER right now and had to call in because I got sick and completely lost my voice. I'm pretty sure that I am going tomorrow but don't really know how I am going to see patients with no voice.

 

[Adcadet]

Me and my kidney stone are pulling 8-hour shifts in the ED. Sucks that I have to rely on ibuprophen + acetominophen (vs. Percocet) while on, but at least the work keeps my mind off of it as much as possible, and I hate getting grogy. And if it gets really bad I'll just check myself in as I'm working in my HMO's hospital.