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Keith Loria is a contributing writer to Medical Economics.
Why do doctors feel they need to stay on the job when ill?
A new study by the U.S. Centers for Disease Control and Prevention reveals four in 10 healthcare professionals report to work while experiencing influenza-like symptoms, and many physicians work when having a cold, fever or other ailment.
A common rationalization for this behavior is that they are simply too busy to take a day off.
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“Unfortunately, it is not uncommon for physicians to go overboard and forget to care about themselves,” says Matthew Mintz, MD, an internist in Bethesda, Maryland, who notes the Hippocratic Oath has a lot to do with it. “In addition, some of the traditions of medical training, such as long work hours and the value of independence, reinforce that the patient always comes first, no matter the cost.”
This philosophy is often instilled in doctors early on. Tom Davis, MD, FAAFP, a family physician and founder of Tom Davis Consulting, St. Louis, Missouri, says the culture during training is one of ignoring one’s own health, even if it puts patients at risk.
“The pace and expectations of medical practice while in training (especially when expected work is not performed) clearly communicates that productivity trumps all,” he says. “This attitude carries over once the young clinician enters practice, especially those with heavy educational debt. Although employed clinicians are often allowed sick days, in reality there are significant financial penalties associated with missing work when ill-as well as pressure from administrators for not being a team player.”
Missing too much work can result in a physician being placed under a dreaded Performance Improvement Plan-a black mark that will follow the doctor if they wish to add or change licenses.
However, Davis notes, clinicians practicing in flat capitated systems, such as direct patient care, are far less likely to practice while ill.
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“Missing a day has virtually no financial consequences and cancelling a face-to-face appointment due to clinician illness is actually a practice builder through credibility development and patient bonding,” he says. “In private practice, given the personal financial risk involved, decisions not to work when ill can be more reasoned, but the same financial pressure applies. After sacrificing years for training and then carrying heavy debt, the financial pressure to catch-up is always there, no matter the age.”
Some doctors see working when sick as a sense of obligation to the patient.
Ashlie Olp, MD, a family physician at Olp Family Medicine in Carmel, Indiana, can’t remember the last time she skipped work due to being ill, and even once after major surgery, went back to see patients earlier than expected.
“My guess is that it’s standard across the board [with doctors], whether that’s right or wrong, we show up regardless,” she says. “Whether it was in residency or in practice, you as a doctor have this innate obligation to help people who are also sick. So, missing a day is not what you do. Your patients are sick and you need to just go into work.”
Of course, Olp says that doctors need to consider the level of sickness when making a decision to show up to work. If it’s a stuffy nose and coughing, that’s fine, but someone with nausea or is shaking from the chills should really stay home, she says.
“Who knows if I’d feel this way if I had another job or was in another profession,” she says.
While it is good that physicians take their profession seriously, Mintz says it can also be harmful when physicians continue to work when they really shouldn’t. But most feel they know before it gets to that point.
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“Physicians have enough knowledge to know what may be causing a particular ailment, even though they probably don't use the best judgement when it comes to themselves,” he says. “Reasoning for this often includes the thought that their immune system-having been exposed to so many viruses-is stronger than most, and they should be able to ‘stick it out.’”
Fortunately, medical educators are recognizing that this type of behavior is problematic and are now introducing topics such as burnout, physician impairment and self-care in their curricula.”
Some ideas for doctors faced with needing to stay home when sick are to make arrangements with a retired doc who could cover for them or coming in on a weekend to make up for lost time.
Olp says that being a physician under the Direct Primary Care model also solves this problem, in that she can utilize telemedicine when ill, seeing patients via a computer from her home if necessary.
“Still, I can only do some of my work remotely, not all of it,” she says. “My advice [for physicians] is to take your meds and go to work, if you can.”