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September 14th, 2010
04:10 PM ET

Medical residents sick on the job?

Many medical residents work while they are sick, according to survey results published in the Journal of the American Medical Association.

This phenomenon is called presenteeism, and it means that workers may be spreading illnesses to colleagues and clients (or, in this case patients) because they don't take time off when they should. For medical residents, poor health may also lead to declines in performance that affect patients and fellow health professionals, the authors wrote. They are Dr. Anupam Jena, Dr. DeWitt Baldwin Jr., Steven Daugherty, Dr. David Meltzer, and Dr. Vineet Arora.

Researchers surveyed 744 residents in a variety of specialties at 35 programs in 12 hospitals. Participants answered questions about their health and work habits during the 2008 to 2009 academic year.

The study authors found that about 58 percent of participants said they worked while sick at least once and 31 percent said they showed up for the job sick more than once that year. Residents were more likely to have worked while sick if they were in their second postgraduate year than in their first. These results are similar to those found in 1999, the study authors said.

Presenteeism may depend on hospital culture, the authors say. At one hospital, 100 percent of respondents said they had worked while sick.  The rate ranged from about 51 to 72 percent at the 11 other hospitals.

"Residents may work when sick for several reasons, including misplaced dedication, lack of an adequate coverage system, or fear of letting down teammates," the authors wrote. "Regardless of reason, given the potential risks to patients related to illness and errors, resident presenteeism should be discouraged by program directors."


soundoff (75 Responses)
  1. THOMAS EINSTEIN MD

    Duh!

    September 14, 2010 at 16:39 | Report abuse | Reply
    • Steven Bullock

      There have always been more sick people than doctors to care for them. In most community facilities, there is no one to replace that sick emergency room doctor, that sick general surgeon, or that sick radiologist. That person has to come to work. and if you don't understand that, you have never walked in the shoes of a community physicain.

      September 14, 2010 at 17:52 | Report abuse |
    • dp

      As a physician, I can tell you that there is no alternative. I worked 7 days a week and was on call (staying up all night) every third night for three consecutive years.(before another 3 years in residency) The only day I had off was the two weeks of vacation I got each year. Otherwise I worked 7 days a week. When you stay up all night on call, you had to work the entire next day until sometimes late in the evening. How would residents not become ill working those hours. I can promise you that the days of quality doctors will end if the current health care bill remains. Becoming a physician takes years of dedication and extreme hard work both physically and mentally. No one will be willing to go through all of that to become a government employee. I go to work when I am sick now and wear a mask and gloves. No one is happy when their physician has to cancel their appointment. We are not supposed to become ill.

      September 14, 2010 at 23:56 | Report abuse |
    • MS

      Matt, you sound like a world class donkey. In case you missed it, there is a huge shortage of both doctors and nurses in this country, and there has been for years. What that means is that there aren't enough medical professionals to take care of the rest of us. Of course they have to work when they're sick, because there's no one else to do their jobs. I worked in an assisted living home as a nursing assistant (that's way down on the food chain in the medical field.) I can't tell you the number of times my residents (the people living in the home) complained when their doctor or nurse or nursing assistant got sick. It was perfectly ok for them to be sick all the time, but you would think it was a sin against mankind for their doctor or nurse to get sick. So much abuse is heaped upon the medical community by so many ungrateful, misinformed people who have no clue about the medical profession, and have no idea the sacrifices people in the medical community make. My brother is a doctor, and when he was in med school you know how many Christmases he had off to spend with his family? 2. 2 Christmases off in 8 years (4 years med school, 4 years residency.) Matt, I bet you've had more than 2 Christmases off. The medical community is much like the military. You don't get to just take time off whenever you feel like it, or call in sick whenever you need too. Doesn't work like that in the medical community or the military.

      September 15, 2010 at 08:29 | Report abuse |
    • Joe Hill

      It's refreshing to hear from so many of my colleagues, who validate my residency experience. My surgical residency didn't recognize "sick leave" and if you said you were too sick to go to work, then you had to go the emergency room for an evaluation. No calling in and telling the chief you coudn't make it – you had to have generated an ER chart. So guess what – no one called in sick. In 5 years of residency and one year of fellowship I never missed a day from illness, but I was seeing patients and operating sick many, many times.

      September 15, 2010 at 11:52 | Report abuse |
    • Heidi Sinclair

      I always worked sick – it was expected – even with fever of 103 told to take ibuprofen – or vomiting – sent to the pharmacy to get phenergan suppository ... only sent home early twice in 4 years – once on HIV/ID ward "if you can't control your secretions you shouldn't be here" – once cuz kept doubling over with stomach cramps checking out to the attending ... It's really really stupid system .... for residents and for patients ...

      September 15, 2010 at 13:59 | Report abuse |
  2. radgirl

    When I was a medical resident I worked when I was sick and now that I am an attending in practice I work when I am sick. Patients are furious when you cancel their clinic appointment becasue you have a cold.

    September 14, 2010 at 16:53 | Report abuse | Reply
    • Matt

      So you work when you are sick!? I would hope that you wear a mask and gloves with all patients. That would only be common sense.

      September 14, 2010 at 17:32 | Report abuse |
    • cpope

      Matt, you obviously don't get it or don't want to understand. It has nothing to do with "ego" as you put it, it has to do with "who the hell is going to cover my shift, my patients, my responsibilities when I stay home". We do encourage our office staff to take off if obviously ill with a cold, flu, whatever but the physician really has no one to call and cover him/her. what you shame you are so hard-headed.

      September 15, 2010 at 09:41 | Report abuse |
  3. fdm

    As a resident, it's a sign of weakness to miss work because of illness. "Real doctors" work when they are sick, as we are told. If you are on call, and need to miss work, who will cover for you?

    September 14, 2010 at 16:58 | Report abuse | Reply
    • Matt

      Your comments just go to prove the incredible ego and arrogance of many doctors and nurses in the USA. "Real" doctors should be looking out for their patients. I assume most hospitals are in small cities and are short staffed,- which only increases the God complex.
      I wish medical schools and residencies would change some of their old school attitudes and smarten up.

      September 14, 2010 at 17:35 | Report abuse |
    • sue

      There is no God complex Matt just no one to cover, your leaving your fellow workings one short when already working short. This by the way increases the risk to patients because nurses and doctors are over worked with to high a nurse patient ratio and same with doctors. Its ingrained that your letting co-workers, hospital and patients down if you don't show up for work. Trust me we don't want to be at work for 12+ hours feeling like hell.

      September 14, 2010 at 19:55 | Report abuse |
    • gjkoerjgpor

      The God Complex is an epidemic in the medical community. It causes more damage than any illness could ever cause.

      News Flash: You doctors are NOT Gods. You are not even close. You poop and fart like everyone else and you will die just like a mangy old dog on the street. Learn some humility.

      September 15, 2010 at 14:53 | Report abuse |
  4. Bryan

    Well, that's kind of the culture. I'm a 4th (last) year medical student. There is definitely a strong onus to come to work everyday in the hospital, sick or not sick. Even when you're sick as a dog, you still feel guilty about not being there.

    September 14, 2010 at 17:04 | Report abuse | Reply
  5. SnakeDoc

    On our first day of surgery internship, the residency director said, "You'll show up for work every day, on time. If you're sick, you still show up for work. The only reason not to show up for work is if you're on a ventilator in the ICU."

    September 14, 2010 at 17:21 | Report abuse | Reply
    • Matt

      That guy sounds like a true world class donkey.

      September 14, 2010 at 17:36 | Report abuse |
    • FlightDoc

      That sounds exactly like where I trained. They named the sick day "rule" after another resident who was on the cardiac cath lab table when he was scheduled to be on-call in the ICU. During orientation residents were told that if you were on the schedule for the ICU you were either there working or if you took sick time you had better be ill enough to be there as a patient.

      As an attending physician now I fully admit to working when ill, first because in some cases there was no other option. In one case I called everyone I could and there was nobody willing to come in to relieve me. In that case there was no Emergency Department Chairperson to call, and the company I was working for told me "I'm sorry, there is nothing you can do." I did wear a mask and gloves for every patient encounter, and I even called in the on-call surgeon to suture a few wounds since my running nose would have contaminated the sterile field even with a mask on. I couldn't exactly put a "closed" sign on the Emergency Department doors for the only hospital in a rural county, but that was the last time I worked there.

      September 14, 2010 at 18:40 | Report abuse |
  6. Howard

    "The study authors found that about 58 percent of participants said they worked while sick at least once"

    Frankly, I'm suprised that it is that low. Every resident I know, if you ask them in confidence, has worked when they were sick.

    September 14, 2010 at 17:23 | Report abuse | Reply
  7. Tina

    When I was a resident, not only did I work sick, but also 36 hour sleep deprived and was told not to show it. It was frowned upon to miss a day and understanbly because the doctor filling in is as exhausted or sick as you are. My intern rounded with appendicitis they checked himself in. true!

    September 14, 2010 at 17:46 | Report abuse | Reply
  8. Celeste

    I'm sure the 36-48 hour long shifts don't help with preventing them from getting sick in the first place, and shaking off a cold once they catch one.

    September 14, 2010 at 17:50 | Report abuse | Reply
  9. Brandon

    I can honestly say that in 5 years of training (residency/fellowship) and 3 years as an attending I oftened worked sick. It is not out of a "God complex" or that we are tough, it is a out of a since of responsibility to both patients and my co-workers. If we called in during training, who covers you and takes care of the patients? Many of us chose this field out of a dedication to taking care of patients and this is often done at a cost to ourselves (time-working long hours, relationships, families and personal lives). Working sick is just another cost. That being said, I did wear a mask when needed.

    September 14, 2010 at 17:57 | Report abuse | Reply
    • Peanut Buttah

      It is not out of responsibility but rather a desire for a fat paycheck. Please stop pretending like you care.

      September 15, 2010 at 14:56 | Report abuse |
    • Jill

      For your information Peanut, medical residents make a base salary regardless of how many hours they work or how many patients they see.

      September 15, 2010 at 21:28 | Report abuse |
  10. Karen

    I worked with mono; I worked with pneumonia; I worked in preterm labor; I missed OB appointments when I was pregnant. The amount of work didn't decrease if you were out- there were just fewer people to do it. Being sick was "dumping" on your fellow residents. As a physician in private practice I work sick, as well. If I call in, 30 people don't get seen.

    September 14, 2010 at 17:58 | Report abuse | Reply
    • FreeSpiritGal

      I respect and appreciate your commitment. I think that many people here in the US have the entitlement attitude and take others for granted, forgetting that doctors and other service professionals are human beings as well. You kinda give up your rights for your own life when you sign up... But this doesn't mean that it's OK to take your commitment for granted. Thank you for your service!

      September 14, 2010 at 18:45 | Report abuse |
    • charls

      I appreciate your dedication; I just hope that none of your patients died because of it.

      September 14, 2010 at 20:53 | Report abuse |
    • What

      You should nto work with mono! What the crap is wrong with you? Pneumonia? People can DIE from that! Stay home. You actually risked people's lives because you were worried what your coworkers THOUGHT of you? That is unacceptable.

      September 15, 2010 at 15:00 | Report abuse |
    • Kasey

      Neither mono (after the prodrome) nor pneumonia are contageous. The only person this doctor hurt was herself.

      September 15, 2010 at 17:49 | Report abuse |
  11. sally

    I am a R.N. who frequently has to work sick.There isn't enough casual staff to cover sick calls and the guilt over abandoning other staff and the patients is great.The health care system doesn't value us and this is a reflection of that.

    September 14, 2010 at 18:32 | Report abuse | Reply
    • charls

      Very true. I just hope that no one died or became sick because you worked while you were sick.

      September 14, 2010 at 20:55 | Report abuse |
  12. KC

    When I was diagnosed with a condition causing lowered immunity, my doctor told me to stay away from ERs because they're full of germs - I thought he meant the patients, but obviously, he also meant the doctors!

    Because two of us in the office had reduced immunity, the boss had a rule that anyone who came in sick would be responsible for the sick days taken by anyone who became sick as a result of that germ-sharing. It was well understood that the one with no immune function whatsoever could end up dead. At my next job, the only acceptable reason to call in sick was your own death, which meant that no work got done all winter as we simply passed around every flu to every employee for months. At the job after that, people were shooed home with the first sniffle, and we got much more work done because we weren't all sick all the time.

    September 14, 2010 at 18:34 | Report abuse | Reply
    • charls

      My point exactly. The supervisor should send home anyone who is sick instead of letting them spread their diseases around the office.

      September 14, 2010 at 20:56 | Report abuse |
  13. MedResidentUSA

    I have responded so many times to these posts and time and time again, I find myself responding to a crowd of nay-sayer, unappreciative conspiracy theorists who want to drag the names of the hard working healthcare workers in this country through the mud. As I have said in the past, medicine is part science and part art and therefore there are flaws to it. We do the best we can to do what is right for our patients – based on evidence. Unlike the naturalist complementary medicine advocate who tells you to get accupuncture or take some herbs, we try as hard as we can to base our practice on evidence from studies. No other health care provider is subjected to such rigorous analysis in their practice methodologies – and perhaps this is the way it should be. We work the way we do because there is work that needs to be done and quite frankly, there are not enough people to do it. That is why there is this tough guy attitude in medicine – because we see things most people do not want to see, we do things most people do not want to do and we do all these things 24/7 because unlike other lines or work where there are holidays, evenings at home with the family or weekends, healthcare is an industry with a constant demand that does not allow for closing time.

    The fact is there is a shortage because healthcare work requires extensive training, a lot of personal sacrifice and a lot of educational debt. Many people would not be willing to take the route it takes to be a doctor – which is fine. Let me say that I am a resident now and I am envious of my other non-doctor friends who have normal lives. These weekends which the rest of the country takes for granted are not our own anymore. We have 4 days off each month for many of our rotations during residency. This means that we work 27/31 days in a month. Additionally, every 4 nights, we work through the night in the hospital. If we are lucky, we may get an hour or 2 of sleep during our safer than before 30 hour shift, but the reality is we work all through the night. We do this because of the demand. There are backup systems in place, but we do not use them unless a dire emergency comes up because the person replacing you often is (like others above noted) also tired, sick or possibly going to be on call again in the next 4 day period.

    So, once more, I ask and beg Elizabeth Cohen or Elizabeth Landau to go to Emory (as you are based in Atlanta) and do a month rotation with the medicine or surgery team. Work their hours with them, even if just observing. Stay with them overnight. Carry a pager. See how you feel when this is done. Then, when you are done with your one month and can go back to the comfort of your lives and do not have hundreds of thousands of dollars in debt to worry about and a family that you can actually see and spend time with after work, on the weekends and during vacation, you may reconsider you ever so hostile stance against the medical community.

    Ms. Cohen, I read your story about why you are an "empowered patient" and I will say that it does not justify your crusade against all medical providers. Perhaps you were unfortunate as human error can occur. That said, our system is one of the finest in the world and if you lived in another country and your baby truly was born with meningitis, your story would be about your dead child instead of the one who had an excessive lumbar puncture. Please, please, please, I BEG of you to go rotate at Emory with the general surgery department or the medicine department. Please see it all first hand so you can get a true sense of how things really work and where all the faults are in the system. There are faults on the providers' sides, but we try very hard, in fact, much harder than many other fields, to do the right thing.

    One more note – I have heard people bashing nurses as well. These are some of the most underappreciated, hardest working, most intelligent and compassionate people we have in our country. Once more, thank your lucky stars that we have them and if they have to work sick because no one else is there to take their place, you'd better believe they will take the precautions to prevent infection and that they will do their job to make sure care is delivered.

    September 14, 2010 at 18:35 | Report abuse | Reply
    • stephani s.

      i couldnt have said it better myself. i just finished residency and I am sick and tired of hearing people and politicians complain about how we train and practice...when most of these people have never stepped foot in an emergency department, icu etc. They certainly do not know whats it like to have a quarter million in debt and constantly worry about getting sued by the type of people who sue for hot coffee. The majority of Americans want everything for free, they want it now and they want their care and their families care to be perfect and free of medical error. Unfortunately for them, we are human.

      September 14, 2010 at 19:16 | Report abuse |
    • charls

      I deeply appreciate the services that doctors and nurses provide to their patients. I strongly disagree with the attitude that doctors and nurses should work while they are sick. I was a patient of a doctor who had VD but still saw patients. I deeply resent his attitude that he could do prostate exam on me while he had VD. I found out that he was sick by reading about it in a newspaper after he was forced to resign and give up his medical license. No body from his office ever contacted me. Pardon me if I am not impressed with sick doctors and nurses treating patients.

      September 14, 2010 at 21:03 | Report abuse |
    • jecljc

      People may also consider that it they didn't go to the doctor when they are not sick then doctors may not be so overworked. While I didn't read Ms. Cohen's post, I wouldn't be too down on the "empowered patient." I am not a physician, but if I were, I think I would be frustrated with all of the people who run to the doctor because they have had a cold for two days or because they scraped their knee. I brought my 8 and 4 year old to the pediatrician once last year and that was for their annual check ups. I do have to admit that I am very particular about their diets, exercise and exposure to fresh air, though. I think doctors are under appreciated, overworked and in some cases, even undertrained, because the system is broken, but it isn't the doctors' faults that the system is broken. So many people have played a role in screwing things up, with the average patient, the insurance company and lawyers high on the list. We are fortunate enough to see one of the most respected pediatricians in our area, but I was shocked at how little of his invoice my insurance company paid this year. My children love this man, he gives good medical advice that allows us to avoid his office, is so busy that he no longer accepts new patients and somehow the insurance company feels justified in "adjusting" his invoice. They have to be making a fortune off of my family since I could have paid all of our medical bills last year out of pocket for considerably less than we paid to carry insurance. I can't help thinking that I must be paying for a lot of people who just don't take any ownership of their health and then criticize doctors for not being able to "fix" them. For all of you who think that doctors should stay home when they are sick, consider avoiding the doctor when you are relatively well or when your condition may improve within a few days if you just consume some fresh oranges and a Vitamin D supplement.

      September 15, 2010 at 02:35 | Report abuse |
    • Surgeon

      Amen to that. The Matt's of the world mistake absolute dedication for a God complex. I think a month-long surgery rotation would provide more than a little insight to those yelling from the cheap seats.

      September 15, 2010 at 03:09 | Report abuse |
    • Name2

      For chrls who commented above me, What on Earth are you talking about? You cannot catch anything from a doctor who has VD (assuming you mean a sexually transmitted infection.) That is not grounds for them to stop practicing medicine. There is no way for them to transmit it to you via an exam. Furthermore, the fact that the doctor had a disease would not be published in the newspaper. I wonder what on Earth you are talking about!

      September 15, 2010 at 07:32 | Report abuse |
    • what he said

      You're wasting your breath here, and wasting your time reading the CNN Health section. For that matter, skip the NYT as well. Everyone is an expert, and it's currently in vogue to slander the health care profession. It's not going away, so unfortunately get used to working 80 hrs a week, sick, healthy, whatever, and people hating you for it. Just go back a few days on this website and read the absurd story about the pinky tip regeneration and the "miracle cure" that was - that will give you an idea as to the caliber of the CNN Health reporting. Most professions show up for work sick once in a while. I get the feeling health care personnel do it more because they see patients and think "that guy/gal is WAY worse than me, so at least I can show up to help him." There is also a strong sense of duty and letting the other members of the team down. As a teacher, many of us feel the same way. Sure, there are subs, but the students will be better off if you can pull it together and go in. While I'm not sure, I doubt there is such a thing as "sick days" in residency. By the way, "sick" likely doesn't always refer to contagious diseases. In reality, it likely means thrown out back, broken arm, urinary tract infection, etc.

      September 15, 2010 at 09:20 | Report abuse |
    • Wendy

      @Med Resident: You could not be more wrong. Guess what moron, natural treatments have been used for THOUSANDS OF YEARS long before your arrogant, jerk-off self was even a thought. Long before this very young country was even a thought. You are a complete tool if you think that natural remedies are bunk. You PROVE that you yourself have a terrible God Complex. It is also quite obvious that you are nothing more than a whore for the drug companies. Way to go in proving those 'nay-sayers' right!

      September 15, 2010 at 15:05 | Report abuse |
    • Me

      "That said, our system is one of the finest in the world and if you lived in another country and your baby truly was born with meningitis, your story would be about your dead child instead of the one who had an excessive lumbar puncture. "

      You are totally full of it. It is quite obvious you have been drinking the 'God Bless America' Kool-Aid and have not been out of the country for any length of time. You are as deluded as they come.

      September 15, 2010 at 15:07 | Report abuse |
    • Oscar

      I am not surprised by your comment at all. It is quite typical. I can guarantee you that you are a middle-aged white man who has not had a real problem in his life. Your comment is so ironic its almost laughable. By the way, I am a white man too so don't try any racist crap on me. I can just tell the difference between old white doctors and everyone else who has a modicum of humility and bedside manner.

      September 15, 2010 at 15:12 | Report abuse |
  14. I.V.Lishman

    As a surgical registrar in the 1960's I once worked from Sunday morning until Wednesday afternoon with only two hours sleep on the Monday on a stretcher in an anteroom to theatre , most of the time operating or assisting. I actually fell asleep for a minute while waiting for the surgical nurse to pass an instrument, but two nurses pulled me up and gave me coffee, bless them! One had no choice. If one couldn't "take it" , one was out, finished, and would have to look for a career elsewhere. I succeeded because I can manage without sleep better than most. But now I am a Consultant I make sure my staff are not overworked like that and I hope we have a kinder system..

    September 14, 2010 at 19:26 | Report abuse | Reply
  15. Hyderabadi

    It is a regular and expected behavior for doctors to work when they are sick whether you are a medical student,Resident,Fellow or an attending in your own practice,I went to round on my patients with a ruptured appendix,after finishing my rounds went to the ER downstairs.
    This culture is imbibed in the early medical training period.I do not think the society really cares or appreciates the sacrifices Physicians make in their personal life for their patients and Career's.
    The health care in USA is the best because of the sacrifices of so many in the medical field.

    September 14, 2010 at 19:27 | Report abuse | Reply
    • charls

      I respectively disagree. This type of behavior by doctors, nurses and other health professionals is terrible. Sick doctors and nurses expose their already sick patients to other disease. How this could possibly be beneficial to their patient is beyond me. I realize that doctors especially are trained to ignore their own sickness but it is totally wrong.

      September 14, 2010 at 20:47 | Report abuse |
  16. charls

    None of this surprising to me. Our society has this thing about going to work sick even if you have sick days which many people do not. Once when I was a supervisor, one of my coworkers showed up sick. I took one look at him and asked him if he was sick and was told me yes. I send him home. If supervisors made a point of sending sick people home, we would all be better. Sick workers spread disease to other employees. But of course our businesses would not like it all. Many employees do not have sick days and so they will not receive any pay if the go home or else they will get fired for not being at work. If doctors and nurses will not stay home when they are sick, how do we expect everyone else to stay home when they are sick?

    Probably the worse business for making sick people work is the restaurant business. Many times I saw people who were sick at work. They would be coughing and sneezing but they came to work anyway. No work; no pay. So the next time you eat at a restaurant, you can be sure that someone working is sick. Probably the fast food and low price restaurants will have the sickest employees because their employees have no benefits and no sick days. Ours is sick society in more than one way.

    September 14, 2010 at 20:43 | Report abuse | Reply
  17. Jess

    "You are to be in the operating room unless you are actively vomiting. At that point, you are to leave, do what you have to do, rinse your mouth out and return". 7 different facilities. I've operated with stomach flus, colds, fevers above 104. I've seen 60 patients in the office with a cold. Guess what? It's not right that medical professionals have to go to work sick, but it happens to be the case. Who is going to see the 60 patients in the office who took off work and waited 6+ weeks for an appointment? What about your elective surgery that you have planned for, and you can't be fit in for another month and now its the holidays?

    September 14, 2010 at 21:00 | Report abuse | Reply
  18. chris p bacon

    I'm a medicine resident and find many of the above comments a bit misleading. I have made many sacrifices, am jealous of my "non-medical" friends and agree that the medical system, as it stands, is quite strained in terms of providing care for the masses. However, there is NO excuse to work when legitimately ill. In many regards the "health profession" is the most unhealthy profession in terms of hours worked, being sleep deprived and general lack of ability to have the time to take care of yourself.. The mentality is simply unhealthy. For those above that posted about the "good ol' days" I can appreciate that there are improvements in terms of work-hour restrictions and other tools to provide for a safer and healthier working environment, but there are still many improvements that need to be implemented.

    Now, back to my statement above about being "no excuse" to work when sick. Let me say that there are gradients of illness, the same gradients that are partially to blame for the strains on our system. An example, I see COUNTLESS patients that have had a sore throat for 8 hours and ask for time of work, narcotics, antibiotics. These same people show up in the ED with similar complaints and, in many instances, don't need any treatment, can still work and just need a bit of TLC and reassurance. As physicians we should be able to recognize this in ourselves but also be objective enough to know when to stay home. Certain illnesses are extremely contagious, like diarrhea/vomiting. This would be one example when anyone should stay home. If you don't know whether to sit on the toilet or bend over it, then stay home...both doctors and patients. The same should be true for a fever or any symptoms of the..da da da...FLU. Stay home. That said, if you have a sore throat or a stuffed nose, you can most likely work.

    Whether you are a patient or physician there are a few other points. Get vaccinated for the flu or any other preventable disease. WASH YOUR HANDS. Wash before you eat, after you use the toilet and EVERY TIME YOU SEE ANOTHER PATIENT. Use appropriate precautions and wear a mask if you are at work with the sniffles.

    Overall, I wouldn't change my choice of profession for anything but I'm not superhuman. I deserve the same comforts and breaks as my patients and I'm going to stay home if I cannot legitimately work. Illnesses can be spread and can impact the ability to care for patients. The bottom line is that it's not safe and, hopefully, some more changes are on the way.

    September 14, 2010 at 21:07 | Report abuse | Reply
  19. andy29

    The selfishness of certain patiens are best described with the following : +/-15 years ago 7 of us were attending an outpatient clinic and we had to see +/- 80 patients within 6 hours. After the second hour one of the MD developed an MI and cardiac arrest. We tried CPR and recovery maneuvers for 1 hour. Patients complained on the waiting . When explained that one of the MDs had just had an MI and died. Some comments went like "so who cares, I do not all afternoon to wait"...When all patients were told of the incident and told that the rest of the clinic was canceled for the day and appointments would be made for the next day Some patients threatened to sue !!!!

    September 14, 2010 at 21:17 | Report abuse | Reply
    • Name2

      That is really sad. I'm sorry you were all treated with such disrespect.

      September 15, 2010 at 07:38 | Report abuse |
  20. Regina

    I am a fellow and have worked when I am slightly sick (common cold, UTI etc.) I have also called in sick when necessary, including when I had the swine flu last year. Overall, docs are likely to underreport symptoms and its rare to have a resident say they are sick when they are feeling ok. There will always been arguments for docs to extend themselves more than they should, including working overly longs shifts which are detrimental to their physical and psychological well being. The problem of physicians being sick is no different than the "problem" of physicians needing sleep - no one makes provisions for anyone being sick so if you call in sick there is never anyone to cover. There are many possible solutions to this problem, including having mid-level providers available to help with coverage, or having back-up call providers who come in only when necessary (as many other professions have). This of course would require money. So instead of planning with the assumption that people, or their children, or some other member of their family will sometimes be ill or otherwise in distress, the system chooses to not allow anyone to be ill....ever.

    This problem is about lack of funds, and a culture that encourages docs to engage in self-abuse as if to prove that they are worthy of privilege.

    September 14, 2010 at 22:16 | Report abuse | Reply
  21. Mar

    I have to agree that would rather have a doctor cancel an appointment then come in sick or too tired. I actually had a doctor who used the excuse that he was overworked and never canceled appointments 'like other doctors' as a reason why he didn't have time to answer my questions. Well I pay a $35 copay per doctor visit and if I am going to go, I want the doctor to actually have the time and energy to treat my condition properly! The appointment was a waste of time and $35 AND I had to come back two weeks later (nurse insisted; I tried to talk her out of it but she insisted I had to come back because it wasn't taken care of properly in the first appointment). Fortunately I saw a different doctor the second time and she had the time to answer questions and solve the problem.

    September 14, 2010 at 22:20 | Report abuse | Reply
  22. MedResidentUSA

    Let me clarify to my colleague medicine resident...I am not suggesting that if one has swine flu or is actively vomiting, has infectious diarrhea or some other more serious illness that one should trudge through it. I am saying that a doctor is not likely to call in sick for the sniffles as many patients are willing to do. As a kid, I tried to get out of school from time to time for being "sick." I surely could have made it to school with a cough, a runny nose or a low grade "fever" of 99.8, but I did not have real responsibility and it was "ok" at that time. I have seen many patients with less than what I described who want notes for being excused from work for weeks. I am not here to play judge, but my point is now that I have responsibility with limited back up, I cannot take the same approach as I did when I was a child or as some of my patients take. Again, I am not passing judgment about their decisions to not want to go to work for their medical illness, but I am saying I cannot be judged for choosing to continue to work when it is reasonable, but maybe not the most comfortable. I would also like to echo the above that if we did not work such insane hours and had down time to relax like the rest of America, we would likely not be so prone to illness and medical error. Those would still occur as we are all human, but it would be less likely.

    September 14, 2010 at 22:45 | Report abuse | Reply
  23. Desiree

    I understand why many patients are appalled that their doctors would work while sick. However, it is important to understand the position of physicians. Medical residents are indentured servants. They often have upwards of $250,000 in debt, and they may make only $35,000 a year (for easily 5 years or more, depending on the residency). If a resident can't "cut it" (meet the standards of the supervising doctors), he/she could lose her chance at the career. Some of the policies are terrible, but the residents are powerless. And, due to the strained system, many of the physicians themselves do not have much more autonomy. Sure, ideally a surgeon shouldn't work when sick, but if the only option is "I perform this emergency procedure or the patient dies" (which happens more often than you think in rural areas with few specialists), what else can the surgeon do?

    September 14, 2010 at 23:00 | Report abuse | Reply
  24. ep

    As a current med student, and as the child and grand child of physicians, you'd better believe that we go to work when we're sick. If we didn't, loads of patients would not be seen, and they'd all have to reschedule. It's similar with physicians' vacation time–all the patients still have to be seen, all the hours still have to be covered. Most patients would prefer that the doctor was called in when sick/tired/on vacation than have to wait even longer to be seen, whether for a checkup or for an emergency. We don't all go into medicine for the money, glamour, and prestige–most of us actually care about other people and genuinely want to help them. That's why we'll go in at all hours of the night to sew you up, deliver your baby, or just about anything else-and THEN go to work again in the morning. It's also why we go to work when we're sick–with some anti-inflammatories and antibiotics. Medicine–especially being a physician–is a profession where people expect us to be available and at the top of our game 24/7 to take care of them when they need it.

    September 14, 2010 at 23:06 | Report abuse | Reply
  25. John

    I'm a second year medicine resident and have never called out "sick" in two years, despite being sick many times. The reason for this is simple, if you call out "sick" one of your colleagues is expected to cover your shift. By calling "out" you are calling "in" one of your co-workers.

    September 14, 2010 at 23:52 | Report abuse | Reply
  26. MGP

    I called in sick as a medical resident and had a letter of reprimand placed in my file. Residents are "owned" by their programs. The entire system is broken and getting worse.

    September 15, 2010 at 04:09 | Report abuse | Reply
  27. Katie H.

    Many people cannot fathom the number of hours many residents spend in the hospital. As a consequence, every resident is completely lacking in sleep. Mix this compromised immunity in with hundreds of patients hacking all over you everyday and this is what you get. My brother is a resident and I am in an accelerated nursing program, so I have a different perspective on reality vs. the ideal. Who would want to go work a 14 hour shift feeling like this? Obviously it is not an option for some. I understand both sides and the risks it presents, but work a few years in a hospital and you realize doctors spreading URI's are the least of your infectious problems when you are admitted to a unit in a hospital.

    September 15, 2010 at 07:16 | Report abuse | Reply
  28. Mary

    Being a doctor or nurse is a vocation not a job. It is something a person has to do. It is part of who they are. So, I am not surprised health workers feel they they MUST be at work. It is in their nature to have that drive.

    Having said that, when you are sick, you should NOT be spreading your germs and making decisions concerning other people's lives. People who are ill don't have the best judgment. I have to wonder how many malpractice suits are birthed from decisions made by sick people.

    If you are sick, take the day off. The world will run without you.

    September 15, 2010 at 08:14 | Report abuse | Reply
  29. Rich

    As an intern I made rounds in the intensive care unit while receiving IV fluids because I was suffering from gastroenteritis, I was pushing around my own IV pole. It was Christmas Eve, there was limited resident coverage and no one to fill in for me. The ICU attending was ill, the resident on call the night before was ill, and I was ill. Fortunately, we did not transmit our problem to our patients. That was just the first time I had to get an IV during residency. Every one of my co residents worked when they were ill at some point during residency. It is part dedication, part stubbornness, and mostly because we have to. Being a ventilated patient in the ICU was about the only acceptable excuse for missing work.

    September 15, 2010 at 09:11 | Report abuse | Reply
  30. NOtoGroundZeroMosque

    The residency program's administrators and hospitals are forcing residents to go to work while sick even with a very high fever!

    September 15, 2010 at 09:19 | Report abuse | Reply
  31. John Thompson, MD, CPA

    Rich, as a physician, who has seen it all as well, I would love to see that picture of you rounding with an IV – now, that picture would speak thousands regarding the work ethics of physicians in training... Kudos to you...

    September 15, 2010 at 09:24 | Report abuse | Reply
  32. Rick McDaniel

    Residents are "tested" as professionals, by putting them under extreme stress and workloads. This is not a safe practice at all, as many of these residents work in ER's, and trauma centers.

    September 15, 2010 at 09:39 | Report abuse | Reply
  33. HPN

    I am glad to see this being brought out. The medical profession has for a long time been on my shit list after having had a sick son and went through years of constant dealings with these people. First of all doctors are the most arrogant and at times ignorant pig heads you will ever run across. They like to use residents as some sort of rite of passage or something. kind of like Navy Seal training or something to sort out the weak from the strong. Most residents are on 24 hour shifts. Now explain to me why the law will not allow truckers or air line pilots to go 24 straight hours straight but will let a "Doctor" make life and death decisions on some one. It isn't like an EMT or fire fighter who may have an hour or more rest at a time, on a busy night interns get no sleep or rest at all. Many turn to drugs to stay awake, not good either. So when are the arrogant bastards going to admit they are just human beings, work reasonable hours, and stay at home when they are sick like the rest of the world. Until they fix this problem I will always continue to have my low opinion of the their profession.

    September 15, 2010 at 09:45 | Report abuse | Reply
  34. Dr. Mama

    It's simple economics. Residents are the lowest paid doctors in the hospital, and they care for a large # of patients. If they stay home when ill, like mere mortals, their colleagues must care for their patients (you can't quite say ... sorry, you have no doctor because yours has the flu). This puts a huge burden on the other residents and places the entire house of cards at risk.

    I was pregnant during my last year of residency and was hospitalized and placed on bed rest for 6 weeks, presumably as a result of my high stress/ low care occupation. This was incredibly difficult for my colleagues, and I felt huge guilt and regret. Caught between fear for my baby and my responsibilities to the job - INSANE.

    http://mamasoncall.com

    September 15, 2010 at 09:59 | Report abuse | Reply
  35. Mithi Govil, M.D.

    Physicians work when they are ill even after they have completed residency.
    This is an expectation placed on them from the day they enter Medical School.
    They work when they are physically or mentally exhausted. They work on Holidays, nights and weekends with public expecting them to be perfect all the time.
    Do people care? They may say they do except when they want "their" doctor. There is a huge "burn-out" amongst physicians and asking for help is generally reported to authorities, seen as "incompetence" by colleagues and patients.
    Communicating an illness to a patient or a colleague is least of the problems with sick physicians working. It takes a toll on the physician and on everyone around them, patients, colleagues, family and most importantly them as a person.

    September 15, 2010 at 10:57 | Report abuse | Reply
  36. JA

    This article is hilarious!
    Only 1/3 of residents ADMITTED to calling in sick. I'm an ob/gyn resident and nobody calls in sick, ever, unless you're on your death bed. In the real world it's not right, but residency is not the real world. Residency is an ungodly call of duty that nobody can truly understand until they've done it themselves.

    September 15, 2010 at 12:06 | Report abuse | Reply
  37. Common Misconception

    Wow, way to blame the residents. The problem isn't over dedication, it's supervisors and hospital policy that essentially uses residents as slave labor, and severely frowns upon missing days, regardless of the reason.

    September 15, 2010 at 12:24 | Report abuse | Reply
  38. Kasey

    When I was an intern I was called to a code on the infants floor. It was my senior resident having a seizure from exhaustion. Two years later I was the sole resident covering pediatrics in an entire hospital, from the ER to the clinic to L&D, and I passed out and had a seizure after a 36 hour shift. My attending's words to me as I left were "You'll be here tomorrow, right? Of course I was.
    Now I am in private practice. The only 2 days I have missed in the last 10 years were after an appendectomy. I would love to be able to take off when I am ill but I am the only pediatrician in town. There may not be a way to fix this problem.

    September 15, 2010 at 13:13 | Report abuse | Reply
  39. Obsession...

    I will admit I come to work sick- but if I'm truly ill I will not push my body to its breaking point. Kasey- if I had a seizure- I'd quit right then right there. No job or lifestyle is worth me leaving my family without a daughter, mother, or wife. But then again I guess it depends on what you consider important. I honestly think this goes back to the capitalistic mindset we all share- money is the center of our life. If we loose our job (thus our money) we have no life.

    September 15, 2010 at 13:51 | Report abuse | Reply
  40. LL

    To HPN – I am sorry that you have a sick son and that the medical profession is on your shit list. To tell you the truth, sometimes, patients are on our shit list too. Certainly some doctors are arrogant, but sometimes, we are just fed up on being shit on by patients and their families. We understand how stressful being sick is, but frankly, after a certain amount of abuse, many of us are just burned out and our empathy gone. I am sure many of us who have been through training, somewhere along the way thought "what the hell am I doing here? why am I doing this to myself? and who the f#$& cares anymore." Yet most of us still drag ourselves out of bed and into the hospital, put on a sympathetic face, and try to care for our patients.
    Finally, I would like to know how many doctors think we can get adequate training with a 9-5, 5 days a week residency in 3-4 years for the cognitive specialities and 5-7 years for the procedural specialties? Should we train until we are 40, carry huge amount of debt in the process? Or should we just put more patients at risk and say screw it, we can practice medicine inadequately trained?

    September 15, 2010 at 14:00 | Report abuse | Reply
  41. Wendy Sue Swanson, MD

    My experience in training was 100% of us arrived sick at some point. I am no exception. The social pressure to arrive, lack of back-up, commitment to work & learning prevailed. The culture can be cut-throat even when a program attempts to provide back up and support. Our rule in training was you left only if, "you couldn't control your own secretions." I'm not kidding.
    The practice of presenteeism extends into practice, of course, like so many have mentioned. Our patients need us and although the system is set up for sick MAs, PAs, RNs, & staff, it is not set up for doctors. It's a systems issue that will forever need attention and change. But it's costly and in the current economic climate I see no relief on the horizon.

    September 15, 2010 at 14:29 | Report abuse | Reply
  42. MedResidentUSA

    @ Wendy: Yes, I am going to say it. I dont care if your hippy holistic natural stuff makes you feel good and you get better from placebo effect. I only care if your herbs have bad effects on your health – or if it interacts with a proven effective drug. If you refuse to stop the herb that is interacting with your needed proven effective drug, I would simply document that I offered it to you, you declined as you knew you needed the herb because of its proven efficacy over thousands of years and when you get sick, I would wave the record in court as you attempt to sue me. Now, that is the frustrated part of me talking because believe it or not (which you will not number 1 because I am being so rude and condescending to you because I am so frustrated by you hostile know it alls who quite frankly are brainwashed by people who know very little as well, such as Kevin Trudeau, and because number 2 you have this innate hatred towards western medicine as do many naturalists like you), but I do have good bedside manners. I check my bias against people like you at the door every day. My patients do like me and have commented so on numerous times. II will also say that I do not believe all natural things are bad or worthless. Obviously, much of western medicine comes from traditional medicine. Taxol is a fine example as is aspirin. What I do say to people like you is before you get on your soap box and tell the people that western medicine is bad and to take your herbs to cure their cancer or heart disease, you should have the same burden of proof placed on you as does western medicine. We attempt to prove that a particular treatment is safe and works. While this is not a perfect process by any means, research does go into this and we try to practice based on evidence. Naturalists tend to say exactly what you do – it has been around for thousands of years, therefore it is good (or even better than western medicine). That is fine – but attempt to prove it like we do.

    Unfortunately, many people who jump on board your bandwagon have no idea what they are talking about and simply repeat things they have been told. They have no true educational experience and have no clinical experience. A great example is the person who claims organic food is the only kind of food to eat. Lets dissect this stupid phrase. Organic food. What does organic mean? Well, the definition of organic is that the material contains carbon. Therefore, food in the organic section and the food elsewhere is organic. So what does the organic thing even mean? Now here is the real catch – are there any studies that prove increased life span, decreased cancer or any other thing with people who eat organic only versus not? I dont know – do you?

    @ Me. It would be simple to categorize me as a middle aged, know it all white male doctor wouldnt it? Well, unfortunately, this is not the case. As you see on many of these angry responses, there are many many many providers who feel like me. We are tired physically and sick and tired of being dragged through the mud when we sacrifice so much for you.

    As for the Kool-aid comment, read about neonatal meningitis. Learn what you are talking about before you slam someone. You will find that in developing nations, if a neonate as meningitis and the organism is not IDed and proper prompt treatment is not initiated, the child's well being will be not so good to put it mildly. Like someone else said, there is a vast amount of knowledge on the net out there. Read about it before you make stupid comments.

    September 15, 2010 at 16:57 | Report abuse | Reply
  43. Ann

    This is absolutely true for nurses as well. Trying to get someone to stay home when they are sick is practically impossible. Who is going to cover those patients? The staff is already "lean" and no one wants to leave the rest of the team short. Many times I have told a friend to "go home, I don't want your illlness and the patient doesn't either". However, when you are working in a culture where you are punished for "calling in" what choice is there?

    September 16, 2010 at 08:00 | Report abuse | Reply
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    September 24, 2011 at 03:27 | Report abuse | Reply

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