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Most Doctors Work While Sick, Despite Knowing It's Bad For Patients
An anonymous reader writes: A new survey published in JAMA Pediatrics found that 95% of doctors believe patients are put at risk when doctors work while sick. Despite that, 83% of respondents said they had "come to work with symptoms like diarrhea, fever and respiratory complaints during the previous year." The researchers doing the survey dug into the reasons for this: first of all, given the heavy workload of most doctors, it's very difficult to find others who can take up the slack when one is recovering from an illness. Beyond that, the profession is pervaded by a culture of working through the discomfort and pain of minor maladies. According to a commentary on the research, hospital policies don't help matters — they often incentivize long hours and don't encourage ill workers to leave the premises.
Doctors ALWAYS know what is best for their patients /snark
Wherever You Go, There You Are
...I can agree this is totally true. Calling in sick does nothing but make my life harder. I feel bad about it, but from a job perspective, the alternative is piss off your co-workers who have to cover for you and get tagged with the reputation that you're lazy and trying to avoid work. Combine that with the need to get a doctor's excuse (another doctor; can't write your own), and it's just not worth it.
While it is true that there are doctors working while they themselves are not feeling well, you guys gotta understand that doctors have to face sick people ALL THE TIME, which means they have higher chance of getting infected with diseases, which means they have to spend more times feeling unwell
It is always so easy to criticize someone of doing something but why is it there is no mention of what makes that someone do that something in the first place?
"More than 95 percent believed that working while sick puts patients at risk, but 83 percent still said they had come to work with symptoms like diarrhea, fever and respiratory complaints during the previous year."
I think that 100% would believe that not seeing a doctor would put the patient at GREATER risk. Maybe in London (where Reuters is based) there are enough doctors working for the central government mandated health industry that sick doctors don't feel the pressure to come in. However, it looks like in Philadelphia (where the data was collected) there aren't enough doctors. I know that my medical doctor friends go to work sick, since the risks associated with someone catching a cold is much greater than the risks associated with not seeing a medical provider. In some places in rural New Mexico, you get to drive for 2+ hours to see a similar specialist. My urban Albuquerque isn't as bad, but things are still pretty backed up and doctors usually schedule months in advanced for routine things.
If a doctor contaminates patients, then the economic value of his work day is probably negative.
I noted the point of high workloads, but it just suggests that we need more doctors, and that subsiding would make sense.
While it is true that there are doctors working while they themselves are not feeling well, you guys gotta understand that doctors have to face sick people ALL THE TIME, which means they have higher chance of getting infected with diseases, which means they have to spend more times feeling unwell
It is always so easy to criticize someone of doing something but why is it there is no mention of what makes that someone do that something in the first place?
Because doing so implies that it's OK because it has a justification. "Hey, it's OK for doctors putting us at risk, because they have a really good reason".
This is a clear-cut example of that "needs of the many" thing. Yes, doctors encounter sickness more often then average. Yes, that probably means they get sick more often. Yes, their work is really hard.
Does the inconvenience of one doctor outweigh the inconvenience of 5 patients catching what he's got?
I once read a study where doctors refuse to use checklists, despite abundant evidence that doing so would reduce the incidence of hospital errors.
The reason? Doctors simply didn't want to use them - they felt that they were good enough not to need them.
(That was awhile ago - now checklists are starting to catch on.)
That is bit of an exaggeration.
In most professional environment I have worked at sick days are not frowned at. However in areas where there is less skilled labor it could get you in trouble as it is often used as excuse to get out of work.
If something is so important that you feel the need to post it on the internet... It probably isn't that important.
until you are fired.
Prioritize the patient queue based on similar symptoms.
My dad is a pediatrician (retired), and this is true.
Doctors' offices and hospitals are full of people who carry infections. You already have a high chance (probably around 30%) of coming out with an additional disease to the one you went in with, both from transmission from other patients, and through medical error. One more sick person (the doctor himself) hardly makes a difference.
Maybe a little exaggerated, but not entirely. I work in technology, same employer for nearly 16 years, and we get PTO instead of vacation/sick time. Company policy is that you can take your PTO whenever you like for any reason (or no reason at all).
I've been dinged severely for "taking too much unplanned PTO" on performance reviews. In addition, my boss one year negatively called out a "lengthy unplanned absence", despite the fact that I was in the hospital after having a heart attack.
Our entirely sociopathic economic system demands it. Poor health and death are no excuse!
“He’s not deformed, he’s just drunk!”
Seriously, if there aren't enough doctors it doesn't matter how good they are, enjoy waiting a month to get emergency* treatment from an overworked doctor who's only going to spend 5 minutes with you. If you drastically reduce the requirements for becoming a doctor, then you'll get prompt treatment from a well-rested doctor who can afford to spend a good long while with you and still charge you less. Sure, they'll make some mistakes... but so do current doctors. Requiring less training might actually reduce the number of mistakes. Especially if the mistakes were of the class of waiting too long due to busy schedules, patients avoiding the hassle, doctors going to work sick/tired, or any of the various effects of not enough doctors.
* there's some conditions that are serious enough that you ought to receive immediate treatment, but don't officially qualify as emergencies.
Don't waste your vote! Vote for whoever you want, unless you live in a swing state it won't matter anyways
Turning up while sick is not good at getting the job done but it keeps them in a job.
Exactly like every single other profession? Seriously. Name one job which doesn't encourage you to go in to work even when you are sick.
This is the work ethic that is pounded into residents and interns.
You MUST work, regardless of sleep deprivation, personal trauma, or contagious illness.
(That is why I became an engineer, rather than a doctor like my father and my grandfather.)
Since there isn't enough staff to cover your absence.
I'm not feeling the best tonight myself
But there are only 4 aides and 2 nurses listed on the online schedule and another one of the PM crew working half the NOC shift
full staff for nights is 1 nurses and 7 aides or 1 nurse and 8 aides
They study for long hours without adequate sleep so they can learn to teach their patients how to live healthy lives. Then they get abused in the residency programs and work for less than minimum wage for 80 -100 hours per week. Then they finally finish and start to practice and have to work long hours without bathroom breaks, food breaks, or just letting off steam. They're getting screwed by insurance companies and hospital administrators at every turn. I'm amazed anyone still wants to go to med school in this country.
>"95% of doctors believe patients are put at risk when doctors work while sick. Despite that, 83% of respondents said they had "come to work with symptoms"
If they are following universal precautions, it won't matter if they are sick or not... (yes, I work in healthcare). If they don't know this, they are not doing the right things.
In today's competitive marketplace you need to do everything you can to generate more business.
From a pure, selfless ethics point of view, the question is: Will humanity be better off if I go into work today or not?
Some things that may be going through doctors' heads when they decide whether to call in sick or not:
If I am sick and go in, then there's an increased chance of:
* me infecting others, and all that that implies
* me making a mistake that is worse than not being there at all
* Others perceiving me as not knowing/not following "the rules," which may impact my future career, which may negatively impact the future of the patients you would have had but won't have.
If I am sick and stay home, there's an increased chance of:
* A patient of a co-worker getting inferior care because my co-worker was covering for you
* A patient of a co-worker getting inferior care because my co-worker was tired because he covered for me in an earlier shift
* Others perceiving me as "not pulling my weight" and "wimping out," which may impact my future career, which may negatively impact the future of the patients I would have had but won't have
Similar thought patterns probably apply to most people in most careers.
Knowledge is how to play a game, intelligence is how to win, wisdom is knowing what game to play.
Name one job which doesn't encourage you to go in to work even when you are sick.
Some (but sadly not all) fast-food and restaurant chains know the PR damage that will happen if a customer tells their friends "I went to $RESTAURANT but my waitress had a runny nose, ewww".
For their own selfish reasons, these businesses insist that customer-facing employees not show visible signs of being contagious. Oh, they don't come out and say it like that - their written policy probably says "don't come in if you are sick" - but what they really want you to do is not come in if you are going to scare away customers.
Knowledge is how to play a game, intelligence is how to win, wisdom is knowing what game to play.
It seems unfair to me to pick on them. All allied health professionals are expected to work whether they are sick or not. It is just the result of the prevailing Judeo/Christian work ethic. Catholics seem to be the worst as personal sacrifice is expected by their beliefs, science be damned.
For example, one of the first things that got discarded was our previously secular hospital's very sane policy of forgiving a sick call by working an extra shift after being placed under the management of a Catholic institution. Apparently to their mind, if you can walk you can work.
In the meantime hospital acquired infections continue to be on the rise, and in many cases more deadly.
Time is what keeps everything from happening all at once.
plenty of available overtime" is a "positive"
It's a sign that you're not being paid enough. Despite the overwhelmingly positive public opinion that any family with a full-time worker should not be in poverty and be comfortable, it isn't true.
When you have middlemen (Insurance Companies) and administrations working to maximize profit, all being paid by the procedure... the quality of each procedure is far less important that the quantity. We need to put health back in the drivers seat as the #1 priority... which isn't going to happen until we Nationalize health care... even then it's not guaranteed to happen.
Does the inconvenience of one doctor outweigh the inconvenience of 5 patients catching what he's got?
Sometimes yes. Sometimes no. And the answer depends on what he's got and what the consequences of him not showing up for work are. There are places where the doctor is the only qualified medical professional around. Should the gunshot victim have to wait a few days for the doctor to get over his bout of the sniffles before he gets help? Should patients in urgent need of care in a rural area have to wait for a week for a doctor to stop coughing when he's the only medical help within reasonable distance? It's not always a simple equation. Sometimes the answer is obvious. Other times not so much.
Bear in mind too that many small practices shut down if the doctor cannot come to work regardless of reason. My wife works in a practice this size. There are about 10 hourly employees that don't get paid if the office cannot open. Fortunately the type of practice they have doesn't deal in emergencies but there are significant economic consequences to more than just the doctor. That means that the illness needs to be of a significant severity before it's reasonable to shut everything down. Doctors work around sick people so unsurprisingly they tend to catch what patients have more often than a typical office worker. Sometimes they have backup (like in a big hospital) and can stay home for a little while to recover. Other times the harm of staying home is greater than the risk of transmitting a minor illness. It's unfortunate but that's the reality of it.
Not exactly. The 'miracle' of American worker productivity is that most of us are now doing our work and the work of the poor sap that got laid-off during the Sub-Prime Pyramid Recession. Now, we're all too terrified to call in sick lest we be tagged as lazy or disposable. So we all work sick, because we need the health insurance (hashtag: irony).
holy christ this. IANADBIAMTO (I am not a doctor, but I am married to one). She is the worst patient in the world. The absolute worst.
That just seems to imply that doctors shouldn't be trained to work stupid-long immune system destroying hours, should be overstaffed (not understaffed) to allow for frequent sick days, etc.
That would be nice but it cannot realistically happen without a single payer government run health care system. Since that is a political impossibility it seems unlikely to happen. Furthermore, low staffing levels are sometimes an economic or functional reality. If you work in a rural area, odds are good there is no backup. Long hours? That's not unusual in a lot of professions including programming. Given the almost limitless need for medical care I don't really see doctors ever working short hours. It's just not a 9-5 sort of profession. Overstaffing will not lower medical costs - quite the opposite. So how do you propose to overstaff AND reduce the already outrageous cost of medical care in the US without going to a government run medical system? That's just not economically realistic.
In other words, double the number of medical schools, reduce the on-call stress that hurts the immune system and reform the residency system.
Doubling the number of medical schools will not necessarily have your desired effect and cannot be done overnight. For one, who is going to teach in them? Basically the only people qualified to teach doctors are other doctors. It would take a generation or two at minimum to double the number of med schools. And how do you do it without lowering standards? I can assure you that the lawyers would LOVE it if standards for doctors were lowered.
As for reforming the residency system, I agree completely there. My wife is a MD and the residency system is a soul crushing hazing ritual from a bygone era that needs reform drastically. The biggest problem with it is that the residents are funded primarily by the government so they are essentially free labor to the hospitals they work in. So the hospitals use them as hard as possible to save money on their own bottom lines. It's a huge profit center which makes it very hard to reform.
Maybe also get rid of the concept that doctors are so much smarter/more honorable than the poluace instead of just having a different skillset.
Just as soon as ambulance chasing lawyers cease to be a thing. Doctors ARE quite frankly held to a standard that you probably are not in your job and I certainly am not in mine. They have to constantly be considering whether they will be sued because most are at some point. My wife has to write all her reports bearing in mind the non-trivial possibility that she may have to defend it in a courtroom. She can even do everything properly with the best standard of care and she still is likely to get sued at some point. Her. Personally. Do you have to worry about that constantly in your job? I'm guessing probably not. Do you have to buy expensive liability coverage? I'm guessing probably not. Doctors ARE held to a higher standard than most other professions. People are extremely unforgiving of mistakes in medicine despite the fact that such mistakes are 100% inevitable because the human body is incredibly complex and we don't understand a lot about it.
If a doctor contaminates patients, then the economic value of his work day is probably negative.
Unless he has a case of ebola that is unlikely to be true. Doctors and medical staff work around sick people all day. It is a virtual certainty that they will regularly transmit pathogens no matter how careful they are. Fortunately most people have robust immune systems so the system still works. Or would you rather that entire medical offices close every time someone gets a case of the sniffles?
I noted the point of high workloads, but it just suggests that we need more doctors, and that subsiding would make sense.
Training of doctors is already subsidized. It's primarily paid for through Medicare and the Department of Health and Human Services. This is actually a problem because since the hospitals are not paying for their residents they are effectively free labor. This creates a strong incentive for hospitals to wring every possible ounce of work out of these "unpaid" but talented workers.
Prioritize the patient queue based on similar symptoms.
It's called triage and I assure you that medical people are well aware of it. Particularly in ERs.
If you drastically reduce the requirements for becoming a doctor, then you'll get prompt treatment from a well-rested doctor who can afford to spend a good long while with you and still charge you less. Sure, they'll make some mistakes... but so do current doctors.
And you'll get a lot of shitty doctors, drive up medical costs, drive up liability costs and hurt a lot of people in the process. Increasing the number of doctors is fine but lowering standards to do it is a DUMB idea. A better idea is to make working as a doctor more appealing so that you attract more good people to the profession. There are plenty of people who are smart enough to be doctors but who simply don't want the (often) horrid lifestyle that comes with it. This can be done without admitting a bunch of second rate applicants to medical school.
Requiring less training might actually reduce the number of mistakes.
Let me let you in on a little secret. EVERY doctor has killed someone. Not intentionally of course but because of a mistake they have made. Statistically the worst time to go into a hospital in the US is in late summer because that is when all the new interns start. They learn by working on you and there is no other way to do it. You can improve training without requiring less of it. Do you really want a minimally trained surgeon with no oversight working on you?
FYI, but you may be interested to know that the AMA does not have quite the monopoly on producing new physicians that you think.
There is actually a second source of physicians in the U.S., the American Osteopathic Association. Just after the civil war, Osteopathic Physicians (who carry the D.O. degree instead of M.D.) split off from mainstream medicine. While initially a fringe movement focused on Osteopathic Manipulation practices, over time it eventually evolved into a full-fledged "second track" for producing physicians of pretty much all different types. Since then, D.O.s have been growing in number, and unlike M.D.s the majority enter the primary care fields (Family Medicine, General Internal Medicine).
Note that this is a distinct USA phenomenon, as Osteopaths in other countries are not licensed physicians and are more like chiropractors.
Speeding is not necessarily bad. Going significantly slower than traffic will probably cause more accidents.
"When you have eliminated the unacceptable, whatever is left, however improbable, must be the truthiness" - Holmes
doctors.
And likewise, no mention of the crappy USA culture of greed, exploitation of labor, and money-grubbing being responsible ?