Why doctors go to work sick.

[Guest guest]

Sniffle While You Work: Why doctors go to work sick.

Why don't doctors stay home when they are sick?

By Zachary F. Meisel and M. Pines March 6, 2009

In Marcus Welby, M.D., the early-'70s medical version of Leave It to Beaver,

hospitals were depicted as sterile environments with shiny equipment and

starched bed sheets. More recent medical dramas have gotten dirty: E.R., House,

and Grey's Anatomy are a lot more likely to feature episodes in which a patient

is admitted with a broken leg and later gets infected by flesh-eating bacteria.

While not all TV medicine reflects real life (it's not that common to call a

code black in order to extract a ticking time bomb from a patient's abdomen),

new studies are published every month on hospital-acquired infections. Not even

celebs are immune: According to reports, suffered serious

infection after his most recent nose job.

This raises an important question: Why do people get infected while in the

hospital? The first and most obvious answer is that hospitalized patients are

sick and vulnerable because their immunity is compromised. But hospitals are

also dirty places that can (and do) serve you up a side of microbes along with

that lukewarm bouillon. Hospitals house hordes of people with infections

together in close quarters, and bugs are bound to spread. While some of this can

be prevented through infection control, doctors frequently don't do a great job

of washing their hands or their stethoscopes between patients. But there's

another reason, which no one who works in a hospital likes to talk about:

Doctors tend to show up to work sick.

Now, why would a doctor dare come to work with a contagious disease and examine

my grandmother with germy hands?

Coming to work ill is part of the culture of medicine. A favorite saying on

surgical wards is " We're rounding with you, or we're rounding on you " —if you're

missing work, you better be so sick that you're admitted to the hospital. Sick

doctors have been known to do rounds while dragging IV poles and receiving

fluids for GI illness. Gross, but it happens. This culture of

work-first/self-second may not be such a terrible thing: Patients want dedicated

doctors who study hard and won't sleep unless their patients are tucked in. But

this hard-nosed culture can cause problems, especially when overtired doctors

make mistakes because a cold has stuffed up that same hard nose.

In some hospitals, working while under the weather is basically policy. Some

hospitals have been reported to fire workers who take too many sick days.

Residents on a well-known hospital's internal medicine service are allotted two

sick days per year. Any more than that, and they work an extra week. When a poor

doc wakes up coughing and achy on what would be her third sick day, there's no

real choice: She sucks it up and hobbles to work. One would hope that she would

wash her hands more diligently that day, but there's still a good chance some

hapless patient will catch whatever she's got. In all likelihood, the otherwise

healthy M.D. will recover without a problem. But the newly infected patient, who

was already sick, might not be so lucky.

Hospitals may promote this culture in part because of the limitations on hours

that residents can work. Unfortunately, the guidelines can make already tight

schedules even more packed. When people call in sick, sometimes a healthy but

sleepy member of the team has to come back to work, or a disgruntled doc gets

called in from a much-needed vacation. Either way, the sick doc at

home—sniffling and coughing through The Price Is Right—feels bad because he just

screwed over a colleague. The next time he comes down with something, he might

try to tough it through his shift.

E.B. t pointed out the downside of requiring young doctors to get more

sleep. Arthur asked why the United States hasn't been as effective as

Europe at killing off hospital infections. Zachary Meisel wrote that ambulances

can be dangerous places. Sydney Spiesel made the case for immunizing everyone

against the flu. Ingrid Katz and i examined the medical sins of

Grey's Anatomy.

This culture of working sick isn't limited to doctors and hospitals. Other

high-intensity professionals are loath to miss a day. But a banker showing up

sick to the stock exchange is far less worrisome than a doctor coming to the

hospital with the flu, which can kill a patient who has a compromised immune

system. Some would argue that coming to work sick is better than the

alternative. When doctors don't show up, their patients must be cared for by

others who may not know important details of their medical history, possibly

leading to medical errors. But the same arguments were made when rules came down

forcing doctors in training to work fewer hours: Despite less continuity of

care, patients didn't fare any worse.

In the end, it conjures images of Snow White and the Seven Dwarves: You might

think you're getting Doc, but instead you get Sneezy, Sleepy, or even Dopey.

What's the solution? The first thing we can do is change the culture. Calling in

sick should not be seen as wimping out. Unfortunately, cultures—even toxic

ones—are incredibly stubborn. Another possibility is to alter the rules: Build

greater redundancy into the system so that the two-day-only sick rule is not

needed. A reduction in resident work hours should be coupled with an increase in

the number of residents or other staff (such as physician extenders who can fill

in). Also, an on-call backup person should be required on all services.

Another solution is to try to keep doctors healthy. Believe it or not, just 42

percent of health care workers got vaccinated during the 2005-06 flu season.

Hospital staffers should be encouraged, if not compelled, to get their flu

shots.

Even better, how about a little consumer-driven pressure? Demand that your

hospital report the flu vaccination rates for its staff. Ask your doctor when

was the last time he washed that dirty lab coat. Make her clean her stethoscope

before she touches you with it. And the next time you see your doctor sniffling

and coughing, tell him to take those superbugs home.

http://www.slate.com/id/2212897

Zachary F. Meisel is a practicing emergency physician, a Wood

Foundation clinical scholar at the University of Pennsylvania, and a senior

fellow at the Leonard Institute of Health Economics. M. Pines is a

practicing emergency physician, an assistant professor of emergency medicine and

epidemiology at the University of Pennsylvania School of Medicine, and a senior

fellow at the Leonard Institute of Health Economics.