There was an interesting blog post at the New York Times: “The Doctor Is In (but Shouldn’t Be).” The piece talks about the healthcare cultural aspects that would drive or pressure a doctor to come to the hospital or the operating room, even if they’re sick.
Seems like common sense to stay away when sick, eh? Some researchers say this should be the norm, to stay away, but they seem to have an uphill fight against “the way it’s always been).
I’m in hospitals a lot (thankfully, as a visitor, not a patient) and I see signs like this everywhere you go:
It’s made pretty clear that you have an obligation to not bring the flu or other sickness into a place where people might have compromised immune systems (or they don’t need a communicable disease complicating their recovery).
But as the Times blog piece, written by a doctor starts:
One winter toward the end of my training, I came down with a cold. At first, the constant coughing and runny nose made me miserable; then they became tiring. To decrease the chances of spreading my germs, I had to tie on a mask every time I came into contact with patients, wash my hands so frequently my skin became raw and wipe down the phone receivers with alcohol when I answered a page. Unable to scratch, wipe or blow in the operating room without contaminating my hands, I learned that for a surgeon with a runny nose, there are no palatable options for the uncontrollable nasal effluvium; I had to wear two masks every time I scrubbed up for a case.
How does this make you feel, from a patient perspective? Like they’re really looking out for your best interests?
As the doctor writes about the medical staff passing sickness back and forth, she adds a story that sounds like a “macho” mindset:
I had been a third-year medical student and had asked my senior doctor-in-training if I could go home because of an upset stomach.
“Sure, go on home,” he replied, an impassive look on his broad face. “Just remember that I’ve never missed a day at the hospital in my life. They’ll have to put me in the hospital to keep me from taking care of my patients.”
Is this truly patient focused? Sure, if the MD doesn’t show up, your procedure will be delayed (which might be a matter of life and death). But getting sick or getting an infection can be as serious.
More examples of the pressure placed on medical professionals by their peers are in the piece:
Resisting the pressure to go to work when ill can be particularly difficult for some health care professionals. Students, doctors-in-training and nurses may be afraid that their supervisors will frown upon any absence, regardless of the reason. “It’s a sign of being soft,” Dr. Widera said, “and they may get a tongue-lashing the next day from those in charge.”
Whether it’s macho or “self-sacrifice,” it doesn’t seem patient-focused:
“The culture of medicine is so completely focused on self-sacrifice that when doctors come into work so sick they need intravenous fluids, it’s considered a badge of courage,” said Dr. Eric Widera, the study’s lead author and an assistant professor of geriatrics at the University of California, San Francisco. “No one is standing up for the patient and saying, ‘This is wrong.’ “
I’m glad some are saying it’s wrong.
I hate to raise this issue, but since most doctors and surgeons are paid on a “piecework” basis, that lost time is lost money they might never make up. It’s worth pointing out there is a financial disincentive to NOT stay away while sick. I’m not saying all doctors would have that money on their mind as a primary reason to come to work when sick, but it’s part of the equation. It’s different than somebody who is paid a salary who gets paid for a sick day by their employer.
Again, there’s evidence of harm caused by sick doctors (and sick nurses):
Hacking, febrile or racked with the sequelae of chronic illnesses, doctors who are sick have continued for generations to see their patients. Although published reports for over a decade have linked patient illnesses like the flu, whooping cough and resistant bacterial infections to sick health care workers, as many as 80 percent of physicians continue to work through their own ailments, even though they would have excused patients in the same condition.
For many doctors and other health care professionals, such self-sacrifice is proof of their dedication and professionalism. Moreover, in what are often precariously balanced hospitals and practices, one individual’s absence can inflict tremendous stress upon others. Overstretched colleagues are forced to shoulder additional clinical responsibilities, supervisors must solve impossible staffing challenges and, worst of all, patients are left with inadequate care.
Wouldn’t professionalism be better defined by staying away when sick? And seriously, if Toyota can figure out how to stay properly to account for worker sickness, can’t a hospital figure out a way to provide adequate staffing levels without placing pressure on sick providers to come in?
Any doctors reading this with a perspective to share?
About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. Mark is also the VP of Customer Success for the technology company KaiNexus. He lives in San Antonio, Texas.