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By October 26, 2010 6 Comments Read More →

Sick Hospitals Visitors, Stay Away. Sick Doc? A-OK?

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:


censored hygiene sign 500x373 Sick Hospitals Visitors, Stay Away. Sick Doc? A OK? lean

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?


mark graban lean blog Sick Hospitals Visitors, Stay Away. Sick Doc? A OK? leanAbout 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 new Executive Guide to Healthcare Kaizen. Mark is also the VP of Customer Success for the technology company KaiNexus.

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6 Comments on "Sick Hospitals Visitors, Stay Away. Sick Doc? A-OK?"

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  1. Matt Wrye says:

    If doctors don’t want to miss work, then they should practice TPM (Total Productive Maintenance). They should exercise, eat right, and take all other pre-cautions they can in order to stay healthy and not get sick. I know that is harder being a doctor dealing with sick people but that is why hand washing is promoted. What else could they do?
    Matt Wrye recently posted..Dilbert and Traditional AccountingMy Profile

  2. Ron Krawec says:

    It’s a misconception that compliance with hand washing will prevent all transmission of illness. It significantly reduces the risk, but it is far from a 100% reduction.

    Want a fix… Pay docs a salary and grant them sick leave. “Presenteeism” is a result of the fee-for-service model (although, granted, showing up sick at work will still occur for other reasons).

    Ron K (PTWonk)

  3. My friend is doing her residency and this “macho” attitude is pretty much the norm in hospitals. It’s funny how doctors and nurses are supposed to be taking care of patience… but can’t really take care of themselves. These 12 hour, 16 hour or even being on call for 24 hours is just ridiculous. NO ONE can effectively work for a 12, 16 or 24 hour shift.
    Richard Dennis recently posted..We NEED More StimulusMy Profile

  4. John Hunter says:

    I complete agree, doctors should stay away when sick. Incentives can distort the best system outcome though. Piecework pay will encourage work to be done that isn’t the best work (shoddy work or working when sick). I believe some doctors are paid basically by piecework – per procedure. My guess is Mayo clinic would have an easier time improving the system in this respect (I believe there doctors are on salary).
    John Hunter recently posted..A Theory of a System for Educators and ManagersMy Profile

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