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A recent JAMA Pediatrics article found that 83% of clinicians admitted to coming to work while sick and 95% admitted to knowing that it could be dangerous for their patients.1 “The decision to work sick is shaped by systems-level and sociocultural factors,” the study authors wrote.
In speaking with rheumatologists on the matter, I found they seem to typify the study’s findings of rarely calling out sick.
“In more than 20 years, I have only taken a sick day twice,” says Stuart Kaplan, MD, chief of rheumatology, South Nassau Communities Hospital, Oceanside, N.Y. “One was after I broke my foot. I took the day off to see an orthopedist and then returned to work on crutches for the next six weeks. The other time was when I had the flu and almost passed out at work. I went home to bed and returned to work the next day.”
Dr. Kaplan
Alexa Simon Meara, MD, clinical instructor and a rheumatologist at The Ohio State University Wexner Medical Center, Columbus, Ohio, says the only time she has taken a sick day was when her water broke during a pregnancy.
“I was teaching medical students,” she recalls. “I had rounded that morning on a busy internal medicine inpatient service and had not finished my notes. While sitting in a hospital bed having contractions every three minutes and attached to a tocometer, I borrowed the nurse’s computer on wheels and staffed all of my residents’ progress notes from earlier that day.”
Evan Leibowitz, MD, MS, rheumatologist, Prospect Medical Offices, Midland Park, N.J., says he must be extremely ill to miss a day of work. “Symptoms of vomiting and diarrhea have kept me out of the office twice in the past four years,” he says.
Elyse Rubenstein, MD, rheumatologist, Providence Saint John’s Health Center, Santa Monica, Calif., says she has not taken a sick day in more than 10 years. “If I do not feel well, I will push through,” she says.
Calling out sick is a significant inconvenience for patients and could even jeopardize their health, says Dr. Kaplan. “Physicians are trained to put patients’ interests before their own needs,” he says. “We are used to working under strenuous conditions, including when we are sleep deprived or not feeling well. In most cases, there isn’t anyone else in the practice who can pick up the slack and see all the patients who were scheduled to see the absent doctor. It may take weeks for those patients to get a new appointment.”
Dr. Meara
Dr. Meara concurs. “As physicians, not trying to be martyrs, we respect how difficult it is for patients to get appointments and often how far patients have to commute to see us. We know that patients have rescheduled their day or week to make appointments or surgeries, made childcare arrangements and so forth. Therefore, we do not want to cancel unless we really have to,” she says.
In addition, making a patient unhappy can have consequences that affect a physician’s reputation. “Medicine has changed due to social media and patient satisfaction scores; we are ultimately judged by our patients,” Dr. Meara says. “If we cancel due to illness, then patients have to reschedule, causing our patient satisfaction scores to potentially drop.”
In addition to having an impact on patients, taking a sick day affects fellow physicians. “I do not like to burden my fellow rheumatologist partners with patient phone calls, medication refills, and laboratory results and other documents to review,” Dr. Leibowitz says.
As a solo practitioner, Dr. Rubenstein does not have any coverage if she stays home sick. “If I have a headache or something small, I come to the office and make do,” she says.
Overcoming Challenges
It’s important to have a plan in place to deal with a sudden absence. “First of all, patients should be notified as soon as possible so that they can rearrange their schedules if necessary,” Dr. Kaplan says. Second, “time slots should be reserved in the schedules of covering physicians to accommodate any urgent patients. This may even require rescheduling some non-urgent patients of the covering physicians.”
Care should be taken to not overburden the covering physicians, because this is not in the best interest of patients, Dr. Kaplan continues. Nurses or other support personnel can assist canceled patients by arranging for medication refills or urgent needs that will hold the patient over until they can be seen.
Dr. Leibowitz
Dr. Leibowitz has some built-in flexibility; for the past two years, he has taken Thursdays off. “If needed, I will work a Thursday to accommodate patients who had to be rescheduled as a result of a sick day,” he says.
Having a good working relationship with his partners makes it easier to accommodate patients. “If one of us has to be out, we have a system to assign coverage to one of the rheumatologists who is working in the office,” Dr. Leibowitz says. “If there are major clinical decisions to be made, we are comfortable calling and texting each other on the fly.”
In addition, having an electronic medical record system has helped the matter. “It is somewhat easier to be away because of it,” Dr. Leibowitz says. “I can log on remotely and take care of many of my own coverage tasks as if I were in the office. However, if I am sick, I should focus on resting and getting better. There is a fine line regarding how often and when to log in. It is a personal decision that each of us has to make.”
Karen Appold is a writer in Pennsylvania.
Reference
- Szymczak JE, Smathers S, Hoegg C, et al. Reasons why physicians and advanced practice clinicians work while sick: A mixed-methods analysis. JAMA Pediatr. 2015 Sep;169(9):815–821.
