Sick / Not Sick

The truth is, most doctors have shown up to work at least once when they were sick. Probably most people have shown up to work with a cold or sniffles or a cough. For physicians, there are unusual pressures to do so. The training environment, hierarchical structure, and role models of medicine encourage powering through illnesses. Taking a day off means someone else has to cover your patients, which incurs more risk to those patients who don't know their doctor. Taking a day off means someone else has to cover your call, working overnight or on a weekend. Taking a day off means you're wracked with guilt. Taking a day off means you're weak. Medicine, at least historically, nurtures, comforts, and cares for patients, but rarely does so for the physician. We are seen as impregnable; we ought to know all about health and disease; and we should never get sick.

Clearly, this is the wrong attitude. And medicine is slowly changing to reflect that. There is less stigma to taking a sick day. There are backup plans in place to cover for physicians who are out. We watch out for each other and make sacrifices for each other. But most importantly, coming to work sick puts patients at risk. Especially with highly contagious diseases like the flu, infection can spread rampantly. Influenza to a healthy doctor is an annoyance; to an immunocompromised elderly patient, it's life-threatening. For our patients' sake, we should not come to work when we think we could get others sick. Being doctors, you would expect us to know this.

However, this whole issue isn't so clear cut and obvious. We had a patient over the holidays with congenital heart disease who needed a bowel repair for duodenal atresia. The patient was four days old and the surgery was an emergency. But pediatric cardiac anesthesia is such a specialized field that our group of anesthesiologists for those cases is very small. And it turned out that the two anesthesiologists who were supposed to be in the hospital had the flu. One person who was not supposed to be working was already in the hospital doing in a pediatric heart transplant. All the others were out of town because it was Christmas. There was physically no one available with expertise in pediatric cardiac anesthesia to take care of this four day old baby. Now, a physician who works will sick puts his patients at risk. But here, being sick at home puts this patient at risk as well. The newborn ended up having his surgery the following day when one of the anesthesiologists felt better. It wasn't ideal, but it was the best compromise in solution.