Reader Mail:
Hi Sarah, I’m a long time reader but have never commented before. I’m a Mom to a toddler and pediatric resident (aka I always have at least a low grade viral illness) and have been struggling more and more with this notion of doctors never being allowed to take a sick day. Your forays with mindfulness resonate with me strongly, and I feel like not taking care of ourselves is so counterintuitive to this. I’d love to say I have the energy to change the culture from the ground up, but mostly I just need to go to bed. Any thoughts are appreciated! -lily
Thoughts:
Hi Lily! Toddler-mothering + residency – that is no joke; I actually never experienced that combo but it sounds very very tough. I support going to bed 🙂 No, in all seriousness, I agree that sometimes the expectations are ridiculous. I also feel they are not always the best for patients! And as a physician you can’t win either way — if you move appointments, people complain (and I get it, it is hard to arrange your schedule ahead of time and then have it change last minute!) and if you come in sick people complain that you could be exposing their children to viral ($*&@# (and probably sometimes the SAME people, because some people just like to complain).
Anyway. There’s no easy answer. And in my case, my schedule is quite tight currently so there’s also internal pressure. If I call in sick on a weekday, I have a dozen patients that I then need to find slots for, and I have zero slots for months unless I overbook. And if I overbook, I have a hard time getting home to my kids which for me is a non-negotiable. So I am also internally motivated to grind out the day unless I am truly TRULY unable to function (has only happened once so far in my post-training job, when I had a concussion after hitting my head and needing stitches last April!). However, my cancellation threshold might actually change when I go 4 days/week (April 1!!!) because I could just put those slots onto one of my days off.
I think that in your case, while you can’t change culture from the ground up, you can still create your own personal culture. Work hard, take good care of your patients, but take care of yourself, too. It may be wise to have a pop-off valve in your schedule IF you are the primary caregiver for your child/children (ie no partner with flexible hours) so that you can confidently cancel patients when you truly need to and not have to worry about the aftermath.
I will say that after residency / fellowship you DO have more autonomy! My office managers have never pressured me to come in sick. You can also do trades if it’s a call issue — if I’m dying, I will ask to trade (never just for ‘coverage’ – I believe call should always be a 1:1 trade and I don’t like owing anyone anything!).
Others in medical (or non-medical) fields – thoughts?
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14 Comments
I work in academia and people come in sick all the time, which irks me since there’s really no good reason (most of us can easily work from home or our work is no so crucial that it can’t wait a day or two). There is a very strong culture here of workaholicism and needed to "one-up" everyone on being busy and putting in long hours, including coming into work while sick to prove to everyone how committed you are to your job.
Ugh, that would drive me crazy! if you CAN stay home . . ., do it!!
Depends on where you work. People have been spreading the flu around here like crazy, bragging that they just took Tylenol to bring down their fever do they can work more. It’s insane. I was sick recently and told my attending just to cover my own ass in the event that they had to put me in a lung transplant. As you know the resident would be the first to be blamed for anything bad that happened to the patient.
yep – that is probably true.
Damned either way . . .
As a medical student, I worked sick for weeks before my body gave out and I had to take time off. My rotation evaluation said "Rotation was noteworthy for a significant number of absences". No mention of the fact that I’d looked like death for days before I gave in or even of the fact that my "absences" were for illness. I’m still mad about that years later.
The medical culture is ridiculous when it comes to illness. I’m personally believing more and more that we need to take care of ourselves as physicians, and so I will take time off if I’m sick. I’ve only done it once as an attending (I called in sick when I developed rigors), but I will do it again if/when it’s needed. We can only do so much before we break ourselves.
AGH that is so upsetting. I think our generation (hopefully) will not perpetuate that @(*&!
This is one of those things where usually I’m happy to be seen by a NP or someone else in the practice if our usual practitioner is sick.
I do go into work sick as an academic when I’m teaching because the hassle of rescheduling a class is just too much. Not for any one-up-manship reason though.
My job only has PTO – so sick and vacation are combined. Which means everyone (I’m guilty of it too) comes in when they’re sick because we don’t want to waste the vacation day. Bad system.
Do you mind if I email you an endocrinology question, btw?
normally i’d say no medical questions but since I actually know you (and YES did see you in person once although we were both running in opposite directions!) you can email me 🙂 Of course I cannot formally give any medical advice
It seems like this is one of those times when building slack into a schedule could be wise. I know that for routine things at pediatricians and OBs we’ve been seen by someone other than the normal doctor, or the NP, presumably because someone was out sick or otherwise called away. Then we didn’t have to reschedule and didn’t have to be cared for by a sick doctor either. But I imagine there are economic reasons to keep a practice booked as solidly as possible, and high demand will push that way too.
Absolutely economic reasons pretty much mandate you overbook, not just book solid, each clinic session. When I’ve had to cover for a colleague its been really really hard, and the 2 time I’ve done it it was for: appendicitis, and early labor. There just isn’t a viable system in medicine for dealing with routine illness.
agree with Ana. If you want wiggle room, you have to pay for it b/c the hospital isn’t going to. That is what I am doing (in part) with my 80% schedule. It is, of course, costing me 20%+ of my salary 🙂
(BUT I am thinking it will be worth it!!!)
This is such an excellent question! I am an academic dermatologist and work in a very supportive department, with many parents of young children. When someone calls in sick, each provider will see a handful of extra patients that day (those arriving early, driving from far away, or who couldn’t be rescheduled for whatever reason). It does add a bit of extra stress, but most people don’t seem to mind since most everyone has been in the sick boat at some point. I agree that having extra administrative time (or a flexible schedule, e.g. <100%) is so helpful bc patients can be added to open slots if need be. Residency is tough because so much of your schedule is outside of your control, but I would lean on your more supportive colleagues. I have seen some excellent camaraderie among our wonderful residents. Don’t be afraid to ask for extra help when you need it. =)
It’s crazy to be able to do a lot of things. Success is the result of what is recognized. Do not always busy at work, you are the best talent. The need for people to see is the result you do.
eg: You study 18h / 24h but still you get the certificate of poor education. One day only 4h but can still test well. Everyone will recognize that person well.