Physicians Stubbornly Work While Sick

The practice of working while sick is common among physicians and advanced practice clinicians, even though it puts patient safety at risk.

Ask any healthcare manager whether they want their employees to come to work sick, and they'll certainly say they do not. But when a physician who's scheduled to see 20 patients that day calls in sick, or when a nurse approaches his manager to say he's too ill to work and needs to leave early, things can get complicated.

"You don't want anybody coming in sick, but if you don't have that coverage there, what are you going to do?" says Mallory Hatmaker, MSN, CNP, an adult/gerontology certified nurse practitioner with Cleveland Clinic's Employee Wellness and Internal Medicine departments.

What sick clinicians often do is trudge through illness and work anyhow, says a new study published in JAMA Pediatrics.

"You can't tell the person that needs open heart surgery" that you're sick and you'll get to them tomorrow, Hatmaker says.

Researchers at the Children's Hospital of Philadelphia conducted an anonymous survey of 280 attending physicians and 256 advanced practice clinicians. It found that although 95.3% of respondents believed that working while sick put patients at risk, 83.1% admitted to working while sick at least once in the past year.

A smaller number of respondents (9.3%) reported they had worked while sick at least five times. "Sick" symptoms included diarrhea (30% worked with these symptoms), fever (16%), and the acute onset of significant respiratory symptoms (55.6%).

Physicians were more likely than advanced practice clinicians to work with these symptoms.

Survey respondents said they worked sick because they

• Didn't want to let colleagues down (98.7%)
• Had staffing concerns (94.9%)
• Did not want to let patients down (92.5%)
• Feared of being ostracized by colleagues (64%)
• Had concerns about the continuity of patient care (63.8%)

Such responses reveal the complex social, cultural, and even logistical issues that cause physicians and clinicians to come to work when they're sick, the study authors say. There's a "strong cultural norm to come to work unless remarkably ill," the study says. Written responses also showed confusion about what actually constitutes "too sick to work."

Hatmaker says she sees many of these issues come up in her work with Cleveland Clinic, where she heads up a system-wide nursing wellness initiative and also works for the internal medicine department's employee walk-in clinic at Cleveland Clinic's main campus.

Cleveland Clinic is trying to care for its staff through the employee walk-in clinic, where any any employee can come in for care without paying a co-pay. It's convenient for a doctor to get reassurance that he or she doesn't have strep throat if someone in their household has it, for instance, or for a nurse to get treatment for a poison ivy or a urinary tract infection without having to miss work, Hatmaker says.

But on the flip side, Hatmaker says she's treated nurses and physicians who have had a 102 fever and can barely sit up and talk to her, but who insist on going back to work.

A Patient Safety Issue
"When I tell them, 'You're not going back to the floor,'" they can't believe it, insisting that they will try to stick it out and muscle through until the end of their shift, or saying they'll work just a few hours longer, she says.

"You get hard-headed employees. I'm one of them myself," she says.

But coming to work sick is not only bad for the clinicians themselves; it's also a patient safety issue. No one wants to be the person who spreads their germs to already-sick and possibly immunocompromised patients, not to mention to other staff members.

Managers need to use their discretion and tell employees, "you are sick, you can't be here" if necessary, Hatmaker says. "It's safety."

Although there doesn't seem to be a ready or easy answer to the problem allowing staff to sick versus being short-staffed, "prevention is key," Hatmaker says. "You have to listen to your body."

She says clinicians and physicians need to make sure that they get enough sleep, take their vacation days, manage their stress, and eat well, because all of those things can help prevent sickness in the first place. She adds that Cleveland Clinic tries to help its employees in this way with wellness initiatives and offerings, such as yoga, stress management tools, a sleep program, and more.

Still, it's hard for physicians, nurses, and other caregivers to admit that they're the ones who need to stay home and lay on the couch for a day or two. It's hard not to let guilt over letting patients and colleagues down get the best of you.

"It's the culture and it's the nature of the job unfortunately," Hatmaker says. "It's dedication to profession. It's workaholics…We're, I guess, a different breed. We're not the ones who are supposed to be sick."