Tuesday, December 8, 2009

Stay Home When You Are Sick -- You Too Doc

I had a disturbing conversation with a colleague over breakfast this morning. She is a physician in a clinic for underserved populations. She is the only physician in that clinic, but she has a nurse practitioner who works with her. Between the two of them, they have more open charts than is advisable, but they are the only low-income clinic in their area and do the best they can to see all the folks who need care. This morning the NP called in sick. This throws a wrench in the clinic scheduling, as the NP was already overbooked with appointments all day. The doctor will now have to work her butt off to see all the patients herself. This means long waits, even less time per patient, and a very long day for her.

She explained to me that the NP felt really guilty for taking off. The NP came down with fever and chills yesterday, but worked through it. This morning, the NP could hardly get out of bed she was so sick.

“But that is what sick time is for. She will still get paid. If she is that sick, she needs to take off. Filling her slot is an administration issue. You administrator should have a back up plan,” I said. Because I am an epidemiologist, I don’t want the sick NP coming to work. I preach it all the time: Stay home when you are sick.

This was not the response the doctor was looking for. “Doctors work sick all the time. That’s what we do. We push through it,” she said. “If we don’t that’s 30, 40 people who are sick because they couldn’t see us.”

“But as a patient, I don’t want the doctor who sees me to be sick,” I said.

She looked at me like I was crazy.

“That’s nothing. You should see what they do in hospitals. It’s even worse in hospitals. No one ever calls in sick; that is unheard of. I’ve seen surgeons slap on a mask and work through it. It’s just what we do,” she said, as if this were a point of pride.

Now it was my turn to give the crazy look. “I’m sorry, but I don’t want someone cutting me open when they are sick. Send the sick one home. I want someone who is alert and paying full attention.”

Doctors should be role models for healthy behavior. They should not be operating with snot dripping into their surgical masks. This should not be a badge of honor. I understand there is a healthcare worker shortage in this country. Rather than pushing docs to work when they are sick, we should be looking for ways to increase the number of healthcare providers.

Another colleague told me about a program she worked in many years ago at a university teaching hospital. The hospital had a severe shortage of nurses. The school created a program where mothers on welfare could get an LVN on their campus for free, provided they would work in the hospital for at least one year after graduation. Tuition was free, room and board were free. Free remedial classes were offered to those who needed them. Daycare was provided. A short-term investment proved a long-term boon – the families were able to get off welfare and became tax payers. The mothers had a good source of income. A career, with benefits. The hospital had plenty of nurses. The program worked so well that they created a LVN to BA RN program for nurses who wanted to pursue it.

I have heard the psychologists say that we teach people how to treat us. If the doctor is willing to work through an illness, she has taught the administration that there is no need for a back up plan. I suppose the back up plan will be the hiring of a new doctor when that one keels over dead? A sick doctor is not fully present in their patient’s care. They run the risk of making mistakes, and we all know about the high numbers of injury and deaths due to plain old mistakes. They also run the risk of infecting their patients with whatever ailment they are carrying, and an ailment that may make the healthcare worker uncomfortable could be deadly to his ICU patient.

In the end, I think I made my friend mad.

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