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Working Sick And Tired

Fri, 01/21/2011 - 6:37am
Amanda Hankel, editor
As I write this column, I am lying in bed, head propped up on several pillows, laptop in front of me, surrounded by tissues, cough drops and the television remote. Yes – I am sick with a cold.

As I write this column, I am lying in bed, head propped up on several pillows, laptop in front of me, surrounded by tissues, cough drops and the television remote. Yes – I am sick with a cold.
 
I usually like to think of myself as pretty tough when it comes to colds. They’re often more of a nuisance to me than anything else – something I have to power through for a few days until it passes. But sometimes, I come down with a bad cold and it causes problems in my usual routine, as questions like: ‘Should I take a sick day?’ ‘What do I have going on today?’ ‘How far behind would I be?’ loom in my head when the alarm goes off in the morning.

I dwell on this topic because there’s been a lot of discussion recently about doctors taking – or more accurately, not taking – sick days or time off when they need it. Not surprisingly, there can be consequences for both the doctor and their patient if a doctor “powers through”, and the surgical industry has begun to take note.

Editorial this month in the New England Journal of Medicine argued that sleep-deprived physicians should not be permitted to proceed with an elective surgery without a patient's informed, written consent. According to the article, studies have shown that sleep deprivation impairs psychomotor performance as much as alcohol intoxication. A study in 2009 showed a significant increase in the risk of complications in patients who underwent elective daytime surgeries performed by attending surgeons who had less than a six-hour opportunity for sleep during a previous on-call night. Furthermore, surveys have revealed that most patients undergoing elective surgery would, in fact, request a different doctor if they knew that their surgeon was sleep deprived.

The risks for a patient can be severe if a doctor is sick on the job, too. In a blog post by Dr. Pauline W. Chen, for over a decade, published reports have linked patient illnesses such as the flu, whooping cough and resistant bacterial infections to sick health care workers. Still, she writes, as many as 80 percent of physicians continue to work while sick, even though they would have excused patients in the same condition. As Chen explains, for many doctors and other health care professionals, the ‘self-sacrifice’ of working while exhausted or sick is proof of their dedication and professionalism.

Being sick and missing work in any profession is a pain to you and most likely your colleagues who have to pick up the slack while you’re out. For surgeons, this can be especially frustrating. In one surgeon’s blog post, he writes when he has a sick day, his assistant begins frantically cancelling patients. Most are fine with it, but occasionally, a patient is angry – apparently, they think, doctors don’t get sick.

In reality, it’s not uncommon for surgeons to work in such a fashion that is prone to sleep deprivation and illness. “We often ignore our own issues because of the time needed to care for others. Most of us live sleep deprived, caffeine-overdosed and on food that we’d never endorse to you,” the doctor-blogger writes.

Is this right? As Dr. Barron H. Lerner writes in his blog for the NY Times, is it ok to be a “doctor telling his patients to do what he says — but not what he does”?

I think the consensus is: no. Yes, it’s a pain to be sick and to reschedule patients, but it’s arguably worth it in the end. Putting your patients at risk for complications or additional illness –not to mention yourself at risk for malpractice – at the end of the day is not worth performing a non-emergency surgery on three hours of sleep. And, according to survey results, most patients don’t think it’s worth it either.

Perhaps the editorial in NEJM and surgeon blogs talking about and debating the need for regulations on sleep deprived surgeons will spark a change in the work habits of doctors, or the regulations that control them. Surely, there will be resistance, but in the end, it would arguably be in the best interest of both doctors and patients.

As for me? It’ll take time for me practice what I preach as well – although my missing work doesn’t bare quite the same consequences. I’ll be in the office tomorrow. Just a few things to finish up … but then I’m headed home to nurse myself back to health, so I, too, can do my job at 100 percent.

Do you call in sick when you need to? What do you think about regulating surgeons reporting sleep deprivation? E-mail me at Amanda.Hankel@advantagemedia.com

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