Doctors know they’re putting patients at risk, but work sick anyway

Employees come to work for different reasons while they are sick. Some are not offered paid sick leave, others do not wish to “waste a sick day on a sick day,” and some feel that even though sick leave is available, they are expected to show up anyway. In February 2016, an article in The Journal of the American Medical Association (JAMA) discussed the implications of an earlier study revealing that though the vast majority of respondents felt that they put their patients at risk while working when they were sick, the concern of letting down colleagues and patients caused them to work through it.

Toughing it out

The concept of working while sick is not a groundbreaking one. Last year, NSF International, a public health organization, conducted a survey that revealed at least 26 percent of Americans go to work while they are ill. Although most judged their fellow co-workers for coming in sick, they admit that these people are hard workers. A quarter of those that work while sick reported doing so because their boss expected it of them. The Centers for Disease Control and Prevention released findings from an Environmental Health Services (EHS) study that showed 12 percent of restaurant food workers surveyed reported working even when experiencing vomiting or diarrhea. They were more likely to work when sick if the restaurant served more than 300 meals a day, did not have a policy requiring manager notification of illness, did not have a replacement on-call, and had less experienced managers.

The state of Massachusetts passed the Earned Sick Time law, which took effect July 1, 2015, requiring companies with at least 11 employees to offer paid sick leave. Nearly a year prior, Dr. Mark Schuster, Chief of General Pediatrics as Boston Children’s Hospital and a professor at Harvard Medical School, issued his thoughts on the necessity of family leave policies in a New England Journal of Medicine (NEJM) editorial. He noted that even though sick children are encouraged to stay home from school and see a doctor if necessary, parents are often unable or experience difficulty taking their children to a doctor.

Yet what if that doctor is coming to work sick? A 2015 JAMA Pediatrics study revealed that 83.1 percent of the 536 physicians and advanced practiced clinicians surveyed worked sick at least once in the past year, with 9.3 percent working sick at least five times. They would work with diarrhea, fever, and significant respiratory symptoms. Over 90 percent did not want to let colleagues or patients down and had staffing concerns. Over half mentioned in free-text responses that they felt there was no clearly defined ‘too sick to work’ standard. In response, Dr. Schuster noted that even when a clinician has good intentions while toughing it out, that decision can make others feel that they need to do the same. He felt that a cultural shift was required, as well as providing a better sick relief system with better workload coverage.

Not there yet

The February JAMA article revived the discussion about health care providers placing their patients at risk. Physicians were more likely to report concerns about continuity of care for their patients, at odds with the knowledge that working while sick can actually harm patients. One physician said it is actually much less stressful to work while sick than to make arrangements to cover care while out. Another noted that peak performance was expected at all times, and that providers were expected to deny smaller, basic needs, such as meals and bathroom breaks, in order to be as productive as possible, so taking time off for being sick was not feasible due to a lack of accommodation. The co-authors of this follow-up discussion article called on health care systems to come up with better solutions for coverage and backup in the event of illnesses.