The JAMA Pediatrics study did find substantial differences in the types of symptoms that would keep a provider at home: While 75% reported they would come to work with a cough and rhinorrhea, 30% would come with diarrhea, 16% would come with a fever, and only 5% would come with vomiting.
To be honest, this sounds about right in comparison to what my threshold would be, and it is about what I would accept as reasonable from a colleague. I do hope that if I were “really sick,” with fever and/or vomiting, I would have the good sense to stay home and ask for coverage, and I hope my colleagues and I would support each other in these decisions.
The study really gets at the sociocultural factors that steer physicians into making such decisions, based on the conditions for being excused that they think are socially acceptable. I suspect these are similar to those that other industries would also consider acceptable. But, of course, the difference is that workers in other industries are less likely to cause harm to large numbers of vulnerable and innocent “bystanders.” Adding to the problem, there is no good “definition” for what is “too sick”; although it is complicated and varies by person, the definition should at least take into account the level of potential contagion and risk to patients.
The authors suggest that, in order to remedy this longstanding situation, open dialogue needs to take place among physician groups to reduce the ambiguity about what is appropriate. A good start would be the generation of clear policies that restrict providers from coming to work with specifics signs/symptoms.
As hospitalists, we should all discuss the article within our groups and honestly determine in advance what our “code of conduct” should be for illnesses, based on our provider mix and our patient populations. (Decisions for ICU, medical-surgical, or oncology may vary.) This would reduce ambiguity and create new social norms about when to stay home. In addition, administrative and provider group leaders need to show strong leadership and support for such policies and ensure adequate staffing in the event of appropriate callouts. Such policies need to ensure that callouts are equitable and non-punitive. These relatively simple measures would go a long way in reducing the risk of illness among ourselves and our patients.
Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].
References
- Szymczak JE, Smathers S, Hoegg C, Klieger S, Coffin SE, Sammons JS. Reasons why physicians and advanced practice clinicians work while sick: A mixed methods analysis [published online ahead of print July 6, 2015]. JAMA Pediatr. doi:10.1001/jamapediatrics.2015.0684.
- Starke JR, Jackson MA. When the health care worker is sick: primum non nocere [published online ahead of print July 6, 2015]. JAMA Pediatr. doi:10.1001/jamapediatrics.2015.0994.