You woke up this morning feeling sick. Your head hurts, your throat is sore, your nose is clogged and running … Every single muscle and bone in your body hurts. You are burning up, you are pretty sure you have fever. Oh, right, your little one had a cold few days ago. And that patient you saw the other day, he was coughing up a storm … Maybe you got it from him?
Who knows …You are clearly sick, very sick. You think about the busy day ahead of you: the busy clinic schedule, patients in OR, the hustle and bustle of the hospital, your office staff, your residents, and medical students. You don’t have any energy to get out of bed.
But you hit the alarm clock and mustering every little bit of strength in your body, you slowly drag yourself out of bed. One foot in front of another. You look at the mirror and see your sunken eyes with dark circles and the red nose. “Nothing a little extra foundation cannot fix,” you convince yourself.
You manage to get dressed. You swallow an extra strength Tylenol, inhale your coffee and you are on your way to work in no time. You won’t miss a day of work for this! You are tough. Your patients need you. You have not missed a day of work for, well, you never missed a day of work. You are proud of yourself. You wish your nose just stopped running. You make a mental note to stuff your lab coat’s pockets with tissues.
You have showed up to work sick many times before. All doctors do. That’s just the way it is.
Congratulations, you made it to work. You see your first patient who happens to have the same symptoms as you do:
“Yes, Mrs. Smith, you need to take few days off from work. Rest at home, have lots of sleep, and eat foods that are easy to digest. Did you say I look sicker than you? Oh, no, I am just fine…”
Your next patient was brought in by his mom as his teacher noted him to be ill. You expertly diagnose him with an upper respiratory infection and advise his mother.
“Little Johnny should stay home for a day, he needs to rest and we don’t want him to pass on any germs to his classmates”.
Your head hurts. Darn that cough. You are sure you have fever. But you keep trudging along. Because doctors are tough.
Why is it that we doctors don’t follow our own recommendations to our patients? The hypocrisy is baffling to me. Do we really think that we are doing a favor to our patients by showing up to work sick? Would you want to go to a doctor who is sick himself or herself, who actually looks sicker than you are?
Would you want to be on the plane if you knew that the pilot was sick and he dragged himself to work that day?
Would you feel comfortable riding on the bus if you knew that the bus driver had a fever, headache and she barely got out of bed that morning?
That respiratory virus which made you ill that day may be all that is needed to push your vulnerable transplant patient down the spiral drain of sepsis, or that fragile premature newborn to respiratory distress.
Perhaps you may not be your 100 percent when you are making a critical decision for a complex patient whose life depends on your ability to make the best decision for her that day.
Always being the high achievers, we are used to pushing ourselves over limits. Studying longer and harder than our peers for years, sacrificing time with family, time for hobbies, time for self care, striving for perfection have been acceptable and in fact, expected for a career in medicine. The reality is, nobody is perfect and doctors are no exception to the rule. We get sick like anyone else. When we do, we become the worst patients. Our judgments stray far from being objective, doing everything completely opposite of what we would recommend to a patient in the same or similar situation. In the name of not sacrificing the care of our patients we actually put them at risk by showing up sick and not caring for ourselves.
It is OK to call out when you are sick. You are human. You need to take good care of yourself first so you can care for your patients. You deserve to treat yourself better. Self neglect is like a snowball, over time it grows so much that no amount of stoicism can stop the down fall. Taking time off when you are ill to rest and recuperate pays off in dividends, both for yourself and for your patients.
Of course we have to acknowledge the fact that some of us may not have the ‘luxury’ to call out when sick. Some of us in private practice or those who don’t have adequate coverage would certainly struggle with the decision to take time off. One size does not fit all and we all need to consider our own individual situations that would be best for the sake of our patients and our own wellbeing.
It is about time we start to challenge our unrealistic, self-inflicted expectations in medicine.
Dr. Gul Madison is an infectious disease specialist practicing in Philadephia.
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