Some ill doctors would still care for immune-compromised patients
A Q&A with presenteeism researcher
In an unpublished study1 of physicians presented recently in San Diego at the 2015 IDWeek conference, researchers found that doctors are willing to work with symptoms and maladies that would debilitate most people.
In addition to the 36% willing to work with test-confirmed flu, 96% physicians said they would work with cold symptoms; 78% with diarrhea; and 55% despite vomiting. Among those with fever, 84% would work despite fever up to 100.9°F; 49% despite fever of 101-102.9°F; and 24% despite fever ≥103°F.
In another disturbing finding, the physicians’ willingness to enter immunocompromised neutropenic patient rooms was 47% for cold symptoms; 29% for diarrhea; and 13% for fever ≥101°F. Reasons cited for working while ill included guilt for having colleagues cover for them (82%) and believing the transmission risk was low (75%). Shruti K. Gohil, MD, one of the authors of the study and associate medical director of Epidemiology & Infection Prevention at the University of California, Irvine School of Medicine, recently sat down with Hospital Employee Health to discuss the findings.
HEH: Why did you focus on physicians rather than healthcare workers in general?
Gohil: We knew that physicians have a strong work ethic and the culture of medicine is somewhat different than that of other professions. The consequences of absenteeism in our work can really have significant impact. If you think historically about the profession, [including times when] both hospitals and physicians were few and far between, you can see that the culture is to work long hours regardless of our own personal needs. Sometimes our work necessitates absolute concentration on our patients and their needs, and this can be at the expense of us paying attention to our own needs.
HEH: The most surprising finding to me was that more than a third (36%) of physicians would work with test-confirmed influenza. That would appear to support the argument that mandatory flu immunization is necessary.
Gohil: Absolutely — getting the flu vaccine is important, as is keeping all of healthcare workers highly compliant for vaccines for preventable illness such as measles. Measles is the most contagious virus that we know of. Keeping your titers up and complying with all occupational health policies are critically important for this reason. This is not just related to willingness to work, but as a healthcare worker keeping yourself healthy is critical.”
HEH: Those that would enter the room of a neutropenic patient included 29% with diarrhea and 13% with fever ≥101°F. Given that those symptoms could reflect transmissible infections, should hospitals have policies specifying that symptomatic healthcare workers should not enter neutropenic rooms?
Gohil: “In our hospital, [our policy is] you don’t go into the room of a neutropenic patient if you are actively symptomatic. We found there were a few too many that would still go in and see their patients. This means we have to do a better job of educating our doctors and letting them know under what circumstances is it allowable to go into patients’ rooms.
What patient-related factors and what sickness-related factors are involved in making that determination? Suppose you happen to be the only physician who can take care of a patient. Maybe you are in a rural part of the country, you happen to be sick, but you are the one that can help someone. There are things you can do by taking precautions. We need to identify what precautions you need to safely manage care, assuming you are not so ill that you have heavy secretions and you are highly infectious to others. If you are just getting over a cold, could you wear a mask and wash your hands a lot? We don’t talk about this much, but as a profession we can begin a dialogue. We need to educate our doctors and give them more guidance.
HEH: The willingness to work with flu seemed to decrease with more training. Was that trend reflected in the other symptoms?
Gohil: The same groups, such as fellows, residents and students, reported more of a willingness to work while they were sick versus the attendings — the attendings being the ones highest in rank. Those three groups tended to be more concerned about their superiors thinking less of them if they called in sick. They reported a sense of duty and of guilt if they didn’t come in. They thought that their patients might suffer if they didn’t come in, and importantly, they thought that they would burden their coworkers if they didn’t come in. They thought there wouldn’t be enough coverage if they were out and all of the work would go their colleagues.
HEH: Emergency medicine and surgical departments reported the highest willingness to work if ill. Is there a mindset or work culture in these two settings that could explain this?
Gohil: We wanted to know if there were interdepartmental variations and we found this. We didn’t explore further as to why — that needs to be the next step in our work, to examine what departments’ culture is contributing to working while they are sick. Each facility may have their own [variations] by department.
HEH: Can you provide an example of the supportive culture needed to influence physician willingness to stay home if ill?
Gohil: We have policies not to come into work in a general way, but we asked our physicians what would help them change their willingness to come into work even though they are actively ill. They believe that any supportive means is helpful. [This could] range from a simple email from leadership reminding staff that the hospital supports them staying home if they are sick, to a set protocol about what they are supposed to do when ill. There are a whole range of illnesses out there that are problematic. For example, when you get a cold, the first few days you are highly communicable, but if you develop a cough that lingers for couple weeks [it doesn’t necessarily] mean you are infectious to another person. It gets really blurry as to when is it ok to come in, when is it not? While many, if not all, [hospitals] have policies that support healthcare workers staying home if they are ill with communicable diseases, as physicians we want to know exactly what symptoms should I be looking for and not working. Clearly our trainees, our students, and our residents don’t want to do anything wrong by showing up to work while they are sick. They just want to know, what is the line? What is the threshold?
HEH: So for the younger doctors, is it a matter of education or fear of the consequences of missing work?
Gohil: That is a really important question. I think it is matter of education and I think it is a matter of them understanding that their leadership supports them. They want to look like they are working hard and are willing to do whatever they can for patients. Just letting them know that there are certain circumstances in which you are doing more harm than good by coming in. This kind of messaging is really simple and helpful. Something we have done at California Irvine is show our interns and medical students the results of this study. And the leadership of the housewide residency programs and their program directors publicly stated during those presentations that they support the residents and interns staying home if they are sick. If they have a question about this, if they have a concern that they can be infectious to other people, we tell them to call your attending before you show up at work and review your symptoms. Or go to occupational health or your primary care doctor before you come to work. We will support you doing that, and that simple statement said so much. We have also had housewide communications that let all of our staff know that we support them if they are sick. Before the flu season starts, we wanted them to be [aware] of this. I think it will have an impact.”
REFERENCE
- Trunong KK, Huang, SA, Dickey Linda, et al. Do no Harm: Attitudes among Physicians and Trainees about Working when Ill. IDWeek. Session 53. HAI: Occupational Health. San Diego, CA. Oct.7-11, 2015.
In an unpublished study of physicians presented recently in San Diego at the 2015 IDWeek conference, researchers found that doctors are willing to work with symptoms and maladies that would debilitate most people.
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