Residents willing to work when they’re sick

Resident physicians who come to work sick risk passing their illness to colleagues and patients, yet many doctors-in-training take the gamble.

A survey of 150 Illinois medical residents found that 51% reported coming to work with flu-like symptoms in the past year, and 16% said they had done so at least three times, says an article published online June 18 in the Archives of Internal Medicine (link).

Medical educators and residency program leaders should educate residents that sometimes staying home is the most professional thing to do, said Anupam B. Jena, MD, PhD, lead author and an assistant professor of health care policy and medicine at Harvard Medical School in Boston.

“Working while sick may demonstrate an admirable sense of responsibility to patients and colleagues, but clinicians also need to worry about the real danger of infecting vulnerable patients as well as colleagues and staff,” Deborah Grady, MD, MPH, the journal’s deputy editor, said in an accompanying editor’s note (link).

The anonymous survey was conducted during the 2010 meeting of the Illinois chapter of the American College of Physicians. Those most likely to work when sick included second-year residents and women.

The most common reasons cited for the behavior were a sense of obligation to colleagues and a commitment to patient care. Nine percent of residents said they had passed an illness to a patient as a result, and 21% said they witnessed other residents pass illnesses to patients.

In addition to the risks of contagion, being tired and sick can endanger patients by impairing a physician’s decision-making ability, Dr. Jena said.

“It’s very different to come to work with a flu-like illness than to come with a headache, which doesn’t get transmitted to patients,” he said. “The culture of medicine has really been to put patients above and beyond your own well-being and health. That is a very admirable goal, but at the same time there are clearly instances when working when you are sick could impair the care that a physician provides.”

The study is a follow-up to a 2009 survey of 537 residents in which 57.9% reported working while sick at least once in the previous year, according to the Sept. 15, 2010, article in The Journal of the American Medical Association (link). The study found no difference in the behavior between surgical residents and residents in primary care, Dr. Jena said.

It would be difficult to extrapolate the studies’ results to practicing physicians, he said. Though most residency programs can develop a backup plan when a resident is absent, it can be more difficult in a small physician practice.

Physicians who choose to work when sick can take simple steps to lessen the risks of infecting others, such as wearing a mask and washing their hands frequently.

“It would be hard for me to advocate for [physicians in private practice] not to work when they’re sick because they’re often the only doctor to treat their patients,” Dr. Jena said.