Published September 8, 2016
It’s a great business model: Start (or find) a life-threatening trend, develop (or acquire) a product absolutely necessary to counteract...
— William Wilberforce
In case you didn’t know, patients may not be the only sick people in the room when they go visit the doctor’s office.
A study published in The Journal of the American Medical Association Pediatrics designed to understand how often and why physicians and advanced practice clinicians work while sick found that 94% of respondents believed that working while sick puts patients at risk.1 Despite acknowledging this, 80% of physicians and health care workers worked while sick and continued to work while displaying contagious symptoms such as fever.1 In fact, 10% of respondents worked while sick more than five times during the same time period.2
The primary reasons given for working while sick were to avoid burdening colleagues and patients, a belief of not being sick enough to stay home, logistical issues around securing coverage, unsupportive supervisors, and a strong cultural norm to work through illness.1
Part of the pressure for physicians to show up to work even while sick stems from administrative and legal obligations to meet goals, such as the number of patients seen per day.1 If these goals are not met, physicians may face penalties from either their employer, insurance companies or government programs such as Medicare.1
Although health care workers are expected to use their discretion in determining whether they pose a threat to patients,3 there is a cultural norm in the medical profession that puts a premium on overachievement.4 Anything that gives the perception of working less than one’s peers is frowned upon.4
Interestingly, many hospitals have policies restricting visitation by visitors who are ill by screening them for symptoms; however, the same policies are not applied to health care workers.5 In fact, most hospitals do not have polices in place that restrict sick health care workers.5 The reality remains that our health care system is ill-equipped to deal with workers who take sick days.3
While it may be no surprise that doctors go to work sick, the kicker here lies in recent events around vaccine policy that are not in congruence with the results of this study. California’s recent vaccination bill, SB 277, severely restricts parental rights when it comes to vaccination—the primary reason being to protect children who are the most vulnerable to infectious diseases. Yet there is a lack of concrete policy restricting doctors from treating patients while they are sick and contagious?
Moreover, organizations that represent physicians, such as the American Medical Association (AMA), are among the biggest supporters of tighter limitations on immunization opt-outs. The AMA has said there is no scientific basis for non-medical exemptions and that personal exemptions put the public’s health in jeopardy.6 AMA members in favor of ending exemptions have expressed that people who decide against vaccination put others at risk.6
According to AMA Board Member Patrice A. Harris, MD:
As evident from the recent measles outbreak at Disneyland, protecting community health in today’s mobile society requires that policymakers not permit individuals from opting out of immunization solely as a matter of personal preference or convenience.7
So while mandatory vaccination policies are being implemented with the intent to protect the community’s health, most doctors apparently continue to treat patients when they themselves are sick and contagious. If the overarching goal is to protect the public from contracting infectious diseases, which is the reason given for mandating vaccines, it would seem logical to develop solid policies to deter physicians from working when they’re sick.
If the goal is to protect the public, shouldn’t there at least be a thorough assessment of the entire health care system to determine how to prevent the spread of infectious diseases within the system?
1 Lyndon A. Why Almost All Physicians Work While They Are Sick. Physicians News Digest July 9, 2015.
2 Szymczak J, Smathers S, Hoegg C, Klieger S, Coffin S, Sammons J. Reasons Why Physicians and Advanced Practice Clinicians Work While Sick: A Mixed Methods Analysis. JAMA Pediatrics 2015.
3 Fabregras L. Missing Work Hardly An Option For Ill Doctors, But It May Be Necessary. TribLiveMedia July 11, 2015.
4 The Daily Beast. Is Your Doctor Going to Work Sick? The Daily Beast July 16, 2015.
5 Doyle K. Many Docs Come To Work Sick. Reuters July 6, 2015.
6 Japsen B. AMA: End Personal, Religious Vaccination Exemptions. Forbes June 8, 2015.
7 AMA Wire. Why Medical Reasons Should Be The Only Exemptions from Vaccinations. AMA Wire Jun.9, 2015.