When the doctor is sick: Tough choices to make

Physicians take the Hippocratic Oath that states, “First do no harm.” Unfortunately, many physicians consistently execute this statement for the well-being of their patients but ignore its tenets when it is necessary to look after themselves. 

In order to fulfill their duties, physicians often knowingly put themselves in harm’s way to provide care to their patients. That is an inevitability for many in healthcare. 

An extreme example is the recent death of Dr. Li Wenliang, a young physician working in Wuhan, China who raised the initial alarm regarding the new coronavirus, COVID19. Despite suspecting the risks of the disease, Dr. Li continued to work to do what he could for his patients; his exposure to the virus led to his death.

While this is a tragic, regrettable case, more frequent are instances of more common causes of cold or flu. Physicians continue to treat patients and provide care despite the personal risks. Even when they become ill, many offer that their primary duty is to the patient, regardless of their own health.

A recent JAMA Pediatrics study examined why physicians come into work when sick. Of 280 attending physicians who completed the survey, 38.9 percent would work with diarrhea, 21.8 percent with fever, and 60 percent with acute onset respiratory symptoms. 

The researchers reported many doctors said the decision to work when sick was shaped by sociocultural and systems-level factors. Concerns about the continuity of care, not wanting to let down patients, being ostracized by colleagues, and having difficulty finding coverage, all contributed to their actions. 

Likely any physician would be able to share stories of working through illness, family struggles or personal sacrifice, in order to make sure their patients were taken care of well and to avoid disruption in care.  

As an oncologist, I have my own story. 

When I was pregnant with my first child and in fellowship, I switched my months of being on more intense inpatient rotations so that my colleagues would have less slack to cover while I was out on maternity leave.

What that meant was at 39 weeks pregnant, colleagues paged me for patient emergencies at 4 a.m. For 24 hours a day, I was rounding in the hospital, seeing patients in the clinic, and taking home calls. 

A supervising attending told me if I was her patient, she would send me home when she saw the swelling in my feet had become so significant that my shoes could no longer contain my feet. But I wasn’t her patient, and the oncology patients in the clinic still needed to be seen, so I stayed and continued on fulfilling my duties.

Anecdotes abound of physicians rounding in the hospital while hydrating with IV bags of fluids due to their own illness, returning from maternity leave after only one or two weeks, bragging about never taking a sick day and coming to work when many others would call off. A resident in my hospital returned two weeks after delivering her first child in order to prevent any undue stress on her training program, her colleagues, and to ensure she would be able to complete her training on time. 

 The best-selling 2016 autobiographical book by the late Dr. Paul Kalanithi, “When Breath Becomes Air,” is a poignant and powerful account of his own journey and views on life and death as a physician and a patient after he was diagnosed with metastatic lung cancer. Kalanithi’s touching story reminds everyone that physicians are human. 

Logically, if anyone should not come in to work sick, it would be healthcare workers to prevent their patients from also getting ill. Of course, if and when they are ill, physicians wear masks, use hand sanitizer, and take as many precautions as possible to prevent transmission of the illness to their patients in order to minimize any disruption to care caused by a sick day. 

Patients must also understand that if a physician unexpectedly cancels an appointment, the decision was an easy one to make. It is important to remind patients that physicians are human, and life happens. 

Physicians must cover for each other, and create a culture of support. In order to care for others, physicians must care for themselves, and each other. 

Shikha Jain, M.D., is a board-certified hematology and oncology physician and the physician director of media relations for the Rush University Cancer Center. She was named one of Modern Healthcare’s Top 25 Emerging Leaders in 2019. 


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