With the respiratory virus season fast approaching, a recent study and editorial (J Szymczak et al. JAMA Pediatr 2105; 169: 815-21, editorial 809-10 -thanks to Ben Gold) are worth a look; they focus attention on the practice of working while sick. In the study, the researchers use an anonymous survey of more than 900 physicians and advance practice clinicians working at a large children’s hospital. 83% reported working sick at least 1 time in the past year and 9% reported working while sick at least 5 times. The authors note “some ambiguity persists around what constitutes being too sick to work, and a perception exists that sick leave is impractical.” Most of the respondents understood that their illness could have an adverse effect on patients, but 97% did not want to let colleagues down and 94% did not want to create staffing shortages.
The editorial makes several more points:
- Healthcare workers “will likely continue to come to work when mildly ill, especially when they identify their role as being essential for care and unique within the institution.”
- “Working while sick was regarded as a badge of courage, and ill physicians who stayed home were regarded as slackers.”
- The editorial argues for more clarity and/or use of key symptoms: conjunctivitis, vomiting, bloody diarrhea, fever >38.5, >2 episodes of watery diarrhea, or jaundice
- “For many respiratory viruses, individuals are most contagious before they are highly symptomatic, so staying home after symptoms develop may not be effective or practical.”
- For influenza, the CDC has recommended that employees “not return to work until 24 hours after they are fever free or 7 days, whichever is longer, with longer periods of time off for HCWs returning to work in a setting of high-risk individuals.” However, with this approach, “staffing shortages would become critical.”
My take: These articles suggest a need for a culture change that supports paid sick leave that is adequate and non-punitive. At the current time, adequate backup is often lacking. Also, these articles serve as a reminder: it is a good idea to get your flu shot!