Doctors often work while sick, putting patients at risk

What happens when the people who take care of the sick get sick themselves? A new survey finds that they often feel obligated to show up to work anyway.

The pressure to work while sick carries special risks when it comes to health care providers because they can pass on infections to patients, many of whom already have compromised immune systems.

The survey, conducted at The Children's Hospital of Philadelphia and published Monday in JAMA Pediatrics, included responses from 280 attending physicians and more than 250 advanced practice clinicians (APCs), a category that includes certified registered nurse practitioners, physician assistants, clinical nurse specialists, and other highly trained health care providers.

Researchers asked how often they worked while sick and the reasons they did so, through a series of both multiple-choice and open-ended questions.

Ninety-five percent of the health care providers who answered the survey believed that working while sick puts patients at risk, yet 83 percent admitted doing so at least once in the past year. They said they had showed up to work with symptoms that included diarrhea, fever, and the onset of significant respiratory symptoms like those from a cold or flu. Many said they were uncertain about what symptoms would be severe enough to make them miss their shifts.

The most common reason they gave for working while sick was not wanting to let their colleagues down, cited by more than 98 percent of those surveyed. Well over 90 percent also said they were concerned about staffing levels, and that they didn't want to let patients down.

Peer pressure was another common reason, with many mentioning a culture that frowned upon taking sick days and concern that they would look unprofessional. Almost two-thirds -- 64 percent -- said they feared being ostracized by colleagues if they took sick days.

According to the study, "Respondents recounted critical comments made by colleagues about those who take sick leave, stories of working (or seeing others work) while so ill that they needed intravenous hydration, and the general impression of an unspoken understanding that attending physicians and APCs should 'buck up' and work."

That attitude, some experts say, needs to change.

"Creating a safer and more equitable system of sick leave for [health care workers] requires a culture change in many institutions to decrease the stigma," Jeffrey R. Starke, M.D., of the Baylor College of Medicine in Houston, and Mary Anne Jackson, M.D., of the University of Missouri-Kansas City School of Medicine and Children's Mercy Hospital, wrote in an editorial published along with the survey. "Identifying solutions to prioritize patient safety must factor in workplace demands."

"Also essential is clarity from occupational health and infection control departments to identify what constitutes being too sick to work," they wrote.

The study authors noted that unlike doctors during their residencies, the attending physicians included in this survey have more autonomy at the hospital and don't have to check in with supervisors who would send them home if they came to work sick.

More than 721,000 healthcare-associated infections (HAIs) are reported in the U.S. each year, and they include some of the most common, serious and expensive illnesses in the United States. While rates are declining overall, the CDC estimates one in 25 U.S. hospital patients has an HAI on any given day.

"The medical literature includes numerous reports of outbreaks for which symptomatic [health care workers] have been found to be the ultimate source of disease within health care facilities," the study authors write. Such infections include influenza, whooping cough, norovirus, and the drug-resistant superbug MRSA (methicillin-resistant Staphylococcus aureus).

The study was limited in several ways because it was anonymous so researchers couldn't assess bias or which job title a responder might have, in order to compare groups. Those who answered the survey (only a little more than half of doctors who were asked chose to participate) might have different opinions than the non-responders. Additionally, the survey was conducted at only one hospital and the patients were children, which could affect the doctors' perceptions of their roles.

But previous surveys have found similar results among different doctors and other locations, showing internal pressures in the medical community to work despite illness.