You think you've got it bad?

I read this article in Slate about doctors going to work sick with wry appreciation.

Coming to work ill is part of the culture of medicine. A favorite saying on surgical wards is "We're rounding with you, or we're rounding on you"—if you're missing work, you better be so sick that you're admitted to the hospital. Sick doctors have been known to do rounds while dragging IV poles and receiving fluids for GI illness. Gross, but it happens. This culture of work-first/self-second may not be such a terrible thing: Patients want dedicated doctors who study hard and won't sleep unless their patients are tucked in. But this hard-nosed culture can cause problems, especially when overtired doctors make mistakes because a cold has stuffed up that same hard nose.

As someone who has gotten IV fluids while on call as a resident (and I have a vague recollection of it as a medical student, too, but I can't be sure), I can testify to the truth of the above description. Even in my current job, the one time I called in sick (with a fever, for the record) I was subjected to wisecracks from my colleagues the next day about their having expected to see me as an inpatient. Some of this is because of a ridiculous culture of institutionalized hazing known as "residency," and the mindset it instills.

In some hospitals, working while under the weather is basically policy. Some hospitals have been reported to fire workers who take too many sick days. Residents on a well-known hospital's internal medicine service are allotted two sick days per year. Any more than that, and they work an extra week.

This is, of course, terrible policy. You can file it with all of the other terrible policies that dictate how residencies are run. (For the record, whatever its flaws, my own residency wasn't this draconian.)

However, there is the very real consideration of not wanting to stick one's colleagues with extra work. If I call in sick, some of my patients can get rescheduled (though it certainly doesn't make them happy), but a great many of them cannot be. Their needs are urgent. Also, unlike in many other professions where the work is specific to the worker and can't be transferred, simply piling up while the person recovers, there's no reason my partners in the practice can't see the various earaches, sore throats and coughs that I am unable to see. They literally have to work harder if I'm not there, and knowing this makes me feel guilty as I squint to see if my temperature has gone down.

Is this a great way of looking at illness? No. Thankfully (said while frantically pounding on wood), I seem to have developed enough immunity to what the local pediatric germ pool has to throw at me that illness is very rare. But the pressure to suck it up and come to work anyway is pervasive, and I think it'll probably be present in the medical community for at least another generation.