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Survey finds clinicians report to work sick despite risks to patients

by Lauren Dubinsky, Senior Reporter | July 07, 2015
Emergency Medicine Primary Care Risk Management
For hundreds of years, the guiding standard for health care workers has been “first do no harm,” but sometimes staffing limitations work against that goal. Many physicians, registered nurse practitioners, midwives and physician assistants go to work sick even though they are aware it puts patients at risk, according to a small survey published by JAMA Pediatrics.

The researchers received survey responses from 280 attending physicians and 256 advanced practice clinicians (APCs). The survey found that about 95 percent of them believe that working while sick puts patients at risk but that 83 percent have done it at least once in the past year and about 9 percent have at least six times.

Diarrhea, fever and the onset of considerable respiratory issues were among the symptoms that the physicians and APCs worked with.
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Nearly all of them reported working under those conditions because they didn’t want to let a colleague down. About 95 percent had staffing concerns, 92.5 percent didn’t want to let patients down, 64 percent were afraid of being ostracized by colleagues and about 64 percent were concerned about the continuity of care.

The researchers then evaluated written comments from the respondents to get a better idea of the situation. The comments explained that finding someone to cover their work poses logistical challenges and that there is a strong cultural norm in the hospital to work unless extremely sick, as well as uncertainty about what symptoms indicate someone is too sick to work.

The physicians who worked while sick were considered courageous but physicians who stayed home were regarded as slackers. In addition, hospitals are putting an emphasis on revenue-based productivity metrics and there aren’t robust systems in place to deal with the absence of physicians and APCs.

In a related editorial, Dr. Jeffrey R. Starke of Baylor College of Medicine and Dr. Mary Anne Jackson of the University of Missouri-Kansas City School of Medicine recommended that institutions develop policies and programs that allow temporary replacement of sick staff who care for high-risk patients. Occupational health and infection control departments also need to clarify what constitutes being too sick to work.

"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 - internal and external - associated with HCW illness,” they wrote.

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