Call in Sick?

Everyone needs a sick day once in a while, but healthcare professionals need a sick day more than most. A 2001 news release from the Canadian Institute for Health Information reported that healthcare workers were 1.5 times more likely to miss work due to illness or disability, when compared to workers in other sectors. Furthermore, this is a long-term trend that has continued from 1987 to 2000.

The news is hardly surprising, since working in healthcare comes with many health risks. In addition to frequent exposure to infectious diseases, healthcare professionals also deal with biohazardous agents, chronic stress, burnout, and other on-the-job hazards.

Reasons to Stay Home

The arguments for not working while sick are clear. Sick employees who show up to work risk infecting patients and colleagues, and also prolong their own illness. For example, a 2006 fact sheet from the Institute for Women's Policy Research (IWPR) reported that a worker with the flu is likely to infect 1.8 out of every 10 coworkers, a scenario that could be disastrous in healthcare settings.

The CDC Guidelines for Infection Control in Health Care Personnel, 1998 lists common infectious diseases, and gives recommendations on what duties healthcare professionals should be excluded from when ill. Some hospitals also have their own infection control guidelines that restrict sick employees from working. The CDC also recommends that hospital policies should "encourage personnel to report their illnesses or exposures and not to penalize them with loss of wages, benefits, or job status. Workers' compensation laws do not cover exclusion from duty for exposures to infectious diseases; policies therefore should include a method for providing wages during the period that personnel are not able to work."

Of course, these scenarios assume that the sick healthcare worker knows exactly what disease they have and are taking the correct steps to treat it. But even doctors make mistakes in self-diagnosis and treatment. In 2003, a Midwestern doctor continued to work through what he believed was a bout of bronchitis, but which turned out to be active tuberculosis. Even more alarmingly, a New York City hospital worker with tuberculosis may have exposed 500 patients to the disease, including 200 newborns (The New York Times, March 16, 2007).

Presenteeism is defined as lost productivity that occurs when a sick employee shows up to work, but cannot perform at full capacity. Since the phenomenon is so common, the economic cost of presenteeism has actually exceeded that of absenteeism. A 2005 publication from the Center for Law and Social Policy reports that 72% of lost productivity due to illness was caused by presenteeism, and 28% was caused by absences. The total cost of lost productivity due to illness is estimated at US$250 billion per year, and presenteeism accounted for US$180 billion of that figure.

Reasons People Work While Sick

Among healthcare professionals and the general public, there is a great deal of pressure to work while ill. In the general population, economic necessity is the number one reason that sick people show up to work. A 2006 fact sheet from the IWPR reports that only 51% of Americans workers have paid sick days. Many employees cannot afford to take unpaid sick days, and some fear losing their job if they miss work. Even employees who are entitled to paid sick leave may not use it out of fear of being penalized.

Healthcare providers have additional reasons for dragging themselves to work while ill. Since patients' wellbeing and lives are on the line, healthcare professionals often feel obligated to show up as long as they can perform their duties. Many healthcare workers have an altruistic mentality, and feel that they should put the needs of their patients and colleagues before their own.

Doctors are notoriously remiss at writing sick notes for themselves. A study published in the March 2001 issue of the Scandinavian Journal of Public Health found that 80% of physicians had worked during an illness for which they would have sick-listed their patients, and more than half had worked while they had an infectious disease. This behavior is common enough that some have dubbed it "the disease of the doctor." "Both physicians and their patients may act unconsciously as though physicians are not supposed to become ill. Self-treatment, sometimes inadequate or incorrect, is frequent and denial of disease is rampant, occasionally aided and abetted by colleagues and family," one doctor noted in an article published in the December 16, 1998 edition The Journal of the American Medical Association. Not wanting colleagues to take on extra work was the top reason given not taking sick leave, according to a study of junior doctors and sick leave, published in the September 2003 edition of Occupational and Environmental Medicine. For physicians in private practice, calling in sick can also carry financial repercussions, since the staff and overhead costs must still be paid while they're away.

Nurses also feel pressured to work while ill. Staffing shortages, peer pressure, and a sense of responsibility towards their patients and colleagues are the primary reasons sick nurses will still report for shifts, according to an article published in the January 2005 edition of Journal of Nursing Administration.

In order for these trends to change, healthcare professionals must place greater emphasis on self-care, and employers need to focus more on their employees' heath and wellbeing.

How to Assess Yourself

According to advice from WebMD, sick employees can work if they are not a danger to others, pose little or no risk of infection, and are capable of performing most of their job duties. Therefore, the common cold and other minor illnesses usually do not require a sick day.

But what about circumstances that are less clear-cut? In an article published on January 1, 2004 in American Family Physician, the author recommends performing a quick risk-benefit analysis. What risks do you pose to your patients, colleagues, and yourself by working? What benefits will your day's work bring? If the benefits outweigh the risks, then it's time to go to work.

Prevention & Precautions

Healthcare workers should follow the same advice they give their patients: Concentrate on prevention and healthy living every day, and focus on recovery when illness strikes.

Prevention:

If you must work while sick, follow these precautions:

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Healthcare professionals who work while ill put their patients, coworkers, and their own health at risk. So the next time a nasty bug strikes, pick up the phone and call in sick. Your body, your coworkers, and your patients will thank you.

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