Wednesday, 6 August 2008

Doctor, heal thyself. And hurry up, for f*$k sake, there’s plenty of work to be done. Posted by Dr. Jane Doe.

I had intended to continue on with my cost cutting theme and bang out another simple idea for saving money within the health service. However, I’m angry about something and I think I’ll share:

I’m feeling a bit under the weather today. It’s nothing serious, but I am too unwell to work today as I am feverish, my glands are swollen, and I’m fairly miserable. It’s definitely contagious.

Now do I,

A) Suck it up, get my ass into work anyway and work anything from 8 to 36 hours straight with no designated break or sleep taking care of critically ill patients and making important decisions regarding their treatment and diagnosis while feeling terrible myself, unable to concentrate, almost unable to keep going, not to mind give them my full attention, such as it is at the moment? And almost certainly pass on my lovely virus to them? Being old and frail and already ill it might even be the straw that broke the camel’s back. And drive home afterwards in an impaired state and possibly endanger fellow road travelers as well as myself.


B) Recognise that my performance and decision making ability as a doctor is very likely to be seriously impaired today in addition to the fact that I have a responsibility to both patients and other health service staff members not to be at work when I may pass on a contagious illness and affect their health adversely and potentially cost the health service more in sick leave for others. If I become sick while at work, then after notifying my line manager who arranges cover I am expected to get a taxi home at the hospital’s expense if I cannot arrange for someone to pick me up.

I have done both. A) is the course of action you are expected to follow in one of the countries I have worked in. B) is the course of action you are expected to follow in another. In both cases the expectations are those of management as well as your seniors and even colleagues at your own level and you are obligated to follow them to the letter, and if you make the wrong decision, the consequences will be on your head.

Which do you think is the right attitude to have towards your job and responsibilities?
Which do you think is the right attitude to have towards the public service employees you are responsible for? Which do you think is the right attitude to have towards your juniors or colleagues? Which is the right attitude to have regarding patient care?

There is a climate of fear in one of the places, and often if you are so unwell that you physically cannot come to work and you do notify management, they will become angry with you, particularly if you are rostered for a 36 hour shift that day. In some places they make another of your colleagues pick up the shift, and then when you are back at work you have to pay them back in addition to doing all of your own extended shifts that week, rather than attempting to get a locum in. Working a 110+ hour week when you are convalescing is a real picnic, let me tell you.
You notify your colleagues, and you can get a mixed response, but usually they are disappointed and more than a bit angry with you. This is because they are going to have a bloody AWFUL day trying to pick up your work along with their own, and everyone is already stretched to over capacity. They too, feel the absence of a locum keenly as they stay on late that evening trying desperately just to make sure the patients are safely looked after, and stable. They won’t thank you for taking time out. I have heard of doctors working when their temperatures are so high that they are actually hallucinating, and still no-one stops them or makes them go home (or admits them to hospital, at least until they collapse!)
The doctors cannot stand up for themselves. There is no support from any quarter. In many cases there is nothing much they can do at all, and they soldier on. But they suffer and patient care suffers too. And no-one does anything about it at all.

In another of the places there is a climate of honesty, openness and taking responsibility for your actions. You are expected to recognize when your performance may be suboptimal, for any reason, including stress, and take appropriate action and notify the appropriate person when relevant. There are ample provisions in place for the inevitable event of staff members becoming ill, or needing maternity leave, or bereavement leave or even a holiday. A pool of medical and nursing staff employed specifically to cover absence are available in the hospital at all times and are allocated on a priority basis according to the activity levels of the services requiring cover. In the unlikely event of all the pool staff being utilised on the same day, a universal bleep goes out to all other similarly qualified staff in the hospital offering extra money and/or time off in exchange for covering the gap at short notice. This almost always works, and averts the need to attempt to find a locum.

I must emphasise I am not referring in the above post to any specific recognised policies or procedures in place at any specific location. Many countries share the type A) mindset with the place I worked, and many countries share the type B) mindset. Both are a way of thinking put into practice. One works well, and one doesn’t. In the end, one ends up saving more money than the other. The thing is, the one that sounds initially more expensive is the one that in the long run works out much cheaper, and I’m not talking about anything other than money here.

Anyone have any thoughts about which one is cheaper, and why?


  1. I think it must be cheaper to have a doctor working at full capacity as the opposite could be fairly catastrophic if a wrong decision is made when a sub-optimal doctor is working, and especially if they are working long hours.

    Plus ca change plus c'est la meme chose.

    It was just like that for nurses back in the day. The only excuse was to be lying in a hospital bed

  2. The answer to all your questions is B)

    Why? Because it's the right attitude towards everyone involved and it's cheaper in the long run because of less cross-infection of others (colleagues and patients), less time off work due to optimal rest, better work performance due to less stress (no climate of fear), and you're facilitated to take pride in your job. And finally, the icing on the get to blog about being sick while being paid!

    Do I get a prize? ;-)

    btw Hope you're feeling better soon!

  3. I remember that very dilemma well, Jane, when I was working in the UK. Bear in mind I spent most of my time working with severely immunocompromised premature babies. You know that if you come in, you might give them your flu, but if you don't, you're colleagues have to cover a double shift.
    No-one higher up gave a toss. I was ill the other day here in oz....I phoned in to tell them. They got the DEDICATED RELIEVER DOCTOR to cover for me. In my hospital, we take turns to go on the reliever roster, where you spend a few weeks covering anyone who's off ill. If there's no-one off ill, you go and work in A+E.

    However, as I'm on holidays in Sydney this week, I'm gonna put those rage-inducing thoughts out of my head for now :D

    Dr. Thunder

  4. We have the reliever thing here too-I'm doing it at the moment! Sometimes you just go help the team on call if no-one's away. Why don't they have that at home? It's so DUMB not to!