It's a toxic combination of denial and bravado, as well as a conviction that we’re somehow different from patients.
I woke up with a parched throat and a low-grade fever, and when I coughed, I phonated with a high-pitched squeak. The diagnosis was obvious.
I had laryngitis and couldn’t speak with my normal timbre. My shift was only an hour from starting, and I was consumed with guilt and fear as I knew that there was nobody to replace me.
There was no point calling in with no voice, but I was even fearful of sending a text message to my colleague, for fear of not being believed.
I started imagining the frenetic scramble of colleagues trying to replace me. I ruminated, pacing in silence, catastrophising despite knowing I had always been thought of as a conscientious worker and was genuinely unwell.
Swallowing a concoction of paracetamol, ibuprofen, honey and lemon, I drove to work. As I arrived, I squawked at a co-worker: “Hi, I’m so sorry I’m a couple of minutes late. I feel a bit under the weather and overslept.”
She replied, “Oh no, you have it too! It’s going around the whole department. Are you sure you’re going to be all right for the next 10 hours?”
I felt immediately relieved and exonerated from any blame, knowing that my symptoms had become validated and were indeed not fictitious. I would make it through for as long as I could, I whispered.
I should have gone home to rest my voice and called in sick for the next day. But I was on duty now, and it was too late. I was already surrounded by a sea of medical staff as handover had commenced.
Why don’t doctors call in sick?
Health-care professionals can be the worst patients.
Doctors can be unimaginably stubborn when they are suddenly in the sick role. Like me, many of us ignore symptoms and think we’re invincible and immune to illness.
Unless we think we need to be hospitalised, we resort to quick-fix over-the-counter remedies to alleviate any symptoms and soldier on, which only covers up the underlying pathological process.
This behaviour often stems from medical school. Taking a sick day was for the weak.
Though learning about illness was essential, acquiring knowledge became a foe as well as a friend. A few of my student colleagues (including me at one point) developed an element of “medical student syndrome”, where you self-diagnose with the symptoms you’re studying.
It was also not uncommon to feel neurotic even though you were dismissing actual physical or psychological symptoms.
Mental exhaustion, especially in the days leading up to exams, carried even more stigma as you appeared physically “well” on the outside when you knew your body was craving rest and recuperation.
This behaviour often carries on when you are a junior medical practitioner. The sense of responsibility to our patients can be overwhelming, especially as overnight you have become a professional.
As an intern, I recall a very diligent, otherwise healthy colleague contracting respiratory bugs from her patients week after week despite following rigid infection-control protocols and policies.
Her white coat would be stuffed with Kleenex packets and blister strips of various cold and flu remedies. She convinced herself that her immune system was disordered and developed a “martyr complex”, which only fuelled her persistent feelings of guilt, remorse and embarrassment.
Eventually, I asked her to reframe her thinking, treat herself as a patient and stop irresponsibly turning up to work coughing and sneezing.
Six months later, she asked me to take my own advice. Regrettably, I didn’t.
What perpetuates this behaviour?
During my later years of specialist training in the mid-2000s, I conducted an informal survey of colleagues about their sick-day behaviour.
More than 70% admitted they had turned up for work knowing they were contagious or displaying symptoms that could potentially infect their patients.
Many hospital doctors operate in surroundings that are notoriously under-resourced and understaffed. They conscientiously adhere to unforgiving rosters that have been written tightly in advance, many of which lack an on-call system to replace them at the last minute.
And the more senior you become, the harder it can be to replace you, especially if your working pattern involves unsociable hours.
As in many professions, sick leave hours are capped, as is any other form of leave.
Remuneration is often inadequate in the early stages of one’s career as young clinicians constantly battle financial hardship in an attempt to claw themselves out of substantial university debts.
General practitioners, of course, have all this and more – or rather, less.
Add a desire to not let colleagues down, or get in superiors’ black books, and the pressure can become overwhelming.
Speaking out may elicit warnings that you are committing “career suicide”.
Those left to fill in for others become overworked themselves, leading to periods of burnout, especially for individuals who may be more sensitive and vulnerable. Without a buffer to counteract this problem, waiting times increase, as does the number of clinical errors.
Productivity declines, morale begins to dwindle, and patients get a raw deal.
Breaking the cycle
Of course, this pattern of behaviour from medical professionals is simply ridiculous. Doctors would never suffer it in others, especially their patients.
It’s a toxic combination of denial, ignorance and bravado that can ultimately lead to the sick treating the sick.
But many of us feel we are a different species from the patients we are treating. We’re the ones who heal the sick, aren’t we?
No, is the simple answer. We’re just like any other patient.
Doctors (and all other health care professionals) need to remind themselves that illness, whether physical or mental (or a combination), is the fate of us all at some point.
With respectful and supportive colleagues who realise this, doctors should be encouraged to take sick days to restore professional and personal equilibrium. This should be guilt-free and devoid of any fear of repercussions.
This also bolsters the paradigm of “self-compassion”, an alien concept that was never discussed at medical school despite the countless lectures, tutorials and seminars that I attended.
So, what happened during the rest of my shift?
Toward the end of my 10 hours, I resorted to using a pen and clipboard to communicate – I was effectively useless. I had no choice but to stay at home for the rest of the week.
On my sick days, I lay prostrate on my couch at home, writing in silence, and began composing a version of this piece.
Upon returning to my normal duties, I distributed this to my medical fraternity as a reminder that in terms of sickness, there is often a very fine line dividing ourselves from the patients we love caring for.
Dr Paul Labana is an emergency medicine specialist.
