How doctors hurt patients they're trying to help

It might be time for doctors and other healthcare professionals to stop playing the martyr. Your patients might actually be better off if they're not in the same room with you.

Dragging yourself into work even if you're ill is still something many doctors do because they don't want to leave patients with inadequate care, burden their colleagues, or forgo pay. As many as 80 percent of physicians continue to work despite their own illnesses, according to a recent Journal of General Internal Medicine article. In the past, being present seemed to cause fewer problems than being absent, notes Dr. Pauline Chen in the New York Times.

But the tide may be turning, she suggests. Chen notes that researchers are beginning to see presenteeism--the practice of going to work sick and therefore, not fully functioning--as a problem to be avoided. From a business standpoint, presenteeism costs $150 billion in lost worker productivity, according to the Harvard Business Review. From a healthcare perspective, when doctors and other healthcare workers go to work sick, they pose patient safety risks as potential infectious disease vectors.

A report in the November issue of the Journal of General Internal Medicine notes the impact of sick healthcare workers runs counter to the Hippocratic Oath to abstain from doing harm. Dr. Eric Widera of the San Francisco Veterans Affairs Medical Center and his co-authors describe a norovirus outbreak at a 100-bed long term care facility. Healthcare providers went to work ill, despite mounting evidence that their presenteeism was perpetuating the outbreak.

To remedy this situation, Widera called for policies to make unrestricted paid sick leave available, the creation of systematic processes for screening sick employees and mandatory exclusion rules.

In an accompanying commentary in JGIM, two doctors go further and suggest telemedicine may be a solution when a face-to-face visit in the same room is not absolutely necessary. "Telemedicine by phone, videophone, Internet, or email, may be an acceptable alternative when a face to face visit is not absolutely necessary," the authors write.

To learn more:
- read the Journal of General Internal Medicine article and accompanying commentary
- here's the New York Times article
- here's the Harvard Business Review article

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