Thursday, 23 Jan 2020

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“Doctors Don’t Get Sick”

If you’re like me (an invincible, omnipotent joint stabber), then you haven’t called in “sick” in years.  I haven’t had a sick day since my knee replacements five years ago and before that, it was during the Eisenhower administration (I was born in hospital then).  

We physicians are clearly better at defining “too sick to work” in our patients than we are for ourselves.

After pondering this ill issue, I’ve come up with some wisdom, goofiness and facts.

The Wisdom

  • Physicians are not allowed to get sick.  My employees can text me with their last minute illness and expect support, forgiveness and a ‘don’t worry – get well’ response. Physicians who call in sick are wimps. It doesn’t matter if I’m under the weather – I still have to work.  Not showing would punish my colleagues and my patients. The schedule, clinics, meetings or surgery won’t allow for an absence and come with the contractual asterisk that says “don’t even think about being sick.”  

I once scheduled a colonoscopy but forgot I was to give a keynote lecture the evening before – yes, just as I was to initiate my GoLYTELY excavation. I could’ve canceled. Instead, I did the math and did the lecture. I’ll spare you the details, but suffice it to say that you can run through a 45 minute lecture between bathroom sprints. Wisely, I did announce at the outset that, out of respect for their time, there would be no questions at the end - as I ran off waving 2 fingers like Joe Namath after Super Bowl III.

  • We’ve seen the enemy and we are not them.  Physicians tend to the sick, defend them from the ICD-10s and manage the mess that sometimes ensues. The rheumatologist who plays doctor all day long is unlikely or unwilling to play doctor whence they go home. Hence, we are less likely to be sick, want to be sick or dwell on being sick in our private lives. Many assume healthy lifestyles: that we spend discretionary income on the best running shoes, take Pilates lessons taught by monks or wear nit-wit bits to quantify caloric expenditures. Each one designed to avert that which we treat daily. 
  • Sick pay is for real people, not doctors. It’s an illusory benefit designed to tempt employment. But most of us have found out it’s more like the Easter bunny or Tooth Fairy.
  • Physicians can be delusional. Despite what we may think, the prescriptive authority does not entitle you to a pass on the sickness that goes around. And for the same reason that your patients are NOT more likely to get that rare drug side effect – neither of you are as “exceptional” as perceived or erroneously rationalized. Instead, the sick physician is more likely to a) deny it; b) rationalize it; or c) self-diagnose and manage it. Of course you’ve heard the joke that the doctor who treats himself has a fool for a patient.
  • Nobody’s business. When and if you do get sick, you keep it to yourself. Pride, privacy, HIPAA and no-buddies business all lend to the allusion of the doctor who doesn’t get sick. Patients don’t want to hear about their doctors being sick. Instead they prefer to hear about other patients and problems like theirs.
  • Chalk it up to nothing. Several studies have shown that >80% of the time, the contagious physician will go to work. When you were a med student, you potentially developed 2-3 conditions with each page turn of Robbin’s Pathology Textbook. Now, instead, you ignore the hip pain, mystery groin, the thriller in the axilla and shrug it off with your favorite diagnosis- “ah that was nothing.”
  • Follow your own advice.  When the physicians’ behavior screams of “do as I say, not as I do”, the Hippocratic becomes hippocritic.  Most are delinquent in their medical follow-up visits. When someone is referred to as “a doctor’s doctor”, it’s meant as an accolade to the physician we admire, rather than what it should mean – the doctor's PCP. Can the rheumatologist who doesn’t have a PCP gripe at his/her patient for not having one?

The Goofiness
Herein lie many statements that just don't hold up...all begin with, “Doctors don’t get sick because”: 

  • They should know better.
  • They get vaccinated more than the rest of us.
  • They wash their hands more than us.
  • They are exposed to everything – hence, they are immunized against it all.

The Facts

  • Hand Washing. While this may be the most important advance in deterring the spread of disease, physicians are often admonished for not being as vigilant (60%) as the nurses (71%) in preparatory hand washing. 
  • A Doctors’ Doctor. A notoriously high percentage of physicians do not have a PCP or go to a walk-in clinic or specialist only. Not only are we less likely to seek help, we more frequently engage in self-care and self-prescribing.
  • Survey Says. According to the Great American Physician Survey 2014 (1344 respondents), only 50-60% of physicans get adequate sleep, exercise regularly, follow their doctors advice or use alternative treatments.
  • Suicide and Depression. Depression is at least as common in the medical profession as in the general population, affecting an estimated 12% of males and 18% of females. Yet physician suicide rates are higher, with the most reliable estimates ranging from 1.4-2.3 times that of the general population.
  • Substance Abuse. The lifetime risks for substance abuse in physicians (12-18%) is either the same or higher than non-physicians.

The Good News

  • Physicians are more likely than the general US adult population (78% vs 65%) to meet US guidelines for physical activity, with many more US adults not engaging in physical activity (25% vs. 6%).
  • Physicians have significantly lower rates of diabetes, hypertension, hyperlipidemia, peptic ulcer, hepatitis C, hepatitis B (0.44%), cirrhosis, and ESRD.  Physicians have similar rates of autoimmune disease compared to the populace.
  • Physicians may have an overall lower rate of cancer (adjusted HR = 0.78) compared to the general population, but have higher rates of thyroid, prostate, breast, ovarian and uterine cancers.

Summary

I asked my sage practice partner, Dr. Kathryn Dao, what she thought of this blog entitled, “why doctors don’t get sick”?  She immediately yelped, “That’s NOT true!”  Seems I should’ve asked her first.

Physicians do get sick. I’ve been surprised to learn of the many efforts to address physician wellness, physician health and preventative medicine amongst physicians. If you happen to have such a program at your center or at your disposal, recognize how fortunate you are and seize the opportunity to be a better healthier you. These programs exist to combat the infallible, selflessness and lifelong devotion to medicine that tragically leads to burn-out, job dissatisfaction and higher suicide rates.

The historic quote from Luke - “Physician heal thyself” - was not meant to be a call for autonomous self-care. Instead it was intended to mean, fix your own home before attempting to fix others.  

My question to you (the physician) is, “who is taking care of your health”?  I pray it's someone smarter than you.

 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject
Dr. Cush is the Director of Clinical Rheumatology at the Baylor Research Institute and a Professor of Medicine and Rheumatology at Baylor University Medical Center in Dallas, TX. He a Professor of Clinical Medicine at the University of Texas Southwestern Medical School.
 
Dr. Cush is the Executive Editor of RheumNow.com and also Co-Edits the online textbook RheumaKnowledgy.com. 
 
Dr. Cush's research and interests include novel drug development, rheumatoid arthritis, spondyloarthritis, drug safety, pregnancy and Still's disease/autoinflammatory syndromes. He has published over 140 articles and 2 books in rheumatology.
He can be followed on twitter: @RheumNow.

Rheumatologists' Comments

I don't get it--you won't take off when you are really sick, but you'll take off for the Ranger's Opening Pitch????
Sick I can overcome. Baseball and hockey I have to get those off my brain so that I can be sharper when seeing patients (not fair to have your partner call you out on the truth, so on this one Im trying to look like a duck, calm on top but peddling like heck underneath).