'No one wants to take a day off.' The pressure on doctors to continue to work when they're sick.

Over the weekend, a doctor was named and shamed in the media.

Victorian Health Minister Jenny Mikakos spoke about a GP in Melbourne who had tested positive for COVID-19. She said she was ‘flabbergasted’ that he would continue to work, exposing 70 patients to the virus, and that his ‘irresponsible’ decision was something for the medical board (AHPRA) to pursue. There are so many things wrong here, and it has caused the medical community to respond with outrage. I’ve summarised some of the arguments:

Confidentiality.

The doctor is now a patient with coronavirus. His right to privacy as a patient has been breached when details about him were released. His gender, approximate age, and workplace were revealed and it didn’t take long for the media to identify and name this GP, who happens to have a famous daughter.

For him to be named and shamed is completely unfair, especially as he didn’t do anything wrong. His business is now threatened by this negative press.

The GP followed guidelines.

This GP did not meet the criteria for testing. He had travelled to a country (USA) that was not considered high-risk at the time, and his only symptom was a runny nose which had mostly resolved by the time he went back to work.

When he did get tested, which he chose to do for the sake of ‘completeness’ (as he has since come out to explain), he informed the relevant parties, stopped working, and his patients were notified and managed appropriately.

If every doctor who had a runny nose didn’t go to work, the health system would collapse.

Listen: An infectious disease specialist answers your 20 most pressing questions about COVID-19. Post continues below.

What it means for a doctor to call in sick.

What this story highlighted for me was the fact that politicians are so out of touch with reality. I think Jenny Mikakos made a blunder in her statement, but she is not a bad person.

I met her last year when she supported a doctors’ mental health event (the launch for Crazy Socks 4 Docs), and I got the impression that she genuinely does care about doctors. What she perhaps doesn’t know is what it’s like on the front line. The public health system is already under-resourced and doctors don’t want to burden their peers.

Cultural factors.

Doctors give each other grief (often behind their backs) when a colleague calls in sick. It’s one of the unfortunate things about the culture in healthcare.

There is a lot of cynicism when a doctor calls in sick, especially if it’s a Friday or a Monday. People automatically assume that they’ve ‘chucked a sickie’ to enjoy a three-day weekend. Doctors become cynical because they are burnt out and the thought of having to cover for someone else when they’re already under the pump is overwhelming. Because of this, doctors are reluctant to call in sick. Discussions about this on Twitter were triggering for me.

Dr Jill Tomlinson (@jilltomlinson) is a plastic surgeon in Melbourne and she recounts her experience of being sick when she was a registrar. Her supervisor had instructed her to take the Monday off, but she turned up knowing what other doctors are like.

Other Boss standing next to him said “yes, so it’s a good thing you turned up, because we would have pretended it was okay, but really we would have been giving you s*** behind your back”.

— Dr Jill Tomlinson (@jilltomlinson) March 7, 2020

The response she got from her bosses validated what she feared – that it’s not okay to take time off work. Reading her thread reminded me of my own experiences as a plastic surgery registrar.

I was sick a few years ago during a long stint of being on call. The senior registrar had changed the roster and I was doing a lot of on call shifts.

Another registrar and I would often screenshot our phone logs because we were astounded by the number of calls we would receive when on call (plastic surgery is a very high volume specialty).

Surgical registrars have an unhealthy preoccupation with who gets ‘slammed’ the most. It’s almost a ‘survival of the fittest’ competition to see who can cope with the most demand. My eighth and ninth days during that particular stint looked like this:

I was absolutely exhausted and passed out on the Wednesday. None of my colleagues gave a damn. One of them came to get me at 1pm to make sure that I would come and help at the clinic.

The next day, one of the senior surgeons came up to me in the operating theatre and asked if I was okay. I smiled, said I was fine, and continued on with the list.

Later that morning, he found me at a desk writing up an operation report, and he asked again, ‘are you sure you don’t want to talk?’. He had found out what had happened and was furious that the roster had been manipulated without consultant approval.

He was concerned about my wellbeing and insisted that I take the next day off. Perhaps he could see that I was burning out. He even put it in writing, with this rather sweet emoji-filled email:

I didn’t know what to do. I was sick but I really didn’t want to take Friday off. I knew it was going to be a busy day with a consultant clinic. Unlike Jill, I decided I would rest, and I regretted it later.

I got a cold response from my fellow registrars and bosses who were extremely unhappy about me not being there. I was devastated and I panicked about what the consultants would think of me. I confided in the head of unit, whom I had a good relationship with.

He told me I had nothing to worry about. I had taken on the most burden that term, which was reflected in my operation numbers. But I did worry. I had thoughts like, what did I do? Why did I take a day off? They’re going to think I’m a slacker now.

These are the things that are happening every day in the health care system. No one wants to take a day off. Everyone wants to protect their reputation. In a job climate that is becoming more and more competitive, we can’t afford to take a day off and risk looking ‘weak’ or ‘lazy’. That’s the reality.

Medical workforce.

And you know what makes it even harder to take a day off? The medical administration.

Heard in every hospital everywhere
"I'm on call tonight, have a fever so I better not come in"
Medical workforce at every hospital everywhere
"Well if you chose to get sick you'll need to find someone to cover you. That's not our job"
Said everyday everywhere.#springst

— Helen Schultz (@drHelenschultz) March 7, 2020

Dr Helen Schultz (@drHelenschultz) is a psychiatrist in Melbourne who won the Patrick Pritzwald-Stegmann Award at the Australian Medical Association (Victoria) Awards last year for her mental health advocacy. She runs a clinic for medical students and doctors, and knows very well the pressures young doctors face when they have to call in sick.

You’d think a department called the medical ‘workforce’ might take responsibility for covering sick doctors, but no. Many hospitals make it the sick doctor’s responsibility to find another doctor to cover for them, which is incredibly hard to do. Most doctors are stressed and burnt out, so we don’t want to burden them even more by asking them to cover our shifts when we are sick.

What it also means is that you have to pay that doctor back, so you may end up doing an extra shift on another week to make up for it – the thought of which is also very stressful.

Another excellent thread on Twitter is by Dr Sonia Fullerton (@sonialf), a Palliative Care Physician in Melbourne, who summarises the systemic factors that contribute to doctors working when sick.

She also describes the scenario when a doctor does call in sick, and the havoc it wreaks. Another consideration is the fact that GPs are private contractors, which means that they do not have the same leave entitlements as doctors who work in the public health system.

6/6 I hope you get to read this Minister @JennyMikakos and @VictorianCHO and address this issue of doctors feeling unable to take sick leave due to systemic, not personal, failings. I hope you are less surprised now that doctors keep on working #coronavirusaus

— Dr. Sonia Fullerton (@sonialf) March 7, 2020

Ramifications of naming and shaming.

The GP who contracted COVID-19 was named and shamed, which has ramifications not just for him, but for all doctors – summed up perfectly by this tweet from Dr Neela Janakiramanan (@NeelaJan), a plastic surgeon in Melbourne:

All that has happened is that no one working in the health industry will disclose symptoms or get tested, not if they will be named and shamed and pilloried by politicians, even when they have acted entirely within the published guidelines at the time. https://t.co/P6A4QMlx1d

— Dr Neela Janakiramanan, FRACS (@NeelaJan) March 7, 2020

What has happened will undoubtedly affect business for this GP and his clinic. Moreover, the AHPRA threat also raises concerns.

Being reported to the medical board is a life-changing (and sometimes even life-ending) event for doctors under investigation. It reminded me of the suicide of anaesthetist and intensivist Dr Richard Harding.

His wife Dr Kate Harding bravely shared the story of her husband’s suicide in 2018. A complaint against Richard had been made to the General Medical Council, which led to a five-month investigation.

Even though the matter was resolved in his favour, the impact of this complaint lasted far longer than the investigation, causing Richard to fall into a depression. He later took his own life.

Threats to report a doctor to AHPRA should not be made lightly. Doctors work so hard for their patients, and receiving a complaint is devastating.

This news story has really made me sad today.

I want doctors to be more compassionate towards each other.

You don’t know what’s going on in another person’s life. They may need time off due to a tragedy. They may be having a relapse of a chronic condition (physical or mental). They may be it’s none of your f*cking business. If a colleague takes a day off, be respectful. One day you may need to take a day off, too.

Doctors are not immune to illness. If a doctor becomes sick, they deserve the same confidentiality as any other patient.

Shaming a doctor and threatening to report them to the medical board can destroy their career, and is detrimental to their mental health.

I am glad to see that the medical community is fully behind the GP in Melbourne. We support you. I hope you are recovering well from the illness and that you are able to return to work as soon as possible.

This post originally appeared on MindBodyMiko and has been republished with full permission. For more from Miko, you can follow her on Facebook or Instagram.