Physician, Heal Thyself
Thomas Robey -- How many colds have you had this season? I'm working on number two. This is from a man who can count on one hand the number of times he missed school in grades K-12 because of illness. Okay, maybe two hands, or a polydactalied hand. Whatever. I've been sick in the third and fourth years of medical school more than any other time in my life. For example, the only time I remember vomiting (ever!) was on my medicine clerkship in Spokane. And I even drink from mountain streams. So what gives?
1. Stress. Lots of it. Long hours. Wanting to learn EVERYTHING, like memorizing the eMedicine article about hepatic encephalopathy.
2. Not eating well. Granted, hospital food is great, especially when it's free. Wait a minute... “Hospital food is great?” I am sick.
3. Not exercising as much. Taking the stairs helps, and that 20 pounds I lost on my emergency medicine rotation wasn't only because I forgot to eat twice during the 12 hour shifts, but being on your feet doesn't cut it for getting the heart rate above 120.
4. Vectors, fomites, sick contacts... we get them all.
5. Sympathy for your patients.
6. Sleep? We don't need no stinkin' sleep.
7. “But I got the influenza vaccine...”
You get a medal if you get through these two years without a viral URI, the flu (stomach or real), strep throat, sinus infection or scabies. For those of you without a medal around your neck, the next test is what you did after you got sick.
The sick doctor has an obligation not to infect her patients. “First, do no harm.” How do you draw the line about deciding to come to work? Stay home with active vomiting? Sure. Is it okay to have a runny nose on pediatrics because everyone else does? In the OR, you'll get you no sympathy from the scrub techs. “Aw, the medical student is spotting his mask...” is as uncomfortable as if I were spotting somewhere else. Lower GI problems? No one wants you around. Don't even think about it! But I'm sure some of us do. After all, not only are we students part of the provider team, we are learning and being evaluated. Missed work equals missed opportunity, right? I don't think so. If you are sick, you're not going to learn. Instead, stay home. Yes, students help the team. But remember your first month on the wards? The team got on without you. They can get by one more day, but be sure to call in. They'll probably thank you for staying home, too.
So what can you do to get back ASAP? There's a lot of stuff that people say works. Many swear by that effervescent pill Gas-Birth. (Names were changed to protect the clinically disproven.) There's something special about chicken soup -– especially if someone else makes it. Drink fluids when you're down. Stay healthy with fruit, exercise, sleep. You know the drill: you've told patients hundreds of times. The CDC promises us the flu vaccine is going to work this year -– get that not for yourself, but for your immunocompromised patients. And you probably know you should be washing your hands AND using hand gel more than you think you need to. Cover your nose. Wipe down your workstation. In the end, the best advice I've received is simply to stay home. You'll be back to your eager medical student self faster that way.
Well, I am especially prone to illness and my career choice is ob-gyn. I anticipate catching all sorts of maladies during clinical rotations. The best advice you give here is 1) wash, wash and wash your hands and 2) stay home when you are sick.
Posted by: katherine | Oct 16, 2008 9:27:05 AM
Yay, Dr. Smelweiss (sp?)...too bad no one caught on to his germ theory 'til so much later...! Wash your hands! Poor Dr. S....i always think of him when topics like this come around.
Posted by: tfb | Oct 17, 2008 6:40:44 AM
do u mean to say that i should stay in the hostel half the year
Posted by: a s | Oct 20, 2008 4:14:37 AM
calling in sick doesn't always work! u sometimes have to actually collapse for anyone in the hospital setting to actually believe u are feeling crappy. or at least thats the way it seemed in the hospital where i went thru my internship. i went to see the dr on call with my temprature of 38.4 degree C and throat that felt like it was being torn into bits. and starting from the record clerk to the nurses, orderlies etc i got very little sympathy.the most popular statment was 'come on!drs dont get sick;u sure u just not trying to bail out on work'. it hurt. cos im rarely sick and hardly ever run away from my work.
Posted by: | Oct 22, 2008 11:01:12 AM
Apart from the cold and other infections I'm more scared of hypochondria:D,is there something we can do to keep away from that?!
Posted by: mary | Oct 23, 2008 8:06:00 AM
Hi Thomas! I really liked your post! Last week I had a cold and reached 39ºC (don't know how much is it in ºF) of fever. I had to go to class AND had ward that night. In the end I decided not to go. I was seeing a patient who, by that time, had 3 weeks hospitalized and we still didn't know exactly if he had an hemolytic anemia or a lymphoproliferative disorder, so I thought it wasn't that great of an idea to go see him that day. Fortunately, that was on Friday, so I had the weekend to get better and on Monday I was right back on track! :D
So, yes, I agree with you. The best thing we can do is stay at home, get some rest, get better and then come back as new!
Posted by: Daro | Oct 24, 2008 8:47:58 AM
"First do no harm"
You have a duty of care to protect your patients.
Currently on the first cold of the year.
Third year I got mumps.
I think mostly I just pass it on to my media naranja. Poor guy. Doctors probably have the best immune systems, along with nurses and primary school teachers.
Posted by: Kirsty | Oct 24, 2008 2:05:34 PM
Yeah, I agree. Doctors must do no Harm.
Sometimes it is indeed a conflict to continue to go to ward when we're sick. I very much agree that staying at home to rest during sick because this can prevent unnecessary immunocompromised patients from getting sick and also make sure ourselves have enough rest at home to remission faster.
Posted by: eLLe | Oct 24, 2008 8:48:46 PM
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