Calling in sick

[elwademd]

There are attendings who don't round on their patients daily? What do their hospital bylaws say about that? My hospitals require it.

At my institution, consult patients have to be seen every other day by an attending (though in our department they are seen daily).

as far as i understand it, the primary physician may bill for a hospital day as long as an attending saw the patient/wrote a note that particular hospital day.

example: patient gets admitted 9/7 for acute coronary syndrome/rule out mi. medicine attending sees the patient 9/7, admits, and consults cards. 9/8 patient seen by cardiology, stress test done and negative, recommendations left. medicine attending comes 9/9, patient is discharged.
the patient is seen every day, but not by the attending. the medicine attending can bill for all 3 days, since an attending saw the patient.

i've seen instances like that. i've also seen instances where no physician saw the patient for 2-3 days. considering the physicians in question continue to work at the hospital, i imagine that either it's not against the hospital by laws... or it is against the hospital by laws, but there's little that the hospital can actually do; or the hospital doesn't care.

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[SoCuteMD]

Sick today - MS3, not a resident. I went in on time, saw my patients (gown and mask), wrote my notes, called my consult, and left about 3 items (mostly orders, which I can't sign) to my resident. I feel really bad and lazy, but today was my only day all week without afternoon responsibilities.

 

[Blade28]

Sick today - MS3, not a resident. I went in on time, saw my patients (gown and mask), wrote my notes, called my consult, and left about 3 items (mostly orders, which I can't sign) to my resident. I feel really bad and lazy, but today was my only day all week without afternoon responsibilities.

You sucked it up for a while, came in, did you work like a trooper, worked hard, signed out and got out of there as soon as you could.

You went above and beyond any med student's duty!

 

[Annette]

as far as i understand it, the primary physician may bill for a hospital day as long as an attending saw the patient/wrote a note that particular hospital day.

The cardiologist is a consultant, not an attending. Billing the 2nd day would be fraud.

 

[Coastie]

Don't feel bad. Med students could call in sick everyday and still not effect the team. Hate to say it, but it's definitely a big something I've realized...

Sick today - MS3, not a resident. I went in on time, saw my patients (gown and mask), wrote my notes, called my consult, and left about 3 items (mostly orders, which I can't sign) to my resident. I feel really bad and lazy, but today was my only day all week without afternoon responsibilities.

 

[Pir8DeacDoc]

The cardiologist is a consultant, not an attending. Billing the 2nd day would be fraud.

He may not be the primary admitting attending but the cardiologist is definitely an attending.

 

[TRAMD]

Dang, I thought this thread was dead . . .

 

[Blade28]

Dang, I thought this thread was dead . . .

It was! No posts in the last 5 days until your one.

 

[TRAMD]

It was! No posts in the last 5 days until your one.

Haha. I was more referring to the 2 month span between above posts.

 

[LADoc00]

Trained in a culture of residents never calling in sick. One day a resident came in really sick and consequently his older attending got very sick, so sick he was hospitalized. Why this continues to happen is an utter mystery to me.

 

[supercut]

I've worked several times during residency with a vomiting bug and dragged an IV pole with me (after manageing to get zofran, not phenergan, so I could continue to function). I know several other residents who have done the same. When I was in med school, a chief worked through a kidney stone.

However, the day I scrubbed a CABG with pancreatitis (ERCP induced) was the day I started questioning what the h#*& I was doing to myself. The attending noticed I didn't look good, and made me scrub out. Nobody made me feel guilty for getting sick, so that was good. But still, I have never felt that I could call in sick as a surgical resident. There is no explciit rule, but often you would be viewed as weak. And it does screw up the call schedule and the hours limits. (and who does the on call intern call to come in when he starts vomiting at 1 am?). I am not aware of any residency that has a way to cover for someone who gets sick. Until this changes, I doubt the taboo on calling in sick will change.

The culture of medicine in general, and surgery in particular, has been such that one is expected to constantly sacrifice one's own heath and well being to provide patient care. Which is why I am no longer a surgery resident and even questioning if I want to continue in medicine at all.

 

[LovelyRita]

On my ER rotation last winter I caught one of those nasty-ass GI viruses from those critters in the ER. Had what I believed was c diff colitis. Anyway, took Immodium and bought 3 liters of gatorade and went to my shift, feeling pretty weak. After 10 hours they let me go home.

As I was driving down the highway at 65mph, I projectile vomited all that gatorade I drank throughout the day, all over myself and the inside of the car, trying to stay on the road, because I was going too fast to just *stop*, so I kept driving, gripping the wheel. I cried the whole way home, it was the absolute most disgusting thing that ever happened to me.

I should've called in sick.

 

[Blade28]

LovelyRita, that's terrible! I hope you feel better soon.

Drink more fluids when you get home, rest up...definitely call in sick!

 

[Winged Scapula]

LovelyRita, that's terrible! I hope you feel better soon.

Drink more fluids when you get home, rest up...definitely call in sick!

I hope so...that incident was last year!

I had a similar experience...puked all over myself and the inside of the car driving home. Its when I knew my ex really loved me...when I woke up in the morning my car, scrubs and lab coat were all clean.

 

[Blade28]

I hope so...that incident was last year!

I had a similar experience...puked all over myself and the inside of the car driving home. Its when I knew my ex really loved me...when I woke up in the morning my car, scrubs and lab coat were all clean.

Ooops, in my rush to her defense I skipped that vital part.

I've had to clean up puke for my roommates before...but trust me, it wasn't love. It was out of necessity (no one else would have cleaned it up otherwise ).

 

[Winged Scapula]

Ooops, in my rush to her defense I skipped that vital part.

I've had to clean up puke for my roommates before...but trust me, it wasn't love. It was out of necessity (no one else would have cleaned it up otherwise ).

Having lived with male roommates before, I am well acquainted with the concept of "cleaning up or no one else will do it".

 

[Blade28]

Having lived with male roommates before, I am well acquainted with the concept of "cleaning up or no one else will do it".

Ah, there you go.

 

[TRAMD]

Having lived with male roommates before, I am well acquainted with the concept of "cleaning up or no one else will do it".

In my house it was more "clean up your mess or I will make you a mess" [in puffed chest growly sort of voice].

 

[lilycat]

The best day of my life PGY-1 year was the morning I woke up with conjunctivitis - the nasty, bacterial kind with awful-looking unmentionable nastiness from not one, but both eyes. Two days off of work, no questions asked, given the nature of the rotation at the time (pregnant woman triage). Prior to the pink eye morning, I had spent the previous 4 days at work (regular shifts and on-call) with a terrible URI - recurrent fever in the 102-103 range, laryngitis, completely lost my voice, etc - didn't call in, and didn't go home even when my senior implied that it might be possible to do so.

 

[drfunktacular]

The best day of my life PGY-1 year was the morning I woke up with conjunctivitis - the nasty, bacterial kind with awful-looking unmentionable nastiness from not one, but both eyes. Two days off of work, no questions asked, given the nature of the rotation at the time (pregnant woman triage). Prior to the pink eye morning, I had spent the previous 4 days at work (regular shifts and on-call) with a terrible URI - recurrent fever in the 102-103 range, laryngitis, completely lost my voice, etc - didn't call in, and didn't go home even when my senior implied that it might be possible to do so.

Bilateral pink eye is better than going to work. Doesn't that say it all?

 

[Marianne11]

I've been reading this post in horror. Although I've never missed a class in med school, and I do show up when I'm sick, I'm now concerned about residency. I have an autoimmune disorder, and my endurance is impaired compared to other students. Although my fellow "healthy" classmates miss school a lot & who knows how they will do in residency. My question regards a fellow classmate....and I'd like your opinion.

She is 20+ years older than the average, she has multiple health issues which requires her to park in handicap parking. I asked her one day how she will handle all the walking, long hours on your feet in rotations & residency etc. She said she would have to sit down a lot. I asked will they let you....she said haven't you heard of the American's Disability Act. After reading this post, how would programs handle this? I was concerned about my health, but I'm 120% healthy compared to her.

 

[beary]

Interesting thread. I fell at work this afternoon (I'm a path resident) onto a concrete floor --> hairline elbow fracture, major pain, and vasovagal episode. I went home early and intend to be back tomorrow. Typing this with my left hand, but I feel guilty.

Off to bed and vicodin land.

 

[Winged Scapula]

She is 20+ years older than the average, she has multiple health issues which requires her to park in handicap parking. I asked her one day how she will handle all the walking, long hours on your feet in rotations & residency etc. She said she would have to sit down a lot. I asked will they let you....she said haven't you heard of the American's Disability Act. After reading this post, how would programs handle this? I was concerned about my health, but I'm 120% healthy compared to her.

If she has a clearly defined illness or condition which qualifies as a disability, then yes, programs have to adhere to the ADA.

HOWEVER:

1) she will have to state, when applying for a medical license, that she has a disability which hinders her performance
2) will have to disclose this to programs

Programs are under no obligation to hire her/rank her in the match, nor is anyone with a medical degree automatically issued a medical license. If she cannot get a medical license, she is not eligible for residency as most all residencies require that as first matter of course.

That said, there are residencies which are easier on you physically and with regard to hours. Perhaps she might consider one of those, although even Psychiatry, which does a fair bit of sitting, still requires a Prelim year. Maybe she might consider a part time residency.

The ADA will protect people with disabilities, but there are some limits...a blind person cannot be a surgeon, etc.

 

[Blade28]

Interesting thread. I fell at work this afternoon (I'm a path resident) onto a concrete floor --> hairline elbow fracture, major pain, and vasovagal episode. I went home early and intend to be back tomorrow. Typing this with my left hand, but I feel guilty.

Off to bed and vicodin land.

Ouch! Get well soon!

 

[beary]

Ouch! Get well soon!

Thanks! Didn't sleep well but still feel better today. At least I can use my right hand for typing.

 

[docB]

My question regards a fellow classmate....and I'd like your opinion.

She is 20+ years older than the average, she has multiple health issues which requires her to park in handicap parking. I asked her one day how she will handle all the walking, long hours on your feet in rotations & residency etc. She said she would have to sit down a lot. I asked will they let you....she said haven't you heard of the American's Disability Act. After reading this post, how would programs handle this?

If she has a clearly defined illness or condition which qualifies as a disability, then yes, programs have to adhere to the ADA.

HOWEVER:

1) she will have to state, when applying for a medical license, that she has a disability which hinders her performance
2) will have to disclose this to programs

Programs are under no obligation to hire her/rank her in the match, nor is anyone with a medical degree automatically issued a medical license. If she cannot get a medical license, she is not eligible for residency as most all residencies require that as first matter of course.

That said, there are residencies which are easier on you physically and with regard to hours. Perhaps she might consider one of those, although even Psychiatry, which does a fair bit of sitting, still requires a Prelim year. Maybe she might consider a part time residency.

The ADA will protect people with disabilities, but there are some limits...a blind person cannot be a surgeon, etc.

I echo what Kimberli Cox said. I will also point out that whatever program she goes into will force her classmates to pick up the slack when she's sick. If there is call or shifts that have to be covered or whatever the other residents will get dumped on. Fact of life.

 

[Blade28]

Thanks! Didn't sleep well but still feel better today. At least I can use my right hand for typing.

 

[doctawife]

I've ended up sick three times, and called in sick once.

1) I ate a Chipotle burrito, proceeded to anaphylax and ended up a patient in my residency's ER. I was working (as a PGY 2) in the medical bay, started having severe shortness of breath, tripoding and wheeze... my co-resident (PGY 3) looked at me, said, "You look terrible... come up front to the shock rooms!" When all was said and done, I'd had 3 rounds of epi, 2L of NS, 60 mg of SoluMedrol, Zantac and Benadryl. An epi drip was sitting at the bedside next to the intubation stuff. I swear to God, I was looking at my attending, who was starting to fondle the ETT, wheezing, "Keep that away from me! I'll be fine! You try to tube me and I'll kill you!"
2) I anaphylaxed again after eating rice and beans at the NICU teaching conference. I told my attending I was going to the ER, stopped by our ER and jabbed an EpiPen in my thigh, then went next door to the adult EC and grabbed steroids, Zantac and Benadryl. Backup was already coming into the NICU to take my call, but I figured I'd already be up all night from the epi and the 'roids, so I might as well take my own call. Dumb, dumb move.
3) I had already been diagnosed with pneumonia and given antibiotics by my actual PCP. Then I developed right sided chest pain, shaking chills and shortness of breath. I couldn't even get up the stairs in my townhouse. I called my boss, called my PCP (who sent me to the ER), called in backup and went to the damn ER. I truly thought I was sick - what ER doc goes to the ER? And that, ladies and gents, was the only time I took a sick day.

 

[Blade28]

3) I had already been diagnosed with pneumonia and given antibiotics by my actual PCP. Then I developed right sided chest pain, shaking chills and shortness of breath. I couldn't even get up the stairs in my townhouse.

What was the eventual diagnosis? Pleuritic chest pain from a bad pneumonia?

 

[Winged Scapula]

I've ended up sick three times, and called in sick once.

1) I ate a Chipotle burrito, proceeded to anaphylax and ended up a patient in my residency's ER. I was working (as a PGY 2) in the medical bay, started having severe shortness of breath, tripoding and wheeze... my co-resident (PGY 3) looked at me, said, "You look terrible... come up front to the shock rooms!" When all was said and done, I'd had 3 rounds of epi, 2L of NS, 60 mg of SoluMedrol, Zantac and Benadryl. An epi drip was sitting at the bedside next to the intubation stuff. I swear to God, I was looking at my attending, who was starting to fondle the ETT, wheezing, "Keep that away from me! I'll be fine! You try to tube me and I'll kill you!"
2) I anaphylaxed again after eating rice and beans at the NICU teaching conference. I told my attending I was going to the ER, stopped by our ER and jabbed an EpiPen in my thigh, then went next door to the adult EC and grabbed steroids, Zantac and Benadryl. Backup was already coming into the NICU to take my call, but I figured I'd already be up all night from the epi and the 'roids, so I might as well take my own call. Dumb, dumb move.
3) I had already been diagnosed with pneumonia and given antibiotics by my actual PCP. Then I developed right sided chest pain, shaking chills and shortness of breath. I couldn't even get up the stairs in my townhouse. I called my boss, called my PCP (who sent me to the ER), called in backup and went to the damn ER. I truly thought I was sick - what ER doc goes to the ER? And that, ladies and gents, was the only time I took a sick day.

Anaphylaxis to Mexican food? Oh the horror! I'd rather die!

 

[Blade28]

Anaphylaxis to Mexican food? Oh the horror! I'd rather die!

Could be worse! Could be an allergy to Italian or Indian food!

 

[doctawife]

What was the eventual diagnosis? Pleuritic chest pain from a bad pneumonia?

Nah, I'm apparently a total wuss - I had pleuritic chest pain from a viral pneumonia. My white count never bumped much above 8.

And KimberlyCox, only Chipotle tries to kill me. Other Mexican food is just fine.

So I'd like to return to the initial intent of the thread - who else has called in sick and for what? The absolute least favorite current 3rd year resident in my old pedi program calls in sick for URIs. The program now has a sort of over/under scoring system for backup call - if you are the poor sob who always gets called in during the first half of the year, the number of backup calls you get assigned the second half of the year goes down. If you are the jerk who is always calling backup in to take your call, you get assigned more backup days. So Nina, the backup weenie from hell, has a million back up calls in her last six months. Take that.

 

[Blade28]

Have yet to call in sick, though I've been pretty damn ill before. Both times, I was the only resident on the service and it would have been painful to ask to stay home!

 

[Winged Scapula]

I called in sick at 0400 from an ER (not my home hospital) when I needed emergency surgery but that was it.

 

[Faebinder]

Called in sick once as a student..... damn pediatrics breaking my otherwise flawless record.

 

[secretwave101]

I think the meaning of "sick" should be totally defined by the service you're covering:

On call: Sick = "near-dead". Vomiting, diarrhea, all but the WORST migrany things shouldn't count. Sniffles shouldn't count. Dehydration is out. Hung over is out. Dead tired - not. If you're surgical, fine. Actual, lipase-elevated pancreatitis...I guess. Delivering, fine. Otherwise, I say suck it up, wear a mask if you have to...go chill in the stall next to Panda if that's what it takes, but get your a** in there and do your work.

Outside rotations etc: Smoke 'em if you got 'em. If you have a program that grants you sick days that you can't bank (like mine), I say call in for hang nails if you want.

The whole thing with sick time is whether or not someone has to cover for you. Sure, it's a twisted system, but unless you can change the system (good luck), you gotta represent when you're on call. Backing someone's call is pure hell.

 

[Tired]

I've never done it during my clinical time.

 

[EUA]

I think the meaning of "sick" should be totally defined by the service you're covering:

On call: Sick = "near-dead". Vomiting, diarrhea, all but the WORST migrany things shouldn't count. Sniffles shouldn't count. Dehydration is out. Hung over is out. Dead tired - not. If you're surgical, fine. Actual, lipase-elevated pancreatitis...I guess. Delivering, fine. Otherwise, I say suck it up, wear a mask if you have to...go chill in the stall next to Panda if that's what it takes, but get your a** in there and do your work.

Outside rotations etc: Smoke 'em if you got 'em. If you have a program that grants you sick days that you can't bank (like mine), I say call in for hang nails if you want.

The whole thing with sick time is whether or not someone has to cover for you. Sure, it's a twisted system, but unless you can change the system (good luck), you gotta represent when you're on call. Backing someone's call is pure hell.

It's true. On busy rotations, I've been very glad that the gross room is close to a bathroom, convenient for explosive diarrhea and/or retching and vomiting. I remember one bad episode, where I'd sign out a case, go have massive watery diarrhea, come back, sign out another case, and repeat. Food poisoning, I think (although not Chipotle!!! Devil spawned crap!)...

However, if on a light rotation... and no one gets put out if I don't show... eh. I'm happier crapping at home with my Us Weekly.

 

[Castro Viejo]

Surgeons don't get sick.

(Or at least that's the line we use around here every June during Orientation...)

 

[pillowhead]

I'm currently out sick with pneumonia. Had a URI for well over a week which I diligently worked through like a good resident should. But then I developed rigors, temp of >39, heart rate near 150, and severe pleuritic chest pain. I actually went to the ER (never been to the ER in my life as a patient) and had a lovely pneumonia on CXR and a moderately elevated WBC.

I'm truly truly sorry for the person who is having to cover for me right now. But sometimes, you just get really sick and can't do it anymore and it's not because you're a lazy bum. I tried walking my dog and was out of breath after walking outside for less than five minutes. If I had to run to a code right now, they'd be coding me after I passed out on the ground

I think this mentality of "residents don't get sick" is just ridiculous. We would never tell our patients "lawyers don't get sick, plumbers don't get sick, teachers don't get sick." If our patient happened to be a doctor, we wouldn't tell them "doctors don't get sick."

Calling in sick for one episode of diarrhea, a cold, most migraines, or just feeling tired is silly. But when you're actually really sick and your diagnosis is actually one requiring surgery, IV antibiotics, or one on which you actually score reasonably up there on the that diseases severity index, you should not be made to feel guilty for doing what any reasonable person needs to do--rest and get better. It's disgusting how bad we seem to treat out own sometimes (in all fairness, my own program has been very reasonable and good to me during this time but I'm not a surgery resident.)

 

[Blade28]

Agreed that once you're so sick you're no longer able to work safely, you need to stay home and receive the proper treatment.

 

[Tired]

Agreed that once you're so sick you're no longer able to work safely, you need to stay home and receive the proper treatment.

I don't agree.

 

[Blade28]

I don't agree.

Well for us hardcore surgeons, this basically means you'd better be at home near-comatose.

Or, as they say:

"There are only two reasons to call in sick, and both involve something growing inside you: either a tumor or a fetus!"

 

[Tired]

Well for us hardcore surgeons, this basically means you'd better be at home near-comatose.

You stay until you're told to go home.

 

[Blade28]

You stay until you're told to go home.

Hey, you're preaching to the choir! Last time I was really sick (in March, on my CT Surg month), I just carried a bag of Advil, Tylenol and a Z-Pak around with me. Alternated between Advil and Tylenol to keep my fevers down throughout the day (probably around Q3H), even asking the circulator to help me during my long cases.

But apparently we gotta be more PC these days.

 

[fuzzyerin]

My last "sick day" was a very nasty N/V/D bug that was going around the hospital. The sick day involved me being hooked up to an IV around 3 pm and given Zofran and fluids for two hours. Kept the IV in for the rest of the day. Had to leave a delivery (a very kind private attending covered it for me). Puked twice during board sign out.

Someone asked me why I didn't go home. I asked if they wanted the intern and second year running the labor and delivery floor. When they said no, I said that's why I didn't go home. Was I helpful to my first and second year, though? I have no idea.

 

[Faebinder]

Hey, you're preaching to the choir! Last time I was really sick (in March, on my CT Surg month), I just carried a bag of Advil, Tylenol and a Z-Pak around with me. Alternated between Advil and Tylenol to keep my fevers down throughout the day (probably around Q3H), even asking the circulator to help me during my long cases.

But apparently we gotta be more PC these days.

Heh, I do the ibprofin to tylenol trick all the time q3 hours too...

 

[Castro Viejo]

Heh, I do the ibprofin to tylenol trick all the time q3 hours too...

You guys haven't learned? DayQuil is the shiznit.

 

[doctawife]

You guys haven't learned? DayQuil is the shiznit.

Not enough anti-pyretic. Gotta get the straight stuff, man! Oh yeah - steroids are nice to have on hand at home as well. Nip that anaphylaxis or asthma **** in the bud.

 

[Castro Viejo]

Not enough anti-pyretic. Gotta get the straight stuff, man! Oh yeah - steroids are nice to have on hand at home as well. Nip that anaphylaxis or asthma **** in the bud.

I can stand the fever but the sniffling, sneezing, coughing, stuffy head crap has GOT TA GO!