Debilitating Toothaches and Calling in Sick?

[mercaptovizadeh]

I told you to get back in there. You're off schedule! Vacation is next month, you bastard!

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[Doctor Bob]

Just because tramadol changed DEA categories doesn't mean someone can't work while taking it. Afterall, ritalin and adderall are in a more restricted category than tramadol, and we don't prevent patients on those medications from working even though they are schedule 2.

The difference is acute use versus chronic use which comes with acclimatization.

 

[drkristy85]

These posts are making my head spin. What kind of psycho program is this that you can't f***in call in sick?! This is ridiculous

Doctors should NOT be martyrs. Some of these old school " I worked 130 hrs per week" doctors try to keep a culture of that, but I think it is up to us to change that. You need to take care of yourself so you can be healthy enough to take care of patients. You should not be spreading illness to patients. We also have the whole mask thing, and yeah, I would rather have a sick resident wear a mask than not, but ideally, stay at home. I hate it when my co-residents (especially the ones with disease-spreading children) show up to work coughing and sneezing on everyone. It is disgusting. I don't want the illness your child caught at daycare. No thank you.

We have 5 sick days per year, and believe me, I use every single one of them. Every year. Many of us do. and we have a relatively smaller program. I got the flu shot, and then I got influenza. For the first time in my life. It sucked. And yea, I stayed home. Some of my martyr attendings did not.

We need to change this culture. because it is ridiculous. You know what, we all spent our prime years , in our 20's, taking exams and studying nonstop, while our friends were out partying. We sacrificed a LOT to get here. And we should not spend the rest of our life being a martyr. Then die young from an MI. Just say no. If enough of us stand up and say no, we can change this.

 

[Crayola227]

No, we can't change this until we are attendings. Don't try when you're a resident. Seriously. Don't.

 

[Crayola227]

Just because tramadol changed DEA categories doesn't mean someone can't work while taking it. Afterall, ritalin and adderall are in a more restricted category than tramadol, and we don't prevent patients on those medications from working even though they are schedule 2.

I've never really figured out if it was OK to to go work on any legitimately Rx'd sedative like benzos or narcs even if you felt fine. I've always been told NEVER narcs because if anything goes wrong and THAT's what in your employee health piss test after a needle stick or on your med list when you go to court, you're ****ed.

I don't think Rx'd uppers are like associated with med errors being attributed to them. Sure, you could be so gorked on amphetamine that you made an error, but I think it helps that that drug class actually has a whole body of literature supporting improvements in various employment measures and cognition, even in those without "medical indication."

I feel impaired on 3 hours of sleep after having a total of 20 for the whole week and 6 shots of espresso, but if I make an error attributed to fatigue no one's going to act like that was outside the pale of resident conduct.

Point being, that yeah, drug class isn't necessarily an indicator of whether or not you can take it and go to work, but if they're cracking down on tramadol my feeling is it's probably going to be looked on more like a narc.

I dunno. Some of the places can fire you if you've got nicotine in your system, not that we should be smoking, but if you are dependent on the patch... I know docs that have had to use something like that for years before kicking it all.

 

[Law2Doc]

...Some of these old school " I worked 130 hrs per week" doctors try to keep a culture of that, but I think it is up to us to change that... If enough of us stand up and say no, we can change this.

Actually you seem to want it both ways. When residents worked crazy hours you didn't really have the issues of uncovered shifts because everyone was in the hospital most of the time. Along came duty hour limits and suddenly your chiefs don't have the flexibility to say, Bob, you go home and get better, I'll just make Steve work an extra shift this week. So It's only partly about culture and more about manpower.

 

[Law2Doc]

No, we can't change this until we are attendings. Don't try when you're a resident. Seriously. Don't.

As an attending you have extreme need for residents to fill all the call shifts or else you would have to be there. So no, you won't have much incentive to allow residents to put your lifestyle in jeopardy and do in house call so Bobbie can wait out his migraine.

A lot if you guys seem to be picturing programs where they have a dozen residents but really only need ten. A lot of programs are the opposite -- stretching coverage and making people carry multiple pagers so that services are all theoretically covered. If one person gets sick, someone else has to forego his elective or vacation or run afoul of duty hours. So you'd better be really really sick because while you are home in bed someone is being put out in a big way. Not being able to call in sick lightly is not being a martyr -- if anything it's the guy stepping in to cover your shift whose being martyred.

 

[Perrotfish]

These posts are making my head spin. What kind of psycho program is this that you can't f***in call in sick?! This is ridiculous

Doctors should NOT be martyrs. Some of these old school " I worked 130 hrs per week" doctors try to keep a culture of that, but I think it is up to us to change that.

Residents don't avoid sick days because of some misplaced sense of duty. They avoid them because they're terrified. A resident is, for all intents an purposes, an indentured servant. They have amassed crippling amounts of non-dischargeable debt, and residencies are just employers that have managed to convince the government to exempt them from every single labor law. You can't negotiate a salary, seek new employment, or continue in this profession if you're fired from this job. You have two options: do whatever they tell you to do or die in poverty. If they gave everyone sick days they would need to hire more staff, or have residents in a position to cross cover call without screwing someone else, or have attendings cover call. Since everyone looks out for themselves that's not likely to happen.

If your employer gives you 5 days off a year, great. Chances are that means that you're in a rare specialty where that doesn't cost your employer anything in terms of work, but still... great. But its not like anyone else has a choice. If there's going to be a change in the system its going to involve legislation, or maybe large scale resident strikes (unlikely when attending pay is still so high), but its not just going to happen.

As an attending you have extreme need for residents to fill all the call shifts or else you would have to be there..

No, as an attending I'm getting a job. If this was just hazing, and I knew one day I would be on the other side of it and enjoying the benefits, I might be fine with the system. Its not like that, though. Most of us just go to work after we're done with training. Its only a small handful of attending physicians and administrators who benefit from the system we've created.

 

[Law2Doc]

...
No, as an attending I'm getting a job. If this was fraternity style hazing, and I new one day I would be on the other side of it and enjoying the benefits, I might be fine with the system. Its not like that, though. Most of us just go to work after we're done with training. Its only a small handful of attending physicians and administrators who benefit from the system we've created.

It's becoming the minority of fields that don't at least infrequently work through hospitals, so I'm not sure it's only a small handful of attendings that benefit from this. Lots of private groups in many fields provide attending backup in exchange for their hospital privileges, so even if you go work in a free standing practice/group you might have call obligations if your group works through a hospital. As an intern, in addition to our inpatients we also covered admissions for various sub specialties where the attendings were specialists out in the community. These guys went to work after training, and yet still benefit greatly from the system. Most would be very unhappy if they had to go back to a life of in house call because residents were out sick, even more unhappy than those attendings who actually worked in the hospitals.

 

[michaelrack]

It's becoming the minority of fields that don't at least infrequently work through hospitals, so I'm not sure it's only a small handful of attendings that benefit from this. Lots of private groups in many fields provide attending backup in exchange for their hospital privileges, so even if you go work in a free standing practice/group you might have call obligations if your group works through a hospital. .

I am not sure what your point is. Sure, most attendings are involved with a hospital- but usually NOT a hospital with any resident or intern involvement.

 

[Law2Doc]

I am not sure what your point is. Sure, most attendings are involved with a hospital- but usually NOT a hospital with any resident or intern involvement.

As a resident I worked with a lot of practitioners that weren't involved in graduate education and you wouldn't think had any resident involvement, but by virtue of having hospital privileges had to put someone from their group on call periodically. It's more common than some of you guys are suggesting. My point is that it's not just academic attendings and house staff that would be impacted -- a lot of those docs in neighboring private groups also rely on residents to troubleshoot and keep them from having to come in at night.

 

[Crayola227]

As an attending you have extreme need for residents to fill all the call shifts or else you would have to be there. So no, you won't have much incentive to allow residents to put your lifestyle in jeopardy and do in house call so Bobbie can wait out his migraine.

A lot if you guys seem to be picturing programs where they have a dozen residents but really only need ten. A lot of programs are the opposite -- stretching coverage and making people carry multiple pagers so that services are all theoretically covered. If one person gets sick, someone else has to forego his elective or vacation or run afoul of duty hours. So you'd better be really really sick because while you are home in bed someone is being put out in a big way. Not being able to call in sick lightly is not being a martyr -- if anything it's the guy stepping in to cover your shift whose being martyred.

No, I don't picture that at all. If you read my other posts I point out that the entire medical system is seriously strained to use the resources it has to meet the needs.

I only meant that if an intern makes waves and loses their job, they are looking at either the end of their career or a helluva a climb to get back to clinical medicine. Even with a completed internship, it depends on which field and even then, good luck with your clinical career, or you're back on your hands and knees to another residency program if you're lucky. So no, I don't think residents should "try to fight" residency policies. The cost of running afoul someone is too great. The only goal during residency should be finishing residency. You will not change the world or the system as a resident. Unless of course, your medical error kills someone then there's enough public outrage to do anything, that has happened but I wouldn't recommend residents counting on that contingency changing anything in their favor.

As a board certified attending, you might consider "banding together" "creating a union" "lobbying in DC" or whatever other kind of thing that people think they can do to try to make the medical system more forgiving or better able to cover resident sick days. While you're correct that an attending may choose lifestyle over those activities, the point is once you've completed a residency, it is theoretically possible to structure your time in ways that were impossible as a resident.

 

[Crayola227]

Perrotfish rocks.

 

[PMR_doc]

This is just plain ridiculous. Like others have said, things have changed a lot in medicine and the whole thing about we are martyrs and we'll work 16 hours a day 7 days a week needs to stop. Even in lean programs, there is enough coverage to have someone be able to have a sick day here and there. Period. Most rotations have more than 1 resident, and for those who don't, it's typically either a rotation where you are in an elective where you are not really needed, or sometimes when you truly ARE the only resident there, that means there is also an attending that covers the service. Sure the attending may not like the fact that - gasp! - they have to do work, but they are not going to die if they have to cover pt. responsibilities for a day if their resident is sick. I had to cover for fellow residents numerous times who were sick - one went into labor earlier than expected, another had viral gastro, another had who knows what. It happens. They are human. And services were busy as crap so we pulled our bootstraps and took care of things with less residents. Things happen and our fellow residents need our support. Just like when I was sick my fellow residents covered for me. Everyone lived, the hospital did not shut down, patients were taken care of, and the world went on as normal. Let's not pretend like it's a world ending situation to call in sick. This ridiculous mentality needs to end - period.

 

[Law2Doc]

... Even in lean programs, there is enough coverage to have someone be able to have a sick day here and there. Period. Most rotations have more than 1 resident, and for those who don't, it's typically either a rotation where you are in an elective where you are not really needed, or sometimes when you truly ARE the only resident there, that means there is also an attending that covers the service. Sure the attending may not like the fact that - gasp! - they have to do work, but they are not going to die if they have to cover pt. responsibilities for a day if their resident is sick....

First, from your post you've not seen how lean some places are staffed. There are places where if someone is out sick someone else has to get pulled back from an elective or vacation and potentially could violate duty hours. That's just reality in a number of the smaller programs in call heavy specialties. The residents wearing multiple pagers and cross covering for numerous services all live this existence. Second, yes the attending is the ultimate backup. Much as ones boss is the ultimate backup in any job. Which is why some of us are saying if you have a toothache or a Migraine or a cold you are probably wise to suffer through. An attending is going to shrug off something big like going into labor or acute appendicitis as unavoidable, and handle it, but might not be as forgiving for something he regards as more objectively minor. And honestly this wasn't that different in law where you wouldn't want to force a senior partner to handle a meeting you'd been prepping for. If you weren't dying you just popped a few OTC meds and powered through. I'm surprised that you think telling interns to just call in sick and let the attendings deal with it is a good idea both from the attending point of view and in terms of residency self preservation -- this is playing with fire. and it reinforces my notion that you don't really appreciate how lean many programs are staffed.

 

[rokshana]

First, from your post you've not seen how lean some places are staffed. There are places where if someone is out sick someone else has to get pulled back from an elective or vacation and potentially could violate duty hours. That's just reality in a number of the smaller programs in call heavy specialties. The residents wearing multiple pagers and cross covering for numerous services all live this existence. Second, yes the attending is the ultimate backup. Much as ones boss is the ultimate backup in any job. Which is why some of us are saying if you have a toothache or a Migraine or a cold you are probably wise to suffer through. An attending is going to shrug off something big like going into labor or acute appendicitis as unavoidable, and handle it, but might not be as forgiving for something he regards as more objectively minor. And honestly this wasn't that different in law where you wouldn't want to force a senior partner to handle a meeting you'd been prepping for. If you weren't dying you just popped a few OTC meds and powered through. I'm surprised that you think telling interns to just call in sick and let the attendings deal with it is a good idea both from the attending point of view and in terms of residency self preservation -- this is playing with fire. and it reinforces my notion that you don't really appreciate how lean many programs are staffed.

if his sn is accurate, he really hasn't dealt with being in a program where they are truly, truly resident dependent...and i'd be surprised if there is a time that they exceed 80 hours in a week much less averaged over 4 weeks...

 

[PMR_doc]

Residency is not meant to be a situation where residents are just bodies covering services. And trust me, we cover more services and institutions than most programs I know both in my own specialty and in other specialties within the same institution/hospital. Again no hospital is going to shut down if someone calls in sick. If an intern is ill and needs to call in sick, that's the way it is. Suggesting that it's ok for interns to work when they are ill is worrisome. If a residency is so malignant that calling in sick is playing with fire, I would run away from that residency as fast as possible.

First, from your post you've not seen how lean some places are staffed. There are places where if someone is out sick someone else has to get pulled back from an elective or vacation and potentially could violate duty hours. That's just reality in a number of the smaller programs in call heavy specialties. The residents wearing multiple pagers and cross covering for numerous services all live this existence. Second, yes the attending is the ultimate backup. Much as ones boss is the ultimate backup in any job. Which is why some of us are saying if you have a toothache or a Migraine or a cold you are probably wise to suffer through. An attending is going to shrug off something big like going into labor or acute appendicitis as unavoidable, and handle it, but might not be as forgiving for something he regards as more objectively minor. And honestly this wasn't that different in law where you wouldn't want to force a senior partner to handle a meeting you'd been prepping for. If you weren't dying you just popped a few OTC meds and powered through. I'm surprised that you think telling interns to just call in sick and let the attendings deal with it is a good idea both from the attending point of view and in terms of residency self preservation -- this is playing with fire. and it reinforces my notion that you don't really appreciate how lean many programs are staffed.

 

[Law2Doc]

Residency is not meant to be a situation where residents are just bodies covering services. And trust me, we cover more services and institutions than most programs I know both in my own specialty and in other specialties within the same institution/hospital. Again no hospital is going to shut down if someone calls in sick. If an intern is ill and needs to call in sick, that's the way it is. Suggesting that it's ok for interns to work when they are ill is worrisome. If a residency is so malignant that calling in sick is playing with fire, I would run away from that residency as fast as possible.

First, see the posts above as to why this has nothing to do with malignancy. There are lots of residencies where the residents are treated with respect and as future colleagues but where hours are long and coverage is lean. If you equate long hours and inability to be out sick as malignant you really have no clue what a malignant program is. I had a very positive experience during intern year-- almost a year long laugh-fest, but we definitely worked hard, pushed the limits on hours and didn't use sick days lightly. So you might not want to throw the "M" word around if you haven't come across a program like that.

Second, yes I agree that residents aren't supposed to just be bodies covering services. Its training and a learning experience. And much of that learning to be a doctor and to make good decisions comes from running a service more or less autonomously at night. But programs are only given so many pieces to work with, and are expected to give residents access to needed electives, etc. And all this has to occur within tight duty hour limits. So in a busy hospital without enough residents that doesn't give programs much flexibility. You or I can say it shouldn't be that way, but that doesn't change anything. Unless additional residents have been allocated or funded there are no more pieces to work with.

Saying residents should just call in sick at will and the attendings will deal with it is perhaps fine on a cushy PM&R service, but doesn't fly in a busy service where attendings might already be working 14 hour days and really can't be expected to cover the nights in house on top of that -- it's already a stretch to have them doing home call as is. Unlike residents who sleep during the day on night float or post-call, an attending is expected to be back at work -- I've seen attendings working 40 hours straight in such situations. So again you'd better be dying to call in sick and have your boss do a marathon shift like that. That's not malignant, thats just reality. And you can find analogies in law and business, this isn't unique to medicine -- you don't get to push work up to your bosses without consequences.

 

[KnuxNole]

I'm not in a surgical residency like Law2Doc, so I know his struggle is different than mine. If someone calls in sick, it means that there has to be someone who covers for patient's phone calls, and admitted patients in the hospital, but nothing that has to ruin someone else's rotation, or god forbid vacation. In his case, especially since there are few people per class, it seems to make since that he would express statements about sick days, since one less person equals having to cover for LOTS of patients...

I wouldn't want to be an attending that works in a residency program though...I wouldn't want to deal with the way they do calls.

 

[Crayola227]

To get back to the OP's post, we can sit here and debate policy,
but the reality is if your program seems PO'd about something or is drawing a line and making a big deal about it,
I suggest you toe the line.

Some programs are more forgiving than others, there's a lot of factors that goes into that, some of it is technical, like # of bodies, structure of schedule, etc. and some of it is culture.

If the culture is telling you "DON'T" then that's the most important thing you need to hear.

Residency is not the time to make waves. Sure, at least your ballot is still secret, and you can probably get away with giving what dollars you're not giving to your loans to politicians, lobbyists, write anonymous letters, get your friends to call their senator or picket something in your place, like there are things you may be able to do to try to improve resident work conditions, but I certainly would do so in secret and direct those efforts outside your institution.

 

[TooMuchResearch]

I'm a little confused. If your pain gets so bad that you can't work, why would you not, for your own health and to get out of the debilitating pain, go to the ER and get a dental consult? I guess I don't understand how doing otherwise makes any sense for you regardless of being in residency.

We don't routinely have dentists in the emergency department. I can provide a dental block to buy some time to get ibuprofen on board and have the patient call a dentist, but I don't typically a) have a dentist on call for standard dental pain (I might have one for an actual dental emergency) or b) have the ability to get you in to dental clinic faster.