Sick doctors, sick notes, and swine flu: why coroner’s reports are so yesterday

A couple of weeks ago a doctor friend from California was visiting me in London. Shortly before her arrival date swine flu fever was gripping the world’s media, with California proving a hotbed for new cases. And, illogically I’ll admit, I felt a certain disquiet that a doctor from the first US State to suffer a swine flu death would shortly arrive in my already less than healthy home.

Events were however to overtake my irrational fears in the form of a swine flu outbreak at one of my daughter’s school and her own subsequent testing for the infection. So instead of suppressing my own anxieties I had instead to warn my friend that entering our household might not be the smartest move.

Luckily my daughter tested negative in time for us to meet and a wonderful evening was had by all. Not surprisingly under the circumstances, swine flu was all the talk and specifically the rather miraculous change in attitude during our lifetimes- in California at least- to sick doctors. Since both of us had spent formative years working as junior doctors in the States, each had stories to tell of the odium meted out to any doctor who dared to call in sick. My friend recalled the one-line order delivered to all interns about what to do if they were sick: ” If you’re too sick to work fine, just send me the coroner’s report”.

This tallied well with my own experience when working as a pediatric intern. After 9 months of working a shift system that could be summed up by the phrase 36 on, 12 off (as in 36 hours working flat out followed by 12 hours off before the next 36 began), and after several days of an increasingly severe chest infection that ultimately left me too weak one morning to be able to get dressed, I finally, through necessity, plucked up the courage to call in sick. Guilt struck as I was I nevertheless felt pretty confident that my superiors wouldn’t want a febrile, green phlegm producing intern in their midst. Especially as I was working on a neonatal intensive care unit.

Now I’m guessing that no doctor of a certain age (any age?) reading this posting will be either surprised or shocked to hear that the response I received was no more and no less than an angry “you picked a fine time to be sick”. Like I said, we’ve all got our stories.  But I think that many will be shocked, as I and my  friend were shocked, by the advice currently being handed out to doctors working in at least one Californian hospital. Shockingly, and as far as I know without precedent, doctors are being told to stay home if they have even the suspicion of a flu-like illness: a sniffle, a sore throat, feeling a bit off but not sure why yet.

Does this advice represent a belated but welcome acknowledgement that the health problems of doctors, hitherto assumed to be at best signs of weakness and at worse fictitious creations of the work shy, are at last being recognised as not only real but deserving of  attention? Sadly I doubt it. Instead I suspect this response reflects a pragmatic recognition that a working doctor with swine flu could act as an all too efficient patient zero for an already vulnerable population.

Having said which I don’t detect any similar recognition in the UK’s National Health Service. To my knowledge no similar edicts have gone out to health professionals across the UK and my own attempts to find out from the Health Protection Agency what I, as a febrile GP with a daughter being tested for swine flu in a school with swine flu should do about work were met with the curt suggestion that I refer to the WHO guidelines and stay home if I felt too ill to work.

So here we are once more: sick doctors and sick notes just aren’t socially acceptable. At least amongst the medical profession. And hence, at least in part, the only limited success of organisations whose stated aim is to encourage sick doctors to seek help. Patients of course see things differently. They don’t want to be cared for by sick doctors, and with good reason. What parent in their right mind would want a febrile junior looking after their premature baby? What patient in their right mind would want an untreated alcoholic and depressed doctor overseeing their health problems? What patient in their right mind would want to come with all their implied health vulnerability to see a doctor who might give them flu, of the swine variety or any other?

Because this is meant to be about patients isn’t it? About what is in their best interests, about not endangering their health? It isn’t surely about being macho, tougher than the ordinary oh-so mortal souls that come to us for help. I’d like to think that Californian fears about swine flu spreading doctors might somehow mark a turning point in the attitude of the medical profession to illness in its ranks but, to be honest, I don’t.

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