There’s an ironic trend in the medical field: Health care workers often come to work while they’re sick themselves, endangering colleagues and patients. Although researchers have worried about the health implications of this trend for roughly five years now, two new studies have finally targeted whysick health workers are continuing to come into the office and offer potential solutions.
In a study, published in JAMA Pediatrics last month, Julia Szymczak from The Children’s Hospital of Philadelphia (CHOP) and her colleagues surveyed 536 hospital workers. They found that roughly 83 percent of the health care personnel admitted to working while sick at least once in the past year—despite the fact that 95 percent thought it would put their patients at risk. “We know that this happens in all types of work environments,” says study co-author Julia Sammons, medical director of the department of infection prevention and control at CHOP. “In health care certainly the concern is that in the course of coming to work we are interacting with patients who themselves are sick and may be vulnerable.”
In targeting the reasons why personnel continue to come in sick, the team found that above all else it is health care workers’ strong dedication to colleagues and patients. “If you are a clinician who has scheduled an appointment for a particular patient four months ago and that patient is traveling from far away to see you, you don't want to let them down and cancel that appointment,” Szymczak says. This strong work ethic, Szymczak thinks, is part of the health worker identity. But when the problem runs to the very core, how do you find potential solutions?
Shruti Gohil, an associate medical director of epidemiology and infection prevention at the University of California, Irvine, Medical Center, and her colleagues might just have the answer—or at least a step that will bring them closer. “It seems like our health care workers are hungry for some careful guidance,” Gohil says. In a new study presented last week at IDWeek 2015, a meeting of several organizations focused on infectious diseases, the team reported they found 99 percent of medical workers would respond to various types of interventions.
According to Anupam Jena, an associate professor of health care policy at Harvard Medical School, both studies lack convincing evidence. “It's true that if you have a doctor working with infectious symptoms, other doctors or nurses could be affected—but the extent of the problem is really not known,” he says. “When a sick doctor works in a medical unit, exactly how many patients get sick? We really don't know.” And Jena is concerned that without hard core evidence, health workers will be hard-pressed to change.
Still Gohil remains hopeful. She draws on an example in 2011 when another drastic change rippled through the medical field: The number of hours physicians are permitted to work. Interns, for example, are no longer allowed to work more than 16 hours a day. Before this mandate it was common for an intern to work 24-hour shifts. Gohil thinks if that cultural transformation occurred, there’s no reason why this one can’t.
Indeed Szymczak and Sammons have already introduced a pilot program within the Department of Pediatrics at CHOP. It puts in place some basic guidelines to begin to tackle the problem, like having a point of contact when doctors or nurses are sick. This relieves individuals of finding their own replacement. “We want to keep moving the dial,” Szymczak says. “Intervention is really the next step for us.”
But the specific steps forward will depend on the institution at hand. “I don't think that the solution to this is a one blanket rule that says your institution should do X to fix this problem,” Szymczak says. “It involves local, adaptive work to say, ‘What are the challenges at our institution in these different clinical areas, What's the culture of our institution?’” So each hospital will have to analyze the reasons sick workers are not staying home in order to find a solution. At CHOP, for example, a strong work ethic seems to be the most salient reason but staffing concerns are a close second. Roughly 99 percent of the medical workers surveyed did not want to let their colleagues down, 95 percent worried about finding colleagues to replace them in their absence, 92 percent feared their colleagues would ostracize them and 64 percent were concerned about the continuity of care for their patients.
Jena’s own research in 2010 echoed the second finding. He and his colleagues found that residents with more experience were more likely to report they worked while sick than did those with less experience. Although Jena’s research did not probe the exact reasons, he suspects staff in more senior positions are less substitutable. He likens a hospital setting to any regular company where it is harder for managers to call in sick because a lot of work flow depends on their input.
The same is true in smaller clinics. “If you're a primary care doctor and it's just you in the practice, then who is going to cover for you?” Jena asks. “Who is going to see those 40 patients you have scheduled that day?” For these doctors, it's extraordinarily difficult to not come into work. All experts agree that in this case, doctors should at least wear the appropriate protective gear and take extra precautions.
At the end of the day, even Jena, who worries that without hard evidence dramatic change will be difficult, remains hopeful. “You just have to rely on the compelling logic that if you have flulike symptoms you're likely to pass that on,” he says. “It's not scientific but it makes good sense.”