"New York Times, May 12, 2009
Do Everybody a Favor: Take a Sick Day
By ANNE MARIE VALINOTI, M.D.
My patient was a 25-year-old man. He sat on the examination table, the picture of misery, coughing, red-eyed and shivering. His fever was 103. An interview and an examination suggested influenza (the rapid diagnostic test for flu wasn’t available at that time), but there was little I could offer him, other than ibuprofen and some homespun advice.
“Go home and get to bed,” I told him.
He looked at me. “Bed? I’ve got to get back to work.” He put on his jacket and power tie and headed back to Wall Street.
I was appalled. Work in that condition? How could he even think straight with that fever? Whom else would he infect along the way?
Still, a tiny part of me was filled with admiration. Here was a tough guy. No reason to let minor delirium keep him from doing his job.
I had recently finished my residency, three years immersed in the culture of house officer training. Of all the sins an intern or resident could commit, the worst was to call in sick, for it meant somebody else would have to do your work — extra patients to admit, phone calls to make, IVs to insert, emergencies to deal with.
As a resident, my greatest pride was in never having missed a day for illness. I’d drag myself in and sniffle and cough through the day. Once, I’m embarrassed to admit, I trudged up York Avenue to the hospital making use of my own personal motion sickness bag every few blocks while horrified pedestrians looked on.
Now, though, I see the foolishness of this bravura. And I confront it almost daily in my primary care practice. No one can miss a day — a minute, even — of work, carpooling, volunteering, vacation, anything. “I don’t have time to be sick!” my patients wail. Everyone must soldier on, leaving sick days to those with less important things to do.
And many patients aren’t satisfied with sympathy and friendly advice. They have come to the office for that little piece of blue paper, the antibiotic prescription. “I would never ask for this under normal circumstances,” I’m told — except (pick one) I’m getting married tomorrow; leaving for a month in the Amazon; having 25 houseguests for the weekend.
Never mind that antibiotics are useless in treating colds and viral illnesses, and that they have their own dangers and side effects. Some doctors will write the prescription just to get on with their day.
I have done this and know plenty of other physicians who have — much as we may resent being bullied and feel we’ve failed in our duty to “first, do no harm.” In fact, we may very well be doing harm. Beyond the possible side effects and allergic reactions, the nonchalant use of antibiotics in the community has helped lead to the rise of the drug-resistant bacteria known as superbugs.
“Clearly, the overprescribing of antibiotics in doctors’ offices, clinics and other community settings contributes to the problem of antibacterial drug resistance,” Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Disease, told me in an e-mail message. “Because most bacteria multiply rapidly, they can quickly evolve and develop resistance to antimicrobial drugs. Overusing or misusing antibiotics can make resistance develop even faster.”
If the swine flu epidemic ever swings into full gear, I will be prepared for the onslaught of ill patients. I will educate them about the appropriate use of antibiotics. I will provide symptomatic relief when I can. And I will let them know it’s O.K. to be sick. It’s O.K. to stay home from work, pull up the covers and drink gallons of hot tea all day. Maybe for an entire week.
And believe me: if you show up to work sick these days, you are not going to earn anyone’s admiration."
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