Sickly doctors could be infecting Wellington patients, with an alarming number of them dragging themselves into work despite knowing the risk.
A study published in New Zealand Medical Journal today calls for a change in hospital culture after finding many medical staff felt immense pressure to work even with flu-like symptoms, vomiting or diarrhoea.
About three out of four doctors surveyed at Wellington Hospital said they had gone to work sick in the past 12 months, despite knowing it would affect their performance.
Of those, nearly half went to work despite knowing they had an infectious illness that could be spread to other patients and staff.
Some told researchers they persevered out of a fear of career reprisals, or because the hospital was too short-staffed to cover them. Some said there was a culture of "intolerance" toward sick days, driven by an inability to deal with sudden staff shortages.
Junior fulltime female doctors were the most likely to dismiss their own ailments and show up for work unwell.
"It shows there are a significant number of doctors working whilst unwell who may be compromising their own, as well as patient, health," the study says.
More than 300 Capital & Coast District Health Board doctors took part in the study, which was co-authored by its chief medical officer, Geoff Robinson, who has himself confessed to working while sick, and possibly infectious.
Robinson said the result would be similar in any hospital, and could be an even bigger problem in provincial centres, where fewer staff were available to cover.
"We do not promote people coming to work sick, but it does seem to be a continuing issue," he said.
However, he rejected suggestions that there was an intolerance of sick leave at the hospital, with the study finding the bigger motivator for doctors working while sick was to avoid overburdening colleagues or disrupting patient care.
Doctors were particularly resistant to staying home, partly because they often backed themselves to make the right call on the risk of infection versus their patients' overall care.
"And doctors are not particularly willing to seek advice, which may be because they think they know best," Robinson said.
Associate professor Mark Thomas, a clinician and expert in infectious diseases at Auckland University, said hospital staff everywhere were undoubtedly infecting patients, and probably more often than was assumed.
Although it was difficult to measure likely infection rates, someone with the flu would typically infect two or three others.
Good hygiene would greatly lessen the risk, but only to some extent.
"You can wander around with a mask, endlessly washing your hands, but you can't eliminate the risk entirely."
He was not surprised that doctors were guilty of coming into work sick, as they often considered themselves indispensable.
Ian Powell, executive director of the Association of Salaried Medical Specialists, said it was just another symptom of chronic staff shortages that had become the norm in many DHBs.
"They are turning a blind eye to the shortage we have," he said. "They do not have the ability to cover for sickness."
But Robinson said that, though Wellington Hospital's size meant it could be more flexible in covering for sickness, some senior doctors were simply too specialised to replace at the drop of a hat.
82 per cent of doctors went into work sick
75 per cent went in despite knowing they were too sick to perform to their usual standards
78 per cent reported colleagues who went in too sick to work
Of those who turned up to work ill, 49 per cent knew they were infectious, with a flu-like illness, diarrhoea or vomiting
Source: New Zealand Medical Journal
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