October 30, 2010 by staff 

Abim, The occurrence of presenteeism doctor, doctors who come to work even if they are sick themselves, is an opportunity for residency directors to retire on the way physicians to schedule training, a program manager said.

A study last month showed that 57.9% of residents said they work when sick at least once and 31.3% had done the previous year (JAMA 2010; 304 (11) 1166-1168). In hospital outliers, all residents surveyed said they worked when sick.

“Hospitals must learn not to set their people up,” said Ethan Fried, MD, MS, FACP, assistant professor of clinical medicine at Columbia University, Vice-President for Education in the department of medicine and director Graduate Medical Education St. Luke’s-Roosevelt in New York. “Just because you can go 80 hours a week and take care of 10 patients does not mean you should go 80 hours a week and take care of 10 patients. ”

M. Fried, president of the Association of Program Directors in Internal Medicine (APDIM), said the creation of zones with little or no flexibility affect the ability of a program to manage patient calls inevitable. Large programs can be “sick call pools,” which are used to cover staff shortages, but small programs may not have that luxury, he adds.

Jack Percelay, MD, MPH, SFHM, FAAP, pediatric hospital with pediatric ELMO in New York, said the culture of the residence is to “suck”, and some physicians perform this attitude in private practice.

“The decision to grant or not to work sick is really related to institutional culture,” Dr. Percelay, SHM board member, wrote in an email interview. “If we want to discourage doctors from working when they are sick, some kind of benefit from sick leave or a backup system must be in place. … It’s a real Pandora’s box. I do not want my colleagues to stay at home with a runny nose, I do not want them to come and get IV fluids in the back room. ”

Dr. Fried noted that the issue is further complicated by the rules on how much training time for residents to be considered competent. He says the American Board of Internal Medicine (ABIM) recently gave the program managers in the discretion “of granting credit to a maximum of one month’s lost time in a period of three years.”

However, presenteeism may be less of a problem with the current generation of people in the past because of changes related to the culture of service hour rules. “We make a big deal about working while fatigued, and is now considered quite improper,” says Dr. Fried. “Students … are much more likely to acknowledge under the weather. “

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