Presenteeism May Be a Problem for Oncologists and, Ultimately, Their Patients

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Research highlights how lack of guidelines regarding illness and adequate staffing at hospitals may link to presenteeism.
Research highlights how lack of guidelines regarding illness and adequate staffing at hospitals may link to presenteeism.

The recent outbreak of the Ebola virus in the United States is placing the spotlight on the health of healthcare workers and when they should and should not be treating patients. It is the law that all healthcare workers get the influenza vaccine every year.

At the same time, there appears to be a significant lack of guidelines when it comes to calling in sick. Many clinicians lack adequate back up coverage and oncologists in particular often feel compelled to come to work even when they may be quite ill.

A new study presented at IDWEEK 2014 suggested that many physicians and nurse practitioners go to work and treat patients while they are sick with acute respiratory illnesses as well as diarrheal disease.

Researchers in Philadelphia, PA, surveyed hundreds of physicians and advance practice providers (APPs) and found that 82% of clinicians reported working while sick at least 1 or more times in the past 12 months. In addition, 58% reported working with significant symptoms, including acute onset of substantial respiratory symptoms.1

“Healthcare systems need to make it easier for staff to not come to work when they are symptomatic and could potentially put patients and their colleagues at risk,” explained study investigator Julia Szymczak, PhD, of the Children's Hospital of Philadelphia in Philadelphia, PA.

“However, that is easier said than done. Our study highlights the complexity of the problem and the fact that it has both logistical and cultural causes,” she explained.

Dr. Szymczak highlighted the need to reinforce working while ill as an unprofessional behavior. She explained how it can lead to adverse patient outcomes, including increased length of stay and highlighted that oncologists may have a particular difficult time calling in sick because they often lack adequate coverage. Lack of back up, however, was true across specialties of surveyed clinicians.             

The survey was electronic, voluntary, and anonymous. It was sent to 929 physicians and APPs and approximately 57% (536 clinicians) responded. The survey included both closed ended and open ended questions and of those who did respond, 95% said they believed that working while sick put patients at risk. Despite this, 61% reported that the cultural norm is to come to work “unless you are dying.”

Medical oncologist Saiama Waqar, MD, of Barnes-Jewish Hospital in St. Louis, MO, said oncologists are trained to be especially vigilant about their patients, who are often older with comorbid conditions. Dr. Waqar has called in sick and said at her institution it is not a problem.

RELATED: Oncology Fellows Underestimate Workload, Report High Burnout

“We have a jeopardy system, if the physician has an emergency or is sick there is always a back-up,” explained Dr. Waqar.

However, Dr. Waqar also acknowledged that many institutions don't have such a system. She said the study findings are surprising and should serve as a wake-up call. “This was a pretty eye-opening study. The issue is what is [defined as] slightly ill and what is very ill. There are different shades of grey,” Dr. Waqar said in an interview with Cancer Therapy Advisor.

The findings suggest there needs to be a shift in cultural norms. A rather eye-opening number of respondents (30%) admitted they went to work with diarrheal illness. Jay F. Piccirillo, MD, FACS, of the Washington University School of Medicine in St. Louis in St. Louis, MO, classified these statistics as a serious health concern.

“The study finds that a large number of physicians and advanced practice providers work while sick themselves,” Dr. Piccirillo said. “What is interesting,” he continued, “[is that] nearly all of the respondents believed that working while sick put patients at risk, which is especially true for oncology patients who may be immunocompromised due to treatment.”

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