Physician, Heal Thyself!

An unwavering work ethic is a hallmark of many health professionals. But a new survey finds that when a doctor is sick, such dedication to duty can have serious consequences.

A poll of 150 attendees of an American College of Physicians meeting in 2010 revealed that more than half of resident physicians had worked with flu-like symptoms at least once in the last year and one in six reported working sick on three or more occasions during that time.

The survey conducted by researchers at the University of Chicago Medicine and Massachusetts General Hospital also asked the doctors whether they believed they’d ever directly transmitted an illness to a patient.  Shockingly, nearly 10 percent of respondents answered yes, and more than 20 percent believed other residents had passed on an illness to a patient. So much for the Hippocratic Oath and the promise to do no harm!

The results published in the Archives of Internal Medicine are further evidence of a culture of self-sacrifice long prevalent in medicine. Researchers say a physician’s sense of loyalty to already-overwhelmed peers, along with a commitment to patient care, often conflicts with an ethical stance against exposing patients and staff to an illness or compromised performance.

Resisting the pressure to work when ill can be particularly difficult for young doctors,” said study author Anupam B. Jena, MD, PhD,. “A work-first, self-second attitude is often seen as ideal among peers, superiors and even patients.”

In the first known account of the reasons for presenteeism among doctors-in-training, more than half of respondents cited obligation to colleagues who’d be forced to cover their duties or an obligation to patient care as the top reasons for not taking a sick day.

Far fewer, a mere 12%, indicated they’d worked when ill due to concerns their colleagues would think they were “weak” and 8% came to work sick because they felt pressured to repay colleagues for coverage.

Seniority appeared to be a factor in the results. Second-year residents were more likely than first-years to select responsibility to patient care as a reason for presenteeism. Gender differences were also brought to light with female residents more likely to work sick and cite patient care as the reason. Female residents were also more likely to report fear of being perceived as weak as a motive for not taking time off.

While time away from the office carries a similar stigma in other high-pressure professions, a business  executive showing up sick to the boardroom is significantly less worrisome than a doctor with flu treating patients. An otherwise healthy doctor can often recover quickly, but an infected patient with an already-compromised immune system may not.

Clearly it’s time for doctors to stop playing superheroes.  Presenteeism needs to be addressed and eliminated. Given the intellect of most doctors it shouldn’t be too difficult for them to understand that refraining from work while ill is the most professional way to ensure responsible and safe care for patients.

A word to my doctors – if  what you’ve got is contagious or makes you so sick that your judgment is clouded – STAY HOME!

NP’s prevent patient readmissions

Researchers at Loyola University Health System  have shown that adding a nurse practitioner (NP) to an in-patient hospital surgical department can decrease post-operative emergency department (ED) visits. According to a study just published in Surgery, by improving the continuity in care and troubleshooting problems for patients, an NP can reduce ED visits. The addition of an NP also resulted in an improved use of resources and financial benefits for the health system.

NP’s are advanced practice registered nurses who have completed graduate-level education (either a Master’s or a Doctoral degree) and have a dramatically expanded scope of practice over the traditional RN role. Their core philosophy  is individualized care. Nurse practitioners focus on patients’ conditions as well as the effects of illness on the lives of  patients and their families and make prevention, wellness, and patient education their priorities.

The study analyzed 415 patient records one year before and one year after the NP joined the staff. The two groups were statistically similar in age, race, type of surgery, length of hospital stay and hospital readmissions. Patients were tracked after they were sent home from the hospital to determine how many unnecessarily returned to the ED (defined as an ED visit that did not result in an inpatient admission).

Mary Kay Larson, the nurse practitioner involved with this study, communicated with patients and coordinated their discharge plan. During this time, telephone conversations with patients increased by 64%; and visiting nurse, physical therapy or occupational therapy services increased from 25% before Larson joined the department to 39% after. Most importantly, these services resulted in 50% fewer unnecessary ED visits.

This study demonstrates the important role that nurse practitioners have in our increasingly complex health-care system,” said senior author Margo Shoup, MD, FACS, Division Director of Surgical Oncology, Loyola University Health System. “Hospitals must continue to adapt to the changing health-care environment. The addition of a nurse practitioner clearly represents a way that we can adjust to meet the increasing demands of patient care while we are being asked to do more with less.”

SRxA has long recognized the value of NP’s and physician assistants (PA’s) in both patient and peer-to-peer education. To help our clients gain access to this important and rapidly growing group of health professionals we have recently established an NP/PA group.   For more information, and to find out how you can leverage their expertise in your next project, contact us today.

Bad day for your bowels?

Having one of those days…weeks…months?  If so, you should consider getting help before you end up with toilet troubles.

Seriously?   According to the results of a study unveiled this week at the American College of Gastroenterology’s (ACG) 76th Annual Scientific Meeting, the psychological and emotional traumas experienced over a lifetime, such as the death of a loved one, divorce, natural disaster, house fire or car accident, physical or mental abuse, all may contribute to adults with irritable bowel syndrome (IBS).

Researchers from the Mayo Clinic in Rochester, MN, found that adults with IBS reported more traumas over a lifetime than matched controls .

While stress has been linked to IBS, and childhood abuse has been reported to be present in up to 50 percent of patients with IBS, most studies of abuse have focused on sexual abuse with sparse detail and also have not looked at other forms of psychological trauma,” said Yuri Saito-Loftus, MD. “This is the first study that looks at multiple forms of trauma, the timing of those traumas, and traumas in a family setting.”

IBS is a chronic gastrointestinal disorder marked by abdominal discomfort, bloating, constipation and/or diarrhea and may be caused by changes in the nerves and muscles that control sensation and motility of the bowel. Trauma may sensitize the brain and the gut, according to Dr. Saito-Loftus, who said that the results of this study indicate that patients with IBS experience or report traumas at a level higher than patients without IBS.

In the United States, it is estimated that 10-15% of the adult population suffers from IBS. The burden of illness for IBS is significant and can have such a severe impact on Health-Related Quality of Life that it has been linked to an increase in suicidal behavior.

Patients and their families frequently wonder, ‘why me?’, ‘why did this happen?,’” said Dr. Saito Loftus. “This will help them understand why IBS happened to them.”

Our advice?  Do not “underplay” the role of stress. Even if you think you can cope with life’s little traumatic experiences on your own, your bowels may not agree.