Tuesday, February 07, 2017

reader mailbag!

Reader Mail:
Hi Sarah, I'm a long time reader but have never commented before. I'm a Mom to a toddler and pediatric resident (aka I always have at least a low grade viral illness) and have been struggling more and more with this notion of doctors never being allowed to take a sick day. Your forays with mindfulness resonate with me strongly, and I feel like not taking care of ourselves is so counterintuitive to this. I'd love to say I have the energy to change the culture from the ground up, but mostly I just need to go to bed. Any thoughts are appreciated! -lily 

Thoughts:
Hi Lily!  Toddler-mothering + residency - that is no joke; I actually never experienced that combo but it sounds very very tough.  I support going to bed :)  No, in all seriousness, I agree that sometimes the expectations are ridiculous.  I also feel they are not always the best for patients!  And as a physician you can't win either way -- if you move appointments, people complain (and I get it, it is hard to arrange your schedule ahead of time and then have it change last minute!) and if you come in sick people complain that you could be exposing their children to viral ($*&@# (and probably sometimes the SAME people, because some people just like to complain).

Anyway.  There's no easy answer.  And in my case, my schedule is quite tight currently so there's also internal pressure.  If I call in sick on a weekday, I have a dozen patients that I then need to find slots for, and I have zero slots for months unless I overbook.  And if I overbook, I have a hard time getting home to my kids which for me is a non-negotiable.  So I am also internally motivated to grind out the day unless I am truly TRULY unable to function (has only happened once so far in my post-training job, when I had a concussion after hitting my head and needing stitches last April!).  However, my cancellation threshold might actually change when I go 4 days/week (April 1!!!) because I could just put those slots onto one of my days off.

I think that in your case, while you can't change culture from the ground up, you can still create your own personal culture.  Work hard, take good care of your patients, but take care of yourself, too.  It may be wise to have a pop-off valve in your schedule IF you are the primary caregiver for your child/children (ie no partner with flexible hours) so that you can confidently cancel patients when you truly need to and not have to worry about the aftermath.  

I will say that after residency / fellowship you DO have more autonomy!  My office managers have never pressured me to come in sick.  You can also do trades if it's a call issue -- if I'm dying, I will ask to trade (never just for 'coverage' - I believe call should always be a 1:1 trade and I don't like owing anyone anything!).  

Others in medical (or non-medical) fields - thoughts?  

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