There are many factors that contribute to doctors not being able to take on the sick role, and it's often not as straight forward as simply not wanting to.
For starters, all doctors know that there is a gradient to being sick, and theoretically, there is a point in that gradient line in which you are deemed "too sick to go to work".
However, in practice, it's actually very, very difficult to properly ascertain where you are on that list. It is hard to be objective when it concerns your own health, which is why it is always valuable for a doctor to have their own personal doctor; an independent assessor capable of making the call that you should be off-duty.
Why is it important to have someone to take that decision away from you?
It can be very easy for a doctor to say "It's just a cold, I'll soldier on" because a lot of the time, it takes a lot more effort to take a sick day than it is to just go to work even though you shouldn't. For a specialist, it means rescheduling appointments that have been booked months in advance; for interns, residents, and registrars, it means finding someone else to do the work you were assigned to do.
Whether in hospital or in clinic, when you're a doctor, there's always more work to be done than there are hours in a day. And more often than not, you're the only one who can do your job because other doctors have way too much on their plate already. Quite simply, there is no one to pick up your slack.
It is undeniable, however, that a sick doctor is no good to anyone. Not only do you risk spreading illness to your patients and colleagues (further contributing to countless hours of loss productivity), your physical, mental and emotional states are compromised and you're more likely to make mistakes.
And in medicine, mistakes are costly and not tolerated very well.
All the same, there seems to exist an expectation within the medical profession, conscious or subconscious, for doctors to push through adversities. Whether it's related to physical, mental, or emotional drain; whether it's due to excessive working hours, unpaid overtime, lack of personal or professional support, work or life stressors or illness of any sort, we all seem to be expected to suck it up and be okay anyway.
Despite being constantly reminded throughout medical school about the importance of taking care of ones health, the comment one of my supervisors made regarding my need to get some time off to visit the doctor was, "Do that while you can, because when you get to my level, there's no such thing as taking time off. When I get sick, I still have to go to work."
And therein lies the hypocrisy of medicine. What they tell you to do and what they really expect you to do are often two completely different things.
One of my colleagues recently confessed to me that she has been struggling with the hours and jobs required of her in her medical rotation. In fact, she was having such a hard time at work that she felt she needed to bring the matter up with the Director of Medical Services so they could together find a solution that could improve her situation.
The response she was met with was appalling. The DCT essentially said, "Suck it up, this is medicine, when I was at your level I had it 100 times worse. I'd be lucky to have a rotation like yours."
My thoughts? Tyrant.
And this is not an uncommon scenario.
My personal thoughts are, it doesn't matter that back in "the good old days" doctors were expected to slave over inhumane hours which were both hazardous to their health and their patients' health. There's a reason why we have put a stop to the Dark Ages. It wasn't working for us. Just because you had it hard, doesn't mean that it's okay; and it definitely doesn't mean that you need to condemn others to the same fate.
In that regard, I have a lot of respect for the nursing profession. Nurses adhere religiously to their stop and start times, they take multiple schedules breaks a day, and are extremely ferocious about guarding these sacred rights. And, more importantly, they look out for each other. They ensure that their fellow nurses take breaks and leave when they're supposed to.
The habit is so inspiring that I can't help but wish that they were just as watchful over their doctor colleagues!
Unlike a lot of my colleagues, I've been very lucky in my rotation so far and I've had wonderful, amazing nurses working with me who care about my health and wellbeing. In fact, it was under the advice of a senior nurse that I took my sick leave and I'm very grateful to her for pushing for it. I had really needed it, but the weight of my supervisor's expectations (and my own) was urging me to push on.
At the end of the day, we are a team. And like any team, we are only as weak as our weakest link. I think it's important for us to look out for one another and stand up for one another when the occasion calls for it.
We all acknowledge that no one is superhuman. We are not immune to disease and when we come across someone who needs a hand with taking on the sick role when they rightfully deserve it, I'd like to think that we could defend that persons right, just like we would want someone to defend our own rights to it when the time comes.
It is incredibly sad to note that, from my observations thus far, compassion is a virtue that is incredibly scarce in the medical profession, despite the fact that it requires it most.
It is both frustrating and disappointing, and I can only hope that this improves in my future observations but until then, I suppose the most I can do is to follow Ghandi's advice and be the change I wish to see in the world.