At the peak of last winter, having cared for innumerable sick patients, I felt ill. My initially vague symptoms melded into more significant ones. My head hurt, I felt tired, and I briefly doubted my capacity to make sound, rather than expedient, decisions. There was no question in my mind that all I needed was one, maybe two, full days of rest. But it was a month where I was working for two different services.
The oldest and most vulnerable of my medical patients needed to be seen at least once, if not twice, daily. In the grip of illness, dehydration and malnutrition seemed to creep up on them, and weighty decisions about their care could not be left to junior doctors.
My cancer patients were a whole different story. They all endured anxious waits to be seen in clinic. Some awaited confirmation of a diagnosis, others a treatment plan and yet others a sensitive conversation about their mortality. These patients had bookings for interpreters, transport and tests. Their spouse or child had taken a day off to digest the news and later, take stock. Anyone vaguely familiar with cancer patients will know the constant companion that is dread, so when someone asked, “If you’re sick, what do you want to do about the patients?”, these are the things I considered.
How would my team manage? The two interns would struggle greatly in the absence of the senior resident, who was himself ill. He had an exam, so I immediately replied: “Stay put, get better.” “Is there anything I can do?” came his guilty response. “Switch off your phone,” I replied, channelling my own desire, but the stakes had just risen. Which specialist leaves two new interns to manage alone?
No one.
Next, my thoughts turned to a greater problem. If patients cancel, you turn to the waiting list. When oncologists cancel, patients have no immediate recourse and they are returned to the mercy of the booking system. A cancellation doesn’t spell death, but it almost certainly compromises symptom management, pain control, and the conversations that ease the act of dying. Show me a patient who says these things can wait.
Every doctor I spoke to was sympathetic. And fully booked. They said “sorry to hear you’re sick”, but what struck me was their unspoken fatigue and wariness. I had been there too, supporting a sick colleague while juggling the kids’ school, ageing parents and a busy spouse, not to mention patients who wanted to be nice but couldn’t help being frustrated. And suddenly, instead of goodwill towards a doctor in need, one felt resentment towards an anonymous, punitive system which turned good colleagues into unwelcome dependants. Surviving as a doctor threatened to diminish you as a human being.
The rule of thumb in medicine is that if you aren’t sicker than your patients, you turn up to work.
I worked 12-hour days. I wore a mask, avoided the most immunocompromised patients, and apologised to the rest. My colleagues were guiltily relieved. No patient became sicker after seeing me, but I helped many. And I got better.
For doctors, this is an utterly commonplace account. After all, a temporary viral illness is nothing compared to conditions that some other doctors endure: the death of a parent; a complicated pregnancy; and of course, mental illness whose manifestations are far harder to share than a fractured arm or a blinding headache.
But there are people who consider sick doctors attending work to be selfish and irresponsible, in the hold of some messianic complex that they alone can help their patients. If you listened to hospital administrators, you might be excused for thinking they’re right. After all, organisations are splashed with well-intentioned messages highlighting the importance of self-care and even offering free help, because we know all too well that illness doesn’t distinguish between patients and doctors.
Unfortunately, like all attractive offers, there is a huge catch: in order to get better, you must be prepared to tax your fellow doctors. No one says you can’t take a day off, but it is an unspoken expectation that you will not be covered. Your boss might convey the message, but it’s a directive from higher up. Hospital executives are hardly inhumane, but they’re not accountable to doctors as much as their own superiors.
So, when doctors say that they have years of accumulated sick leave, it’s false to conclude that they never get sick.
They just fall ill and recover while working. Indeed, institutions around the world exploit this impeccable work ethic to stay open and make a profit. If every doctor seriously heeded the advice to take time off when needed, it is possible that careers would struggle and certain that patients would suffer. The message to doctors has always been clear: if you want to get sick, do it on your own time.
This festering wound of doctors was aggravated by the Victorian health minister, Jenny Mikakos, who chided a veteran general practitioner with mild viral symptoms for seeing patients after returning from an overseas trip. He followed the guidelines for coronavirus testing; when he turned out positive, she humiliated him and lectured doctors on responsible conduct during a crisis, forgetting that they are the ones manning the frontline. Then, somehow deaf to the disbelieving howls of protest, she added fuel to fire by suggesting that the doctor who didn’t take a sick day should be pursued by the same regulatory body that investigates sexual misconduct and drug addiction.
I want to believe that given the potential for the government to lose control of a crucial narrative, the minister made a human error. That she really wasn’t “flabbergasted” to know that a doctor with a mild illness went to work in service of his patients, including those confined to a nursing home, in which case we should forgive her and move on.
For of course, the alternative is far more concerning. If a health minister is truly flabbergasted at the lived reality of being a doctor in an overstretched system, where is she receiving her advice? If she is being falsely reassured that all doctors are allowed to take sick leave, they just choose not to do so, who is doing the reassuring? If the health minister lacks confidence in doctors, will the public follow suit?
It is one thing for a patient to be misinformed but a health minister wields power, with which comes responsibility. In navigating the newest challenge to population health, it is worth remembering of the oldest adage of medicine, primum non nocere. First, do no harm.
• Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar. Her latest book is called A Better Death
