Sick leave needs to become a viable choice
25 October 2017
“I would have to be almost needing admission into hospital myself before I would call in sick.”
The above sentiment is all too commonly heard among junior doctors working in our public healthcare system. I have not only heard others express similar views, but have uttered similar words myself. I am not proud of these words.
Because pushing ourselves to work when we are physically or mentally not coping with the workload is not smart. Yes, perhaps our commitment to our jobs in the face of personal illness reflects a form of resilience. But it is very likely that, over the long-term, such an attitude will compromise our ability to look after ourselves, and unfortunately, our patients.
As doctors, we know the importance of rest and recovery. We write medical certificates on a daily basis, allowing our patients the opportunity to prioritise their own health over the demands of their workplace. Yet so often we deny ourselves the same right.
We are not a superhuman species for whom the regular rules do not apply. We are no more exempt from the effects of illness, fatigue and burnout than the rest of society. And if the data on medical student and doctor mental health is anything to go by, a great proportion of us are struggling with the demands of our job.
Our reluctance to take sick leave outside of some of the direst circumstances is a sign of a system that is failing the junior medical workforce.
Our hospitals are well-oiled machines with an absurdly small repository of spare parts. If one part needs maintenance, the entire system struggles to cope. So when the parts experience a little wear and tear, they are left in the machine. And they stay there, even if their work is suboptimal. Sometimes they stay there even if they are broken.
A system that lacks contingency is fragile. This fragility lies at the core of doctors’ inability to take sick leave.
When we go to work feeling unwell, tired, or burnt out, often it is not because of some false bravado. It is not simply a ‘cultural problem’. It is because we know there will be no cover. Calling in sick feels like a betrayal. We work in small teams during the day, and usually every team member is working hard to meet the bare requirements of their job. Calling in sick leaves the remainder of your team with an impossible workload. Patient care could be delayed, or worse, entirely compromised.
So when the alarm goes off in the morning, we do not rationally choose to go to work rather than opt for rest. It does not feel like a choice. We could not possibly call in sick. We cannot leave our colleagues unsupported. More importantly, we cannot leave our patients.
What is the solution? As is so often the case, funding lies at the core. The system needs redundancy, but redundancy is expensive. Hospitals may be reluctant to hire expensive locums to cover unexpected leave. While most networks have relievers on the roster, they are often spread thinly in coverage of expected leave.
We know there is a surplus of doctors graduating medical school – so many that our training programs are flooded. We also know there is an increasing desire for part-time and casual employment, to enable flexibility while training. We need to channel this opportunity into a repository of relievers and locums who can be called upon on short notice to cover an unwell member of the junior medical staff.
If you were unwell, and you knew that calling in sick (with reasonable notice) would result in your unit being staffed by a competent, willing and well remunerated covering doctor, would you feel more comfortable taking the day off? I certainly would be.
Our reluctance to take sick leave does not have a cultural aetiology. It is a cultural complication from an under-resourced system. But this solution is remote to our day-to-day choices. Our choice feels simple. The system is what it is, and self-sacrifice comes all too naturally to many of us.
Finally, to my junior doctor colleagues – let us not judge each other when we are unwell. There is often a sense of annoyance when we are called in to work on our days off, sometimes even when we are not officially ‘on call’, because a colleague has called in sick. It is natural to feel frustration. But this frustration should not be directed towards our colleagues, who are unwell and smart enough to know that they need time off.
Let us focus our energies on searching for solutions. Chat to your workforce unit. Perhaps your health service needs a locum bank. Perhaps it needs more staff on a relieving roster at any given time. Or perhaps the State Government needs to be pushed to provide dedicated funding in order to introduce more spare parts into our hospital machines.
For the sake of our own wellbeing, sick leave needs to become a viable choice.
Dr Kunal Luthra
If you are experiencing any concerns with sick leave or any other workplace issues, please contact the AMA Victoria Workplace Relations Unit on (03) 9280 8722.
This article appears in the December 2017/January 2018 edition of Vicdoc.