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Viral Radiology: Knowing When to Say When with the Stigma of Calling Out Sick


Given a certain perception that calling out sick is frowned upon in health care, radiologists and other health care workers may feel conflicted about being absent even if an illness has reduced their capacity for getting work done on a given day.

For the first time in memory, if ever, I spent my birthday this year in the throes of an upper respiratory infection (URI). It fell on a Thursday, but the condition did a thorough job, hanging in there to wipe out some post-B-day socialization I had planned for the ensuing weekend.

One of the many pleasures of shifting to telerad work over a decade ago was that come into much less contact with other potentially infected humans. Working remotely in a health-care occupation, I have a small fraction of the viral exposure faced by most of my peers. Pre-telerad, I would get one or two URIs per year. Working from home, I have had more than a few zero years.

The flipside is that, without any risk of infecting coworkers or patients, I have much less of a reason to declare a “sick day” unless I am in a really bad way. That runs counter to a routine many of us learn as small children. Your payoff for being sick is that your parents keep you home from school. This is a bonus if you’re not actually feeling all that bad, but you still have a fever or the like, because now you just have a staycation day.

One might still indulge in calling a sick day if one’s telerad job is salaried with little or no bonus for productivity and more time off than one really needs. If it costs nothing, why not call in sick? There are, after all, legitimate reasons to do so. A sore throat can make dictation painful and/or be exacerbated by speech. Bleary eyes or a foggy brain might impair the quality of one’s work.

On the other hand, suppose your comp is based on productivity or you need/want every last second of your time off. Taking a sick day would detract from that. You would have stronger motivation to “tough it out” at your workstation, armed with a box of tissues and your OTC meds of choice.

This conflict isn’t exclusive to work-from-home types by the way. Long before the pandemic, or indeed any sort of telemedicine was a thing, in fields such as health care, there was a stigma associated with calling in sick. There was a sense that you were letting your teammates down and they would have to take on your workload along with their own. You might have to “pay back” the time in a less desirable shift.

At one point in my residency, I had gotten over the worst of an episode. (It mercifully happened on a weekend, so I didn’t have to call out.) I decided it was safe to show up at my usual hour on Monday morning. I had the lingering aftereffect of a ragged hoarseness, which sounded terrible. However, I felt fine otherwise and assured everyone around me of this. It wasn’t purely my idea. I had seen more than one of my attendings in that department show up in similar condition during the previous year or two.

The attending with whom I was working that morning commented a couple of times on how lousy I sounded, and I repeated my assurances each time. However, by midmorning, she came to a decision and told me: “You might be totally right, and 100% not contagious. But if I get sick in the next few days, even knowing there are other sick people around, I might find myself blaming you. So, kudos for showing up and being dedicated, but it’s time to go home now.” Off I went.

Live/work in the milieu of “calling in sick is weak and shameful” long enough, and it rubs off on you. I don’t think I ever called out of a day at any other point in my residency or fellowship. If memory serves, I took all of two days during the subsequent six years of on-site work (contiguously for a single illness). Should I have called out every time I had a cold in the hope of not giving it to anyone else? Nobody else did but they were steeped in the same “avoid calling in sick” culture that I had been.

However much higher my calling out threshold is with telerad, it’s not unreachable. Putting aside extremes such as scenarios in which I have to visit an urgent care or hospital, I can think of things that would take me out of the game. I have never had a particularly bad migraine, for instance, but I know they can be debilitating. If I completely lost my voice and couldn’t dictate at all, that might be a showstopper.

On the other hand, I am a pretty good typist, and could still turn out some decent work if the keyboard was all I had to work with. Similarly, I have had mercifully mild migraines where scintillating scotoma reduced my field of vision, and I thought it best to hold off reading cases for the 30 minutes or so they took to pass.

Under such circumstances, especially with telerad gigs, I have been able to execute “not quite” sick days, wherein I have notified the administrative types of my diminished capability. They have pretty much always agreed that a strict all-or-nothing approach (a rad is either well and expected to turn in 100 percent) or sick and doing nothing wastes a lot of potential.

For instance, if I shoot HQ a message that I am not speaking at all, and will be typing reports for maybe 50 percent productivity, they have less of a deficit for others to fill. Alternately, maybe they know that they can get by with that shortfall for a day or two, and don’t need to bring in anyone. Meanwhile, I can reassure myself that whatever comp I get for a day’s productivity hasn’t been completely lost.

This recent episode provides another example. I typically work from 7 a.m. to 4 p.m., and it was getting progressively tougher for me as the day went on. At around 2 p.m., I had wiped out my worklists and had nothing to do. Historically, I knew some more stuff would probably trickle in during the next couple of hour so I shot a message to the top admin. There is nothing left for me at the moment, and I am kind of a sick mess, so I am crashing. Let me know if you urgently need me for anything.

Happily, they didn’t, and the afternoon nap was therapeutic.

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