When residents call out "fake sick"

After all, "it is just a job"

Recently I heard the story about a residency program where it is a cultural norm to call out “fake sick.” In other words, if a resident has a particularly long or rough day, if they feel they need some rest— even in the absence of fever, chills, drenching night-sweats and propulsive vomiting— they will call out “sick”. Covering residents remark how interesting it is that fake sick days are usually on weekends or adjacent to weekends (Mon-Fri), and that this is remarkably more common than in prior years.

Its incredible how times have changed. I trained at Northwestern Medical Center in Chicago between 2009 and 2012 in internal medicine. If I ever called out “fake” sick, my program director would give me a “real” ass-kicking.

“Fake” sick is something that admittedly we have no public data on, but programs know well. It would be easy to deduce fake sick days by analyzing rates of illness by calendar day— as suggested. Real illness doesn’t discriminate between Weds and Sat, but fake illness does. Program directors— particularly of large programs— should run this analysis in their ranks. I suspect many have. I wager the programs where this is the biggest cultural problem have program directors who are the least willing to study it.

Other programs don’t have a culture of “fake” sick, but have mental health days. A mental health day can be taken for any reason and at any moment, and as such has similarity to a “fake” sick day— a difference without a distinction.

On Reddit, there are many interesting threads where residents discuss this practice, here is one example.

Among the replies that caught my eye.

I would be curious to read this person’s medical school application essay. Those essays typically contain phrases like “medicine is a calling” “a profession” “people place their lives in your hand” “it is a trusted and ancient art”. I wonder how that sentiment transforms to “this is just a job.”

Another reply caught my eye.

In the last 5 years of my career, I have never seen so many trainees having to go to the dentist— an epidemic of carries that must be filled during rounds or clinic. It is not a joke, but a truth: I went to the dentist before I started medical school, and when I became a professor.

One of the challenges in my line of work (oncology) is that we experience the range of human emotions in a single morning. The first patient is someone with multiple myeloma whose cancer has grown despite all therapies, and now is certainly going to die, and you have to counsel that woman, and her daughter, about this news, and what to expect, and then you come in the hall, and 30 seconds later, you have to enter the room of someone with Burkitt’s lymphoma in the abdomen, who you swore was going to die, but has achieved a complete remission and may even be cured.

Agony to ecstasy in less than a minute, and both patients need you to be there for them— fully present— emotionally available. There is no mental health day in between, nor afterwards. Because tomorrow on the schedule is another patient with relapsed leukemia who disease is blasting off, and has no more available therapies, and they want to talk to you, and not any covering doctor.

I feel pity for the trainee who finishes medical residency thinking “this is just a job”— somewhere along the way we failed to show you why it is not.