Take 2 “Suck It Ups” & Call Me In The Morning

Take 2 “Suck it ups” & Call Me in the Morning

12/12/17

Z: What up Z-Pac? It’s your boy Z dogg MD. Check it out I’m live and direct out of the Portland Hilton in Portland, OR. I’m so excited to be here. Getting here was a bit more difficult, but now that I’m here I’m excited because I’m speaking at the Kitt Saber (??) symposium tonight for the foundation for medical excellence and I posted about this a while back. Hopefully members of the Z pac that are Oregonians are gonna show up and represent!  Health 3.0 ya know what I’m sayin??!! But anyways the topic for today’s show is calling in sick to work. And let me tell you the circuitous way that I ended up at this topic . And I wanna start also with a little housekeeping.  Shop.zdogg.com is up and running. We ran out of “I narcanned your honor student” female shirts, but we’re going to get them back up hopefully soon. So we brought back the limited edition Zeezus shirt, so check that out. These are definitely great gifts for a Zpac-er or people you want to show that you’re super edgy and dope in healthcare for Christmas. And the thing is we take the revenue from those shirts and put it into a fund specifically earmarked for producing dope videos for yall.  SO any money you spend there, not only do you get a dope shirt, or give a present, but you get to actually support the production of future videos.  Including videos for PT, OT, social worker, case manager coming soon as well as RT. I know you’ve all been asking for it. EMS – we haven’t forgot about you either

Alright , so that being said, let me make sure we have sound so you all can hear me. Because sometimes that goes wrong. Let me tell you the story of how I got to Portland and why we’re talking about sick days. (Checking computer)  Hey we got it. There’s your comments.

I flew Southwest. And as yall know I love Southwest, but it is a cattle car. So I’m jammed up against the window right. And in come these , to sit in the middles in the aisle, and in come these huge people, they were a couple. And they are big. Big and I’m a little Z (??) . The woman sitting in the center was so big, that just the spread of her arms —it was like there was an elbow in my face. On top of that everybody on the damn plane is coughing and sneezing. The dude behind me sounded like he was gonna puke. My first elephant conditioned response is “What’s wrong with these people? Why are they traveling when they’re so sick?” Are they out to harm other people? Like this is a crime against everybody else on this plane. And then I took a breath and realized….wait a minute…we do it in healthcare all the time. We go to work sick as a dog on the regular. Sometimes it’s part of our culture of suck it up. Sometimes we have no choice because our employer or our group will not allow us to take sick days without a penalty. And sometimes we just don’t know how sick we are and we show up like idiots even though we’re in healthcare. It’s ya know, physician and nurse and PT and dietician – Heal yourself. So, it started getting me thinking this is what we should talk about today. So I put up a poll on FB. Let me get this thing up here, because you guys, you really like polls. I said, “Do you go to work sick as a dog from time to time, or do you call in sick?” and it was pretty clear what the answer was. We had 60,600 votes so far in 5 hours, less than 5 hours. And 70% of people basically said “I go in Hell or high water” doesn’t matter if I’m sick…and 30% call in sick.  Now this doesn’t surprise me because of my own experience in the hospital. And it doesn’t surprise me because there was a study or some data recently that said the vast majority of healthcare providers reported going in sick, even when they have a fever. Now in my entire 10 year career as a hospital doc, practicing at Stanford w/ my medical group. I never once called in sick. Once I called in because my wife was having a baby and my good friend Dr. John Kaniff (?) valiantly covered for me and took my shift even though he was off. And so I still am grateful for that. But I never called in sick. Now does that mean I wasn’t sick? NO! It means I had horrible upper respiratory stuff. Sometimes I had GI stuff and I would just go in and I would wash my hands fastidiously and wear a mask. But was that really keeping my patients safe? Was it in the best interest of the general health of the hospital and the patients? And of my own health and the health of my family, because the sicker I am the more likely I am to get them sick if I don’t have a chance to get better. But that was the culture of it. Because in my situation, if I called in sick, someone who was off. Like literally wasn’t working, a doctor who either had days off or was on vacation or something else, would get called in because no one else is there to see the patients. So it was just simply a question of “who do I hurt?” And then when I come back I’m gonna be disoriented -all the patients, and stuff’s gonna have happened  to them. So there’s all that stuff that goes through your head.

So I asked yall in the survey, give me comments. Let me have your voice. Because part of the purpose of this whole incident report platform is to give you guys a voice. So let’s do that. You guys had some great comments and I pulled some of the comments that caught my attention and I wanna go through them. Now the other thing I wanna say before I get into that. While I was on the plane I learned a way to cope w/ severe plane-related anxiety. Everyone’s coughing, I’m jammed into a corner, it’s claustrophobic. Remember when I did an incident report about meditation and this book I was reading, “The Mind Illuminated”? which btw if you go to amazon.com/shop/zdoggmd….that’s not complicated(chuckle)….it’s got a list of all my recommended books and gear and stuff. So this book’s called “The Mind Illuminated” , we were talking about this and how it’s sort of jumpstarted my meditation practice. Well I was on the plane so the first thing I did was take these noise cancelling Tao- tronic (?) headphones. They look something like this… (shows headphones/earbuds). They cost $45. I’ll put the link on after… actually you know what, here I think I have it copied already because I was sending it to somebody. I’ll put the link in the description you can buy it through Amazon. And if you do buy it through Amazon, through this link, you’ll be sending a couple pennies our way which is nice, again we’ll put it in our video production pile. So I put this in….. let me just get this for you guys right now because I love these things. (Typing on computer) Again they don’t pay me, this is just me saying I love these things. Uh, here they are. Ok , they’re in the comments now.   Theyre noise cancelling. You put them in. they fit right in your ear. So already w/o even turning them on its pretty quiet around me, like I can barely hear myself talk, and you turn this little switch and boom… All the rumbling and low frequency noise is gone.  And so I put these in my ear and the nice thing about these, I love them for travel, or if you’re on break at the hospital you can put em in if you don’t want to be bothered. Put your pager on vibrate, or whatever, put your phone on vibrate and they’re so tiny that when you’re done, you just put them in your pocket. I love em. And everything got kind of quiet I could just hear mumbling, I could hear a little coughing a little sneezing, and then I did my meditation practice. Now I thought it would be too distracting, but part of the practice of meditation is actually identifying distractions and then refocusing back on the breath. So I was able to do that. The next thing I know an hour and a half had passed.  We were on the descent. So… highly recommend meditation. It can help turn an airplane flight from and ordeal to a chance to better understand and train your mind to be less reactive and all the other things we talked about.

Now…that being said let’s talk about your questions and comments on coming in to work sick.  Let me pull them up, the ones that I pulled. So, Kayla Deaver(??), from the poll that I posted, wrote:” I’m a stem cell transplant nurse. My patients routinely have a WBC < 0.1 . If that was my loved one and a snotty nurse came in to take care of them I would tell them to GTFO. So I call in at least when I know im contagious. It’s just the right thing to do.” Alright, so here’s an example of the ethics, the morality of coming into work sick. You’re around immunocompromised patients. Whether you wear a mask or not, you still have a chance of contributing illness to a population that could die from getting infected. It’s the same reason you should get a dang flu shot, alright? But that’s another talk that we’ve done. So that being said, should you stay home?  Well the answer is if you have a fever, if you feel like you’re contagious, if you feel like you’re going to make people sick then yes. And if you’re getting over something you probably should wear a mask. And this is all true. The question is what happens when your employer first of all doesn’t have policies…and there were plenty of comments on this…or you don’t have coverage. What do you do? This is conundrum that we find ourselves in in healthcare. Time and time again.  Because while we’re asked to support our patients and be very altruistic, almost like in no other  profession, we’re asked also to go above and beyond in regards to our personal health and the safety of others by coming in. When we’re always understaffed. Well if you don’t come in you’ll hurt someone else on your team- or the patients don’t get seen. So let’s read some comments about that. Rosemary Wright says: It depends. I feel awful or guilty either way, whether I come in or stay home. I hate this part of medicine that doesn’t value our health or mental health.” That’s what it is!  In the 10 years I was at Stanford I never called in sick, because it felt to me, correctly or incorrectly, like stabbing one of my colleagues in the side and twisting a knife. When I should just take a couple of pills of “suck it up”, wear a mask and go. Well, I’m also taking care of 90 yr olds who are immunocompromised. I’m taking care of young people on steroids who are immunocompromised. I’m taking care of cancer patients. You know, with those patients I would glove, I would put on the mask, I would wash…but still, what if there’s something on your shirt or coat? It’s still not the best thing to do. But what choices do we have? And that’s what we wanna talk about. So, another comment, “In my hospital system”, says Lynette Vanmastrick-gordon (??) “ you are allowed to call in sick only twice a year. (Z: Twice!) otherwise you will be in discipline.  You also earn PTO which has to be used for sick days and cannot be taken during holidays such as Christmas and Thanksgiving.  I’m not sure how that’s even legal”.  Well, I don’t know the legality of it, but I know that these are policies that probably sprung up via administration to keep down costs and make sure people are staffed and also, frankly, to stomp out some degree of abuse which will always occur to some degree in systems like this where it’s on “scout’s honor”. Are you really sick or not? It’s not like you need a doctor’s note. And of course, any of us can get a doctor’s note pretty easy. Hell, I’ll just ask any of my homies. I’ve never had to do it, but it wouldn’t be hard. So this is why these systems exist. The question is are they productive? Are they going to encourage you to do the right thing if you’re sick? And the answer is probably not, right? Let’s read another comment here. Andrew Wilson says:  I work as a paramedic. The issue w/ us, and many in healthcare -we’re not special-  is that if there’s not 2 of us in the unit it’s inoperable. Unfortunately, d/t severe staffing shortages there is nobody to take your place and that puts the public at a greater risk. We bitch and moan, but at the end of the day we put our patients and the public first. It’s a cultural thing in healthcare. If we don’t show up, nobody will. Intellectually we understand the risk of getting others sick…but”. So, Andrew Wilson nailed it. This is the heart and soul of it. We go into this thing to help people. We feel responsible to others. We feel responsible to our team. We feel responsible to our employer. We feel responsible to ourselves to step up and work. And if we’re sick, we will take 2 “suck it ups” and call no one in the morning, because that’s how we are. But is that the right answer? Or should we have some processes in place to actually staff up and cover up and all of that? One thing to remember, and we did a talk on this, for example for doctors in this country. We have, in the developed world, one of the lowest ratios of doctors to patients. So in other words there are very few doctors to a whole lot of patients in the US. And there are many reasons for this , we talked about it in our previous show “Is Scrooge McDoc destroying America?” but the bottom line is we are understaffed. We’re understaffed w/ nurses, we’re understaffed w/ us, we’re understaffed w/ EMS. It’s a big deal. Our frontline emergency responders. So what do we do when we’re sick?  At least we ahv e aplae where we can bitch and moan about it, but what about real, actionable change? Well one of the things we can do is have more staff, be more effective with the staff that we have, but then have processes in place where there’ s an activation protocol when people get sick. But then we have to have a shift in culture where people cannot take advantage of a sick policy just to take off. Many people have kids that get sick, many people have family emergencies, many people are taking care of elderly loved ones. It is hard all around. This is true not just in healthcare, but in healthcare we feel it acutely because of those who depend on us in our jobs, not just our patients but our fellow healthcare workers, our teammates, right? Let’s read another comment here. So Cam Boozefield (??) says: “That depends. One day a week that I work has no patients on site. So it would be ok on that day. But the downside is the other 4 days w/ patients and the doc and I are the only staff employed there.” Z: I think this is a front staff, a front office worker. “I don’t know Zdogg, would you run a clinic w/o a receptionist? Just you running the whole show w/o support staff? “  Z: so Cam would suck it up and go in. “Otherwise my boss and I both lose a day of work, and the patients would have to be rebooked. It’s too much work” So this gets to the other point. Many of us in healthcare, whether we run a private practice, we run our own office, we’re on RVU based payments- in other words we get payments based on our productivity. If we take a day out for sickness we don’t get paid. So were costing money. The patients don’t get seen because there’s no one else to see them. We have to back catch up. As it is we’re seeing 30 patients a day! So now you’ve got this backlog. Such that even Cam there, who’s working the front office is like “I ain’t takin a sick day because it will be a disaster!” Dude, come on, what are we doing? So again, even just shining a light on it is a start, because we don’t talk about this stuff publicly. Half the people on the board are scared to say anything because they’re worried their employer will retaliate. Right? Let’s read another comment. Carrie Maddox, relating right to this, says : “The challenge is that there’s no “sick leave”, only PTO which is lumped into one big category to be used for sick or vacation”. And that’s the other thing are you gonna sacrifice vacation days if you’re sick? Most people will say “hell no, I wanna go to Hawaii w/ my family” or “I wanna like, spend time in the mountains w/ my family. I don’t wanna take a sick day so I will suck it up and come in –to the detriment of everybody around me” Right? It’s the infrastructure that leads to the culture and they feed each other. Last comment, “So this is horrible” says Janine Solice (??), this is a patient so we’re getting the voice of the patient, “why are there not sick days?  I am a patient that has no immune system d/t my 11 kidney infections and 14 rounds of abx.  I had to stay home and not leave the house to avoid being exposed to a bad virus before surgery. I cannot afford to get sick or I’ll be in the hospital on a vent or the ICU”. Z: exactly right. So here’s a good example, like my parents-in-law, the grandfather is still alive at 103 and was staying w/ them in Las Vegas over the holiday- Thanksgiving- and some extended family came to stay and brought their kid who was openly sick, coughing everywhere. 103 yr old grandpa got deathly ill and nearly died. Well, that was preventable right? If we changed the culture of how we think about going out w/ sickness if we can avoid it, especially if there are vulnerable people. This also goes into the whole vaccine thing btw. Vaccinate yourself so you don’t injure others w/ your choices. Alright, that being said let’s go and see if theres any new comments here. “The system is obviously broken” says Doug Greer (??) “there’s nothing noble about working sick”.  Z: Agreed the system is definitely dysfunctional, but we can start to make changes. Joey Leste (??) says “ This is why no one wants to be a nurse anymore. I was a new nurse 10 years ago but this system will pull you in and spit you out in the end” Z: Well that’s an encouraging (laughs)….!!! Look guys, so in a system where we staffed up, we have a culture of supporting each other, not letting each other down when we’re sick, meaning we’re able to call in when we’re sick because we know our team will step up to cover us. And we know we will do the same if they’re’ sick because we trust that if they’re ill, they’re ill. And we will do our best to support each other, along w/ the golden rule “Do unto others” because they will then return the support, because that’s what we do for each other on a team. That- in the end -is heart of the Health 3.0 call to action on this. We have to do better. WE have to work w/ our administrators. We have to work w/ the people who are paying the bills. But we have to work with each other on a team too, to say there’s really no room for abuse of sick days. But there’s also no room to come in when you’re deathly ill. We’ve gotta make it a cultural thing. We almost have to bring an element of shame back . Make it so when you come in you’re gonna get shamed. But only if the system allows you to call a sick day w/o being totally disciplined and punished.  It’s a mix of things. Kind of like handwashing is starting to become a shame issue. If you come out of a room and don’t wash your hands, you’re going to get shamed by infectious control if they’re there and probably other people eventually. I think this idea of kind of accountability to our tribe is actually very important and it’s a kind of way that we can help make these things happen. So all that being said, I’m gonna wrap up by saying the Zdogg shop helps us make videos. Go there! I’ll put the link in the description. These cool headphones, right? (showing noise-cancelling headphones previously mentioned). I have come to the conclusion that they are invaluable. If you’re in a break room, you’re trying to get away from it all or if you’re travelling. So I’ll put a link for these and again, if you buy it through Amazon it will give us a little bit of support to make videos.

I want you guys to stay safe if you’re sick, call in. Hit share, hit like. If you’re really nice support us on Patreon.com/zdoggmd. We would really, really, really appreciate it.

You may be wonder why I’ve been focusing so much on money. It’s because doing this stuff costs a lot of money and the plans we have for 2018 involve making a lot of content for you guys. So in order to support that, this isn’t even profit we’re talking about, this is just paying the costs of what we do. We need your help. We need your support. Things like this where we take your voice and actually put it out there to the world to millions of people, ultimately in terms of reach, it’s important. And I think w/o having these kind of platforms where the ??? where we’re trying to build a better healthcare system for ourselves and for our patients. Anyway, that’s my pitch guys. I love you Zpac!