1Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA USA.
2Program in Bioethics and Humanities, Carver College of Medicine, University of Iowa , 500 Newton Road, Iowa City, IA 52242 USA.
Antimicrob Resist Infect Control. 2019 Sep 5;8:149. doi: 10.1186/s13756-019-0602-7. eCollection 2019.
Sickness presenteeism among healthcare professionals can compromise patient safety. To better understand what motivates this phenomenon, especially among trainees, the authors investigated attitudes of medical students, resident physicians, and faculty physicians about working when sick with what might be an infectious condition.
In 2012-2013, the authors employed a mixed methods, two-stage, cross-sectional survey at the University of Iowa Hospitals and Clinics of medical students (third-year students in the first survey and fourth-year students in the second survey), resident physicians in Internal Medicine, Pediatrics, and Family Medicine (first-year residents in the first survey and second-year residents in the second survey), and faculty physicians in Internal Medicine, Pediatrics, and Family Medicine. The first survey included one open-ended question querying attitudes about sickness presenteeism, answers to which underwent content analysis that identified 17 codes used to develop 23 additional closed-ended questions for a second survey.
127 participants completed the second survey (44% response rate). Sixty percent of these participants felt obligated to work when sick; and 33% felt obligated to work with influenza-like symptoms (fever, myalgias, cough), with residents and students being more likely to do so than faculty (67% vs. 35% vs. 14%, = 0.001). Most participants (83%) were motivated to work when sick to avoid creating more work for colleagues, and residents and students were more likely than faculty physicians to want to avoid negative repercussions (84% vs 71% vs. 25%, < 0.001) or appear lazy or weak (89% vs 75% vs. 40%, < 0.001). Most participants also recognized the need to avoid spreading infections to patients (81%) or colleagues (75%).
When deciding whether to work when sick, students, residents, and faculty report a mixture of motivations that focus on the interests of patients, colleagues, and themselves. Awareness of these mixed motivations, particularly among trainees, can help inform interventions aimed at limiting instances of sickness presenteeism to support a culture of patient safety and counter any tendencies toward a hidden curriculum of efficiency and achievement.
医疗保健专业人员带病工作可能会危及患者安全。为了更好地理解是什么促使这种现象发生，尤其是在受训者中，作者调查了医学生、住院医师和教员医生对患有传染性疾病时工作的态度。
2012-2013 年，作者在爱荷华大学医院和诊所采用混合方法、两阶段、横断面调查了医学生（第一次调查中的三年级学生和第二次调查中的四年级学生）、内科、儿科和家庭医学住院医师（第一次调查中的第一年住院医师和第二次调查中的第二年住院医师）以及内科、儿科和家庭医学教员医生。第一次调查包括一个开放式问题，询问对病假出勤的态度，对回答内容进行分析，确定了 17 个代码，用于为第二次调查开发 23 个附加的封闭式问题。
127 名参与者完成了第二次调查（44%的回应率）。其中 60%的参与者感到生病时必须工作；33%的人感到有义务在出现流感样症状（发热、肌痛、咳嗽）时工作，住院医师和学生比教员更有可能这样做（67%比 35%比 14%， = 0.001）。大多数参与者（83%）生病时工作是为了避免给同事增加更多的工作，住院医师和学生比教员医生更希望避免负面后果（84%比 71%比 25%， < 0.001）或显得懒惰或软弱（89%比 75%比 40%， < 0.001）。大多数参与者也认识到需要避免将感染传播给患者（81%）或同事（75%）。
在决定是否带病工作时，学生、住院医师和教员报告了一系列关注患者、同事和自身利益的动机。了解这些混合动机，尤其是在受训者中，有助于为旨在限制病假出勤以支持患者安全文化并抵制任何效率和成就隐性课程倾向的干预措施提供信息。
