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with Rod Moser, PA, PhD

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Wednesday, March 3, 2010

When Your Medical Provider is Sick

“You see sick people all day. How do you keep from becoming ill?”

This is a relatively common question that I get. The simple answer is that I do get sick; perhaps not as often as other people, but I do encounter an unfamiliar bug from time to time that gets me. Being on the primary care front line, I tend to see people when they are the sickest, and most contagious – the first few days of an illness. The vast majority of my patients are children or teenagers, among the most vulnerable of humans to becoming ill (the elderly is also high on the list).

I started to see the signs over the weekend: congestion, headaches, sinus pressure, fatigue. Something was cooking, for sure. As the day progressed, I had a sore throat, some nasty post-nasal drainage, and my least-favorite symptom, a hacking, productive cough. Since most colds only last a few days in adults, I didn’t pay much attention to it. My primary medication is conscious neglect – I simply ignore my symptoms, and trust that my well-seasoned immune system will do its job. I suspect I am getting my annual nemesis – sinusitis.

The day before I became ill, I saw an unusual number of patients with respiratory illnesses. Fourteen out of my 15 afternoon patients were coughin’ and snottin’. As much as I try to stay upwind of those random coughs and sneezes, it is not uncommon to get a full spray, especially from kids. I need to look in the throat and take throat swabs, which invariably triggers some gagging. I need to look inside those snotty noses, listen to rattling chests, and touch contaminated skin. I sit in a room with poor ventilation (it was designed with windows that do not open located ten feet off of the floor so you can’t see out), and touch stuff that is likely crawling with fomites (germs on surfaces). Auto mechanics can’t avoid getting oil and grease on their hands, and medical providers are going to come in contact with bodily fluids. That is just a hazard of our job – our glamorous job.

I keep tongue depressors in a jar that has a lid on the counter near the sink . Why parents think that tongue depressors make nice toys for kids while they wait is a mystery to me. When I see kids playing with those wooden sticks, I know that some dirty hands reached into that jar and took a few. It constantly amazes me that people think examining rooms are like a kitchen at home. They open the cabinets, take out a few suckers or stickers for the kids, grab a handful of band-aids and basically help themselves. I have signs on the doors telling them not to do this, but they either do not read them, or ignore them. I often find snot on my computer keyboard, or crumbled goldfish crackers. I will see a parent actively texting or talking on a cell phone while an entourage of kids cause exam room havoc. Sorry, I digressed a bit. The bottom line: medical providers do get sick.

Unless I am close to dying, I hate to call in sick. I usually have a full schedule, so thirty or so people with be highly inconvenienced if I stay home in bed and their appointments are canceled. Being sick themselves, you would think that patients would understand when medical providers become ill, but they do not. We are not supposed to get sick.

At this stage of my cold, I know that I am not contagious. Viral infections, like colds, tend to be contagious a day before you know you are ill, and two days after. I was on day four, but still had quite a cough. The cough associated with a cold can last for a week or so. My cough was caused by some postnasal drainage from my sinuses.

Coughing is exacerbated by a dry environment and of course, talking. The more you try not to cough, the more likely you will cough. If I was hiding from an axe murderer, I am sure I would start coughing to make it easier for him to find me. As soon as I enter the examination room, I can feel the tickle. I am struggling not to cough. I drink a little water, but it doesn’t help. I cough. Now, I have to wash my hands all over again. A few minutes later, another cough, again followed by hand washing. This is how my day progresses. I usually suck on a cough drop, but I ran out. Since we stop seeing pharmaceutical reps in our office, we have no samples to dip into.

I try to cough into tissues so that I can dispose of them, before I wash my hands, yet again. The skin on my hands is starting wear out from repeated scrubbing. My little patients just freely cough in the air, or directly in my face if I am not quick enough. Older children are taught to cough into their antecubital area (the crease at your elbow), looking a bit like Dracula. This is apparently better than coughing into your hands and not washing them. It really doesn’t matter where those coughs end up, it isn’t good.

The only people who worry when a medical provider is coughing would be those rare people who are well. Chances are that they will pick up a virus or two just sitting in our waiting room, but if they do get sick in a day or so, they will surely blame it on me.

Today is my day off, so I can cough freely at home. After two, 12-hour shifts of dealing with people like me, I need the rest. Most of the day, with the exception of writing this blog, has been kicking back or falling asleep in a reclining chair with three dogs at my feet. Tomorrow is another 12-hour shift and I need to head out and buy some cough drops. A few years ago, I had a series of non-stop or back-to-back colds that kept me hacking for about two months. I don’t want to repeat that dance.

Comment on this blog post and ask your questions on the Cold and Flu Exchange.

Posted by: Rod Moser, PA, PhD at 6:23 pm

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