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Why most doctors ignore their own advice and report to work when sick

Posted by Dr. Marla Shapiro, Canada AM's Health and Medical Expert on

According to a variety of definitions presenteeism is the act of attending work while sick. Some would say it is the opposite of absenteeism and recently, it is garnering more attention. The Harvard Business Review points out that most studies confirm that presenteeism is far more costly than illness-related absenteeism or disability.

Two Journal of the American Medical Association studies found that the on-the-job productivity loss resulting from depression and pain was roughly three times greater than the absence-related productivity loss attributed to these conditions. That is, less time was actually lost from people staying home than from them showing up but not performing at the top of their game.

Does presenteeism apply to physicians? Well according to a new JAMA Pediatrics study, many physicians and advanced practice clinicians, including registered nurse practitioners, midwives and physician assistants, reported to work while being sick and in this situation there is another factor that they point out has to be acknowledged and that is that despite recognizing this could put patients at risk, they still show up.

The researchers point out that health-care associated infections can lead to substantial illness and death and excess costs. This is especially true for immunocompromised patients and others at high risk, including newborns. However, a gap in knowledge exists about the reasons why attending physicians and advanced practice clinicians work while sick.

The authors administered an anonymous survey at the hospital to attending physicians and advanced practice clinicians ( grouped as APC), including certified registered nurse practitioners, physician assistants, clinical nurse specialists, certified registered nurse anesthetists and certified nurse midwives. They received responses from 280 attending physicians (61 per cent) and 256 APCs (54.5 per cent).

The survey found that while most respondents (95.3 per cent) believed that working while sick put patients at risk, 83.1 percent reported working while sick at least once in the past year and 9.3 percent reported working while sick at least five times. Survey respondents reported working with symptoms that included diarrhea, fever and the onset of significant respiratory symptoms.

The reasons why physicians and APCs reported working while sick included not wanting to let colleagues down (98.7 per cent), staffing concerns (94.9 per cent), not wanting to let patients down (92.5 per cent), fear of being ostracized by colleagues (64 per cent) and concerns about the continuity of care (63.8 per cent).

Three areas were highlighted by health care workers- logistic challenges in identifying and arranging someone to cover their work and a lack of resources to accommodate sick leave; a strong cultural norm in the hospital to report for work unless one is extremely ill; and ambiguity about what symptoms constitute being too sick to work.

So when are you too sick to work? In the case of the medical profession certainly putting patients at risk is a big factor. In the general community as well, presenteeism remains an issue.

So take stock of how you are feeling as an awareness of that is the first and most basic step. This includes both mental health and physical health.

  • Dr Maria Shapiro
  • Doctor
  • Sick
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