Doctors are turning up to work even when they're ill – and that is bad news for all of us

The stigma around health problems, taking sick leave, and a perceived failure to cope means many doctors are reluctant to raise issues: they want to present as a picture of health and strength to patients, peers and senior colleagues

We have all dragged ourselves into work when we are ill. Despite good intentions, we have then spent the day struggling to concentrate, stifling coughs and longing for our beds. While we think we will get brownie points for at least being at work, can we genuinely say we delivered our usual high standard throughout the day?

Wanting to turn up and give your best at work, when clearly too unwell, fatigued or stressed is known as “presenteeism” – the opposite of “absenteeism”. Doctors are notorious for it even though they would regularly advise patients to stay off work under the same circumstances.

A new survey makes for stark reading: 72 per cent of doctors surveyed say they will always come into work, even when they are too unwell, fatigued or stressed to be productive. A total of 46 per cent also say they feel guilty when taking time off – despite only 12 per cent saying their colleagues make them feel guilty. These results make sense – research shows that doctors under-report illness and take a third fewer sick days than other healthcare workers.

On the surface, the reasons for this seem obvious – the NHS is woefully underfunded and under resourced, and has been so for some time, which makes for a challenging and relentless working environment. Doctors don’t want to let patients down or put more pressure on stressed colleagues by not turning up.

The individual psychology behind it is, however, more complex.

The stigma around health problems, taking sick leave, and a perceived failure to cope means many doctors are reluctant to raise issues: they want to present as a picture of health and strength to patients, peers and senior colleagues. Many doctors feel they must accept the suffering, long hours, hunger and tiredness bcause “That’s what we signed up for”. This attitude perpetuates what is known as the “superdoctor” syndrome.

But doctors are not superhuman, nor should they be expected to act as such.

Should patients be worried? Most would probably admire the stoicism and commitment. For a patient who is sick or has a loved one who is sick, the priority is getting access to a doctor; the doctor’s own health and wellbeing is rarely even an afterthought.

But evidence suggests the issue of presenteeism, brought about by the Superdoctor syndrome, has its downsides for doctors, patients and for healthcare as a whole. Attending work when too unwell and not taking time off to recover increases the risk of longer-term sickness absence, in addition to mental health issues and burnout. Research has also found that healthcare employees who continue to work while unfit to do so are more likely to make mistakes, leading to adverse clinical outcomes.

And even when doctors are not ill, all too often we see them stretching themselves to their limit.

As individuals, accepting when we are not fit to do our jobs is part of building our own resilience, and this is all the more pertinent for a doctor. The 2017 amendment to the modern Hippocratic Oath sums this up (“I will attend to my own health, wellbeing and abilities in order to offer care of the highest standard.”)

Organisations can also ask themselves if they contribute to the problem, or if they raise barriers to doctors taking sick leave. For example, are there procedures to cope with workload in the event of a doctor’s unplanned absence? Are there policies to enforce absence when necessary, and what is the threshold?

In a new report by the Medical Protection Society, we are calling for organisation-wide interventions to safeguard the wellbeing of doctors, including recommendations that all healthcare organisations should have clear policies and procedures in place to ensure healthcare professionals feel able to take breaks and to take time off when ill.

Of course, it is not all about policies. There must also be a wider culture which frames legitimate sickness leave by doctors as responsible and healthy behaviour. We as a profession should also support colleagues, and seniors should lead by example – being role moels and challenging others who suggest “things were far worse in my day” as some sort of badge of honour.

Counteracting the “superdoctor” syndrome is not easy – there is rarely a panacea for something that is so deeply embedded in the profession’s culture that it has become the norm. But that doesn’t mean we shouldn’t take collective steps to counteract it. Clearly doing nothing comes at a cost.

Professor Dame Jane Dacre is President of the Medical Protection Society