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Why doctors don’t take sick leave

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6719 (Published 09 December 2015) Cite this as: BMJ 2015;351:h6719

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Re: Why doctors don’t take sick leave

Kathy Oxtoby's analysis of the reasons as to why doctors are reluctant to take sick leave are fine as far as they go. Nobody likes letting colleagues down and many are nervous about adversely affecting their careers. However, I feel there is a deeper, more sociobiological reason for this phenomenon which lies in the nature of the doctor/patient relationship.

This relationship is at its heart one of unequal status. The doctor is accorded a higher status than the sick patient, at least for the duration of the illness, even though in normal life he, and I suspect this applies more to male than to female doctors, may naturally be of lower status than his patient. Doctors 'punch above their weight' in terms of social status because they have access to a body of knowledge of, and have acquired skills in relation to, healthcare, which other people do not have and consider to be valuable. Strip doctors of their knowledge and skills and put them in a cave with others from a broad spectrum of society and they would find their true level, often rather lower than that which they currently enjoy.

It follows, then, that to put a doctor into the subservient role of patient, involving a rapid descent of the greasy pole of status, would cause considerable anxiety to him. Marika Davies has outlined the pitfalls of continuing to work when sick but preservation of one's social status is such a fundamental instinct for most people, including doctors, that they feel compelled to carry on regardless.

Competing interests: No competing interests

12 December 2015
William A Hart
Retired GP
Brough, East Yorkshire