Intended for healthcare professionals


Why doctors need to resist “presenteeism”

BMJ 2015; 351 doi: (Published 09 December 2015) Cite this as: BMJ 2015;351:h6720
  1. Kathy Oxtoby, freelance journalist
  1. kathyoxtoby{at}

A culture of avoiding time off when sick may be storing up problems for the future, Kathy Oxtoby hears

Doctors are less likely than other healthcare workers to take days off sick. Official figures show that they take a third as many sick days as other NHS staff and a fifth the number taken by healthcare assistants and ambulance staff.1

The will to be at work even when ill is embedded in medical culture (see box), but the drive to work when unwell affects not only doctors. It also has an impact on doctors’ friends and family and on the patients they treat.

Some doctors avoid taking time off sick simply because they would prefer to be at work, says Cosmo Hallstrom, a consultant psychiatrist who is based in London and works in private practice after 25 years in the NHS. “Doctors are highly motivated in their work and highly rewarded emotionally,” he says. “It’s a way of life. And I believe work is good for you—and a great healer.”

Keir Shiels, a paediatric registrar at Queen’s Hospital, Romford, east London, says that avoiding taking time off when unwell can have an impact on doctors’ lives outside work. “I’m often unwell on the days I have off, because the adrenaline from working in a stressed environment stops,” he says.

Stress effects

One particular problem is that doctors don’t always have insight into their own health and wellbeing, and this can affect their performance, says Nicola Lennard, medicolegal adviser for the Medical Defence Union. “Ill health can not only have a significant …

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