How can I deal with guilt over being off work sick?BMJ 2023; 380 doi: https://doi.org/10.1136/bmj.p109 (Published 07 February 2023) Cite this as: BMJ 2023;380:p109
We have a responsibility to model good self-care
Helen Garr, medical director, NHS Practitioner Health, says, “There’s no lesson at medical school that teaches us to come to work when we’re unwell. But somewhere along the way we’ve learnt as a profession to feel guilty when needing time off, often underpinned by the unwavering need not to let down our colleagues or our patients.
“Looking back at the end of a hopefully long career, will you regret taking that time off? Unlikely. Will you look back and regret not taking that time off that you needed? That’s more likely, especially if that caused even more problems.
“We’re driven by a need to put other people and our patients first—are we really doing that when working while sick? We’re more likely to make a mistake at work when ill. How would you feel if your pilot was unwell yet still flew the plane as they felt guilty about being off?
“We all have a responsibility to model good self-care, to support and care about our colleagues who are unwell, and to give each other permission to take time out when unwell.
“At NHS Practitioner Health we support healthcare staff who desperately need to take time off but are prevented by overwhelming guilt; we give permission and guidance to enable them to take the time they need. We’ve seen increasing numbers of staff over the Christmas period and, as a service, we recognise the challenging times the NHS workforce is experiencing.
“Remember that you are replaceable in your job. You are not replaceable as a wife, husband, father, mother, daughter, son, or friend. Put on your own oxygen mask first and give yourself and your colleagues permission to take the time you deserve to recover.”
Ask yourself four simple questions
Claire Davies, a GP in London and coach (clairelouisedavies.com), says, “Taking sickness absence from work as a doctor can often come with a free guilt trip. Sometimes the guilt is worse than the actual illness, even if we are significantly unwell. But nursing a guilt complex instead of ourselves does not serve us or our recovery well.
“There are many reasons why medics easily feel guilt. Often we have an overdeveloped sense of responsibility towards others. Guilt is also about comparing ourselves to others—yet we are all different and the circumstances of others are not comparable with our own.
“Guilt is also linked to imposter syndrome. The American psychiatrist Laurence Blum noted in his work with physicians that some went into medicine because of unconscious guilt—a career in doing good was a way of somehow making amends.1
“So, how can we give ourselves a healthier response to guilt? We can start by asking ourselves four simple questions:
How is this guilt serving you?
What response might be more helpful?
What response would be kinder to you?
What would you say to a patient in the same position?
“Writing down our responses to these questions is a more fruitful way of doing this exercise. The answers may be easy, yet some doctors still struggle to apply the answers to their own situation.
“Feeling guilty about being off sick is common, so it’s likely some of your peers have experienced it too. If you know a doctor who is off sick, why not help to ease their guilt and reach out?”
Know when you need to look after yourself
Eilidh Rice, a GP trainee in Culloden, Inverness, says, “Having post-traumatic stress disorder from birth trauma, while being a single parent to my medically complex disabled son, has forced me to take frequent leave. It’s been a difficult, humbling journey, requiring me to learn effective ways to manage the guilt this causes.
“Acknowledging the wider implications of working while sick has allowed me to embrace a holistic approach to sick leave and ease instinctive feelings of guilt. There is risk to patients and colleagues from working when you’re infectious, and you can’t safely care for patients when your ability to function is impaired by exhaustion, stress, or poor health. When taking necessary sick leave, you’re doing the right thing for yourself, patients, and colleagues.
“After my son’s latest admission I could have returned to work immediately on discharge, but instead took an extra day of leave without guilt. I was exhausted and stressed, and taking an extra day reduced the risk of needing a longer period of leave later. I recognised that I wouldn’t want a doctor who hadn’t slept in days to care for my sick child, so why would I let guilt push me into putting somebody else’s child in that position?
“Instead of feeling guilty for taking leave, I focus on the reality that it’s not a weakness to admit to being human and recognising your limitations, it’s good medical practice. Knowing when you need to look after your physical and mental health is a strength, one that makes you a better doctor and colleague.”
You can’t fix a broken system by flogging yourself
Christine Peters, consultant clinical microbiologist, says, “We’ve all had that feeling—lying in bed with a crushing headache, feverish, and not having slept all night. The grimness is worsened if you’re meant to be reporting for work bright eyed and alert in a couple of hours. It’s at that moment—when you know you have to call in sick—that the guilt starts.
“Guilt for colleagues who will have to cover—usually double hatting—as when was there spare capacity for sickness? Guilt for patients whose care may be compromised as staffing levels deplete. It’s bad enough for one day, but long term sickness can lead to exponentially rising guilt. In 24 years as a doctor I have had long periods of ill health, including with covid-19 and depression, and managing guilt is part of the experience.
“Firstly, it’s not your fault. As doctors we don’t blame patients for illness, we seek to heal and restore. Apply the same compassion to yourself. Next recall all the times you’ve covered for colleagues’ illness, and know that when you are back to fitness you will continue to do so. The pressures on staffing are the responsibility of leadership, not yours individually. You can’t fix a broken system by flogging yourself.
“Forcing yourself to work when you aren’t fit for it is not a professional or sensible option. The cycle of illness and impeded recovery will backfire in the long run.
“Finally, when colleagues say ‘get well soon’ and ‘don’t rush back,’ take the encouragement to heart and look after your own health by shedding the damaging and inappropriate guilt.”