Maybe You Should Stay Home, Doc

September 27, 2010

Three out of five doctors surveyed report going to work while sick during the previous year, according to report published in JAMA.

Three out of five residents reported that they came to work during the previous year despite being sick, according to a study published in JAMA. In doing so, these physicians possibly exposed their patients and colleagues to suboptimal performance and, in many cases, communicable disease.

The survey, which involved multiple hospitals, found that 60% of residents worked while sick at least once during academic year 2008-2009; one-third did so more than once. At one hospital, 100% of residents reported working when sick. More than half of resident physicians surveyed said they didn't have time to see a doctor.

"Hospitals need to build systems and create a workplace culture that enables all caregivers, not just residents, to feel comfortable calling in sick,” study author Vineet Arora, MD, MAPP, associate professor of medicine and associate director of the internal medicine residency program at the University of Chicago, in a press release. “Their colleagues and their patients will thank them."

The phenomenon—known as "presenteeism" and defined as the problem of workers being on the job but not fully functioning because of illness—has attracted a great deal of interest in the business world, with studies suggesting it can cut productivity by one-third. Some estimates claim that presentees cost US companies $150 billion a year—more than absentees, medical care, and workers on disability combined.

Medical researchers, however, have been slower to focus on the issue. With that in mind, Arora and Anupam B. Jena, MD, PhD, resident in medicine at the Massachusetts General Hospital, piggy-backed onto a survey led by DeWitt Baldwin, MD, at the American Council for Graduate Medical Education. The survey, which involved 744 second- and third-year residents in 35 programs at 12 hospitals, asked questions like: "Were there occasions when you think you should have taken time off for illness, but did not do so?" and "Did your schedule permit you to see a physician regarding your health?"

In the study, 60% of the 537 who responded reported working while sick at least once and 31% at least twice. Those with additional experience, who had been second-year residents during the reported year, were slightly more likely to work when sick, with 62.3% responding that they had done so in the past year.

The choice of specialty, gender, and nationality of the resident made no significant difference in responses, said the authors, noting that the lack of demographic or specialty factors associated with presenteeism "suggests it may be pervasive.” The one outlier, a hospital with 100% noncompliance, "suggests that hospital culture could play a role."

Factors that encourage presenteeism include high-performance jobs, the difficulty of finding replacements, a strong sense of teamwork and obligation toward colleagues, and the culture of loyalty to and concern for vulnerable clients. "Not many professions come with that kind of pressure," said Jena.

There are several reasons why residents may work while sick, said the authors, “including misplaced dedication, lack of an adequate coverage system, or fear of letting down teammates. Regardless of reason, given the potential risk to patients related to illness and errors, resident presenteeism should be discouraged by program directors."

For more:

Resident perceptions of resident duty hour standards

To Leave or to Lie? Are Concerns about a Shift-Work Mentality and Eroding Professionalism as a Result of Duty-Hour Rules Justified?

The Accreditation Council for Graduate Medical Education's limits on residents' work hours and patient safety