Presenteeism: B.C. doctors cite workplace factors as top reason for going to work when sick

Beata ChamiIn British Columbia, physicians across a variety of specialties say that they routinely come in to work when feeling unwell, or when experiencing events in their lives that might in many other lines of work justify their absence.Presenteeism, or attending work when too unwell or stressed to be at work, can yield serious consequences for the safety and well-being of both physicians and the patients that they care for. Research suggests that physician health, patient care, and organizational productivity are impacted as a result. In order to maintain a healthcare system where the providers of the care do not become the ones in sudden need of it, this is an important issue to address.Our group did a qualitative study of B.C. physicians to determine the factors related to presenteeism behaviour. In-depth interviews explored the reasons for physician decisions to attend work when unwell or for other reasons that should have compelled them to stay at home. We evaluated how the physician’s role identity and workplace dynamics influenced their decisions. Professional and cultural norms were, unsurprisingly, important. However, other issues, such as thresholds of illness, and emotional responsibility factors emerged as additional reasons.Workplace factors were the most cited reasons for physicians going to work when unwell. These included difficulty finding coverage for shifts, anticipation of workload upon return, and concern about the comprehensiveness of care that patients would receive in the physician’s absence.Professional and cultural norms served as the second most frequent reason for presenteeism. Physicians felt that medical culture dictated that there was no tolerance for them to fall ill, and those who took time off were perceived as "weak."Our study’s participants never referred to mental health problems as a valid reason for a physician to stay home from work.Gender-related expectations also played a part. The female physicians interviewed expressed that they did not want their colleagues to think that by allowing a woman into medicine meant that the regular medical standards and expectations would not be fulfilled. The acknowledgement of this theme is alarming, particularly in the 21st century, as there are numerous movements and initiatives promoting equal rights among both genders, particularly in the professional realm.Finally, nearly all physicians cited the emotional obligation and duty of care they had to their patients, despite having a justified reason for taking leave. They went to great lengths to accommodate their patients and maintain the implicit promises that they had made regarding their health and well-being. For many physicians, the more vulnerable their patient population, the more they downplayed their own challenges by comparing themselves to patients’ circumstances.What can be done? Systems-based changes might be a place to start. Perhaps a flexible resource pool of specialists who could cover non-rostered duties, and who would be available to cover unanticipated sick leave (Tan et al., 2014). Clear, written guidelines that state the expected threshold for work absences would serve as an objective measure of “being sick enough,” and might help relieve feelings of guilt when staying home. For those who need to cancel and reschedule clinics, information on best practices and pertinent information to pass on to locums would be helpful (Chambers, 2015). For medical students and residents, senior staff can actively address presenteeism and role model the appropriateness of taking leave when needed (Rhodes & Collins, 2015).Women in medicine can often shoulder a greater burden in needing time away, and can deal with a disproportionate burden of the repercussions of having done so. Our study found that female physicians experienced a great deal of stress balancing their maternal and professional duties. Statistics Canada indicates that women tend to take on most family-related responsibilities, such as child rearing and domestic work (Milan, Keown, & Urquijo, 2011). This results in women being more challenged in maintaining a work-life balance. Therefore, policies that encourage more family involvement with childcare, such as on-site childcare would be a step in the right direction. These efforts could help alleviate stress among physicians with children, as they would be easier to check in on during the workday. This way, the physicians would worry less about their child’s wellbeing while at work, allowing them to better concentrate on their professional responsibilities.Although these recommendations are important steps and would ameliorate some aspects of physician presenteeism, there are still a number of causes that suggest that there is an internal guilt driving physicians to engage in this behaviour. This goes beyond the institution and its cultural causes, and is grounded in broader societal values and expectations. Clearly, there is more research needed around this topic within the Canadian healthcare system. Whether it is the patient or physician’s health in jeopardy, presenteeism presents as a critical issue that has the potential to negatively impact societal wellbeing.Beata Chami is a researcher and organizational psychologist. She currently serves as the Physician Wellness Program Manager for the UBC Faculty of Medicine, department of Obstetrics & Gynaecology.Opinions expressed in this article are those of the writers, and do not necessarily reflect those of CanadianHealthcareNetwork.ca or its parent company.ReferencesChambers, C. (2015, November). Superheroes don’t take sick leave: Presenteeism in the New Zealand senior medical workforce—A mixed-method study. Retrieved from the Association of Salaried Medical Specialists website: http://www.asms.org.nz/wp-content/uploads/2015/11/Presenteeism_A5-Final-for-Print_164753.pdfMilan, A., Keown, L.-A., & Urquijo, C. R. (2011, November). Families, living arrangements and unpaid work. Statistics Canada. Retrieved from http://www.statcan.gc.ca/pub/89-503-x/2010001/article/11546-eng.pdfRhodes, S. M., & Collins, S. K. (2015, September/October). The organizational impact of presenteeism. Radiology Management. Retrieved from http://www.ahra.org/AM/Downloads/OI/qc/RM375_p27-34_QC.pdfTan, P. C. M., Robinson, G., Jayathissa, S., & Weatherall, M. (2014). Coming to work sick: A survey of hospital doctors in New Zealand. The New Zealand Medical Journal, 127(1399). Retrieved from https://search.proquest.com /openview/c675219933cdf273feea78745676338d/1?pq-origsite=gscholar&cbl=1056335

Presenteeism: B.C. doctors cite workplace factors as top reason for going to work when sick

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