IF there is one good thing to come out of the coronavirus disease 2019 (COVID-19) pandemic in Australia, let us hope that it will end forever the culture of presenteeism among our health care workers.

Doctors have a long history of working while sick. Perhaps the most dramatic examples come from those stationed and isolated in Antarctica, including Dr Jerri Fitzgerald, who treated herself for breast cancer over months during 1999, and Dr Leonid Rogozov, who performed an open appendicectomy on himself in 1961. Even if not treating oneself for a serious illness in extreme conditions, doctors have long been part of a culture which purports to put the patient’s, and their colleague’s, needs above their own, by showing up for work no matter what their health.

It is a common experience for junior doctors to hear the disappointment in a senior’s voice when calling in unwell, to be questioned about why they are off sick, or to be “humorously” told that the only excuse for not turning up to work would be because they are intubated in intensive care. The culture of presenteeism — turning up to work while sick — is endemic in medicine and indoctrinated into junior doctors from the beginning of their careers.

Presenteeism is not unique to the medical profession. An international report, including from the Australian National University, published this year surveying 500 respondents from 49 countries, found that up to 96.5% of non-health care workers and up to 99.2% of health care workers have gone to work with minor flu-like symptoms.

This comes at a cost – a report from the Centre for International Economics in 2016 has estimated that presenteeism is costing Australian workplaces $34 billion a year via reduced productivity and infection of co-workers.

The reasons why doctors and other health care workers turn up to work sick at such high rates are well documented. They include inherent characteristics in those who choose to work in health, a sense of responsibility to patients, and not wanting to burden colleagues, who inevitably have to take on additional work. Among highly skilled health professionals, a high workload, numerous immovable deadlines and little to no sick relief availability are all common contributors. These elements have combined over decades to form part of a culture that at times can perceive illness as weakness, and promotes “soldiering on” as the norm.

And then … there was a global pandemic. Nearly overnight, attitudes to working, and how and where work occurs, shifted worldwide. Those who can work from home are doing so, with companies such as Twitter announcing a movement to a remote work model indefinitely. And as for working while ill, the risks are not inconsiderable. The severe acute respiratory syndrome coronavirus 2 (SARS Cov2) infection can present like a common cold but leaves on average around 20% of patients requiring hospital and 5% needing intensive care. Coming to work with respiratory symptoms is no longer acceptable in most workplaces.

In line with the general population’s work practice, working while unwell in health care has rapidly become unacceptable. Early in the pandemic in Australia, a Melbourne GP who attended work with mild respiratory symptoms was vilified in the media and by politicians, but pre-COVID-19, coming to work while unwell was simply par for the course. Nursing staff in aged care facilities who continued to work while ill were roundly criticised, whereas merely months before, they would likely have been encouraged to attend work regardless of their state of health.

The change in culture with regards to working in health care while unwell is unprecedented and well overdue. While social distancing and improved hand hygiene are reducing rates of upper respiratory tract infection and influenza in the general community this winter, illness is unavoidable. While the attitude to working while sick is likely to be an overwhelmingly positive change, challenges remain for the health care sector.

Finding cover for sick leave is often difficult and usually impossible, particularly for medical staff, so providing a contingency plan is essential. A certain volume of sick and carer’s leave requirements per year is predictable and can be planned for, particularly for vulnerable workers such as parents of young children, those caring for elderly relatives or who are immunocompromised. In addition, access to rapid COVID-19 testing is essential for health care staff, such that they may return to work when feeling well in the knowledge that they are safe to do so.

Many who work in health care are fortunate to have stable employment with access to paid sick leave. Others, however, are part of a casualised workforce, particularly in the aged care sector, and do not have this luxury. Systemic changes both within health care and in other industries will need to occur to allow individuals to care for their own health, as well as that of their co-workers and the community.

It seems incredible that one day we will be telling junior doctors, nurses and other health care staff about a time that their seniors would turn up to work with fevers, coughing or with diarrhoea. We should embrace the new culture around sick leave where people can truly heal themselves by staying at home, resting, and returning to work healthier, happier and better positioned to provide excellent health care.

Dr Kate McCrossin is an anaesthetist working in public practice in Brisbane. She also has an interest in value based healthcare, specifically patient reported outcome measures. This article represents her personal views and not those of her employer.



The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.


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8 thoughts on “COVID-19’s silver lining: ending presenteeism in medicine

  1. Anonymous says:

    Thankyou Dr McCrossin for your article, which demonstrates a wish for more supportive attitudes in the workplace when people are unwell.
    I do believe it is worthwhile pointing out the problems of “presenteeism”, and the fact that sickness can impair performance.
    However, the fact is that it is not just acute, infectious illnesses that cause people to turn up to work when they are not 100%. If everyone stays away from work every time they are not fully able to function at their normal levels, do we have to ban people coming to work if they haven’t had the optimum number of hours of sleep? (parents of small children, partygoers, GORD, worriers who lie awake thinking about work, people in relationship stress……)
    A runny nose now has a sinister implication due to COVID 19. Nonetheless, a minor URTI (as defined in the pre-COVID era) often WAS minor, and a sufferer, though possibly infectious, might be far more able to function than someone with severe hay fever. It would be impossible to run a workplace roster if all the hay fever sufferers called in sick for most of spring.
    Making workplaces more hospitable requires attitudinal change similar to those needed for dealing with longer term, non infectious conditions (such as, perhaps pregnancy), or conditions which are classed as “disability”. Focus on what the sick person CAN safely do – taking into account both their safety, and those of their coworkers. And if you are someone who is in robust health, thrives on 4 hours sleep per night, and/or has a partner who does the 24/7 childcare, then learn to listen and try to understand the experience of those who have to struggle more to make it through certain days, but keep going regardless.

  2. Alison Jarman says:

    ‘Finding cover for sick leave is often difficult and usually impossible’. Did the commentator below not read this part of the article? Rural health services face particular challenges in contingency planning, given very limited staffing. Couldn’t the pandemic also be an opportunity to find ways of addressing this?

    Sacrifice and heroics should not be the basis of maintaining a functioning health system. As you have pointed out yourself, extreme fatigue is unsafe.

  3. Kate McCrossin says:

    Thank you for the comments. To the anonymous commenter who referred to my ‘ignorance and naivety’, I would disagree with either of these descriptors however I do apologise for omitting the unique challenges facing our colleagues in outer regional and remote areas. I have indeed worked as a doctor in a 2 doctor town. The best figures I can find would indicate that around 12-13% of medical practitioners in Australia work in outer regional and remote areas. This should have been mentioned in the article as a significant and possibly insurmountable challenge (in the short-medium term at least), as well as a possible contributor to the difficulties with recruitment to these areas. I do hope however that for those in inner regional & urban areas, this article has provided some food for thought. With regards to absenteeism, the term has been used a couple of ways in the comments. The definition includes staying away from work ‘without good reason’, certainly an undesirable practice. Presenteeism is more common than true absenteeism in my experience and those of my colleagues, but is interesting to hear other perspectives.

  4. Anonymous says:

    I’m not sure how to address the ignorance and naivety inherent in this article. Where does it come from – somehow there’ll always be someone to cover you if you call in sick? Have you ever worked in a country town as the only or one of two doctors? What does an obstetrician with the ‘flu do if he/ she’s one of 2 in the rural town, and his/her partner’s at a conference, then a cord prolapse or obstructed labour comes in? That obstructed labour could be you! As a rural paediatrician I occasionally got no sleep for over 48 hours, and at a medicolegal conference asked a barrister how many hours’ sleep deprivation was sufficient excuse not to attend an emergency. Answer: no limit, but if a mistake happens, we’d consider mitigating the sentence (!!)

    As for the implication in the comments section that we relied on full support at home, I resent the judgement and naive supposition that this was in some way a patriarchal power play. It belittles the agonising personal decision mutually taken by my wife and I finding ourselves with three babies under 16 months. It required above average dedication plus sacrifice from both of us, which in humanity you shouldn’t belittle or play down. Medicine is more than a niche safe supported urban endeavour!!

  5. Anonymous says:

    Good luck to hospitals finding senior staff to cover absenteeism if it becomes frequent amongst senior medical staff. They can barely manage to find cover for absent junior staff. On many an occasion particularly over the weekend I have had take over the role of a junior medical officer as well as my own when the JMO has called in sick.

  6. Anonymous says:

    I can very easily picture who left the comment above – an older, white, male VMO, who’s wife mainly care for the kids, and is able to take time off for golf every Wednesday whilst his registrars do all the work

  7. Dr Lizzy Harvey, GP says:

    Strongly agree Kate. So good that this culture is shifting. I am at home with a cold (swab over weekend -ve) and normally would have soldiered on. Although I haven’t taken the day off, I have stayed home and doing T/H consults only.

  8. Anonymous says:

    What presenteism problem ?
    We already have huge problems with absenteeism in our public hospitals, mainly junior staff ( but sometimes senior ) calling in “sick” but turn up the following day looking fine.
    Some individuals do it very regularly.

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