Updated: Nov 17, 2018
We've discussed presenteeism previously but feel it warrants further attention in light of recent discussions on social media. Presenteeism is basically the opposite of absenteeism - it's showing up unwell even when you shouldn't. This is an engrained part of the medical culture for various reasons. A few very valid reasons which were voiced on social media include the following:
You're it - if you're a physician working in a solo practice or small community, who do you turn to?
The workload will grow in your absence - the 'paperwork' continues to pile up and patients need to be rescheduled.
You don't want to burden your colleagues - burnout is already an epidemic so why would I want to contribute to the problem?
Your staff still needs to be paid - running a medical practice is a business, one without sick pay (as discussed in our 'wish list' newsletter last week).
We'll add the following one that wasn't voiced but we all know to be true:
The medical culture perpetuates the notion that doctors can't get sick and that admitting it is a sign of weakness (an unfortunate pile of BS that somehow seems to be still alive).
These few points get the message across - calling in sick ain't that easy when you're a physician! But guess what, physicians are humans and do get sick, suffer personal loss and grief, etc., so sometimes staying home is the right thing to do for everyone.
So what are the solutions?
Talking about this is essential to finding the way forward. We all know that the problem with absenteeism starts in training, where we feel incapable of 'calling in sick'. Pieces like this recent one, Terra Nova, written by a resident in the New England Journal of Medicine don't help: "Everlastingly cheerful, I stayed at work with a temperature of 102°F, as measured by a knowing nurse; I worked through pneumonia and norovirus, covering my mouth with a surgical mask as though that would protect my patients..."
We need more people to talk about how the proverbial 'wheels didn't fall off' when they called in sick. In fact, some people on Twitter said that their colleagues were supportive of their sickness-related absence and that they had a sick call schedule in place; another said same day appointments were the key to absorbing a sick physician. The fact is, inflexible systems are part of the problem, but so are we if we don't try to improve them, and enable physicians to take care of themselves too.
“Which of us can resist the temptation of being thought indispensable?” ~ Margaret Atwood