‘Soldier on’: Concerns over healthcare workers going to work when sick

Morgan Liotta

15/05/2020 3:38:35 PM

Results from a recent international study reveal that healthcare settings have some of the highest rates of ‘sickness presenteeism’.

Female doctor looking concerned
An excess of frontline healthcare workers continue to work when unwell, an international study has found.

Almost 60%.
That is how many healthcare workers admit going to work with an influenza-like illness, according to an Australian National University (ANU) Medical School study.
That number jumps to 99.2% for healthcare workers when experiencing minor flu symptoms, including a cold, sore throat, fatigue, sneezing, runny nose, mild cough and reduced appetite.
Healthcare, welfare and education settings had the highest rates of sickness presenteeism ­– continuing to attend work when unwell.
The researchers underlined the fact healthcare workers represent a particular concern because of the potentially serious public health impact and risk of infectious disease transmission.
As the world battles to contain the spread of coronavirus, these figures present a stark reminder of health concerns and ‘important lessons’ on protective measures, study co-author and ANU Professor Peter Collignon said.
‘This study shows too many people go to work when they are sick, and this includes many people on the frontline of healthcare,’ he said.
‘More than half of the global population of physicians and nurses went to work when they had flu-like symptoms,’ he said.
‘What frequently worried us was the high percentage of frontline healthcare workers, including hospital workers, who presented to work with mild respiratory symptoms.
‘It was bad enough before COVID-19, when it was just influenza and other respiratory viruses. But now we have coronavirus, it is more important than ever not go to work when you are unwell.’
So why do healthcare workers still go to work when feeling unwell?
Professor Collignon attributes it to the age-old ‘soldier on’ mentality.
‘We found these people do it because they feel they are indispensable or letting the team down … which is very present in the healthcare community. They feel they would be doing a disservice to the community,’ he said.
‘Doctors and nurses might feel they need to go out of their way to help others, but it is best for everyone if they do not present to work if unwell.’ 
Dr Rebekah Hoffmann, a GP with a special interest in doctor wellbeing, agrees it is a common theme among healthcare workers to feel pressure to work overtime and ‘not let the team down’.
‘There is often great pressure from colleagues, supervisors but, most significantly, our own self expectations to continue working when ­– potentially or actually – unwell,’ Dr Hoffmann told newsGP.
‘There is the pressure that taking time off work will place an increased burden on others, increase your work when you return, or let down your patients when they need you.’
Dr Hoffman acknowledges the link between sickness presenteeism and the mental health of doctors, saying they are even less likely to take a ‘mental health day’.
‘Mental health is an unseen illness and still carries a substantial stigma and shame, even in the medical community,’ she said.
‘Admitting that you need time out of the workplace for your mental health is a significantly harder thing to do than for physical health.’ 
Despite such findings, doctors in Australia are still going to great lengths to protect themselves amid fears of infecting their patients or household – potentially placing further toll on their mental health.
Professor Collignon sees the need for ‘a behavioural and cultural shift’ to contribute to lowering the high rates of people presenting to work when unwell.
‘The governments have a role in that, but all of us in the community have to change processes,’ he said. ‘Especially during COVID-19.’
The ANU study also supports calls for a review of sick-leave policies in healthcare settings in order to ensure appropriate access and cover for staff taking leave as a strategy to help prevent transmission of infection.
The RACGP’s recent submission to the National Medical Workforce Strategy Steering Committee highlighted that the GP workforce needs support to provide better retention of leave entitlements.
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