Do You Come to Work When You're Sick?

Abstract & Commentary

By David J. Pierson, MD, Editor, Professor, Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, is Editor for Critical Care Alert.

Synopsis: Most respondents in this survey of medical students, residents, and staff physicians reported coming to work when they had a respiratory tract infection, with staff physicians most likely to do so.

Source: Gudgeon P, et al. Do you come to work with a respiratory tract infection? Occup Environ Med 2009;66:424.

This article reports on a questionnaire study administered to medical students, residents in internal medicine and surgery, and staff physicians at the University of Toronto in the summer of 2006. The authors queried the subjects about whether they personally came to work when they had symptoms of a respiratory tract infection, and sought to determine factors that influenced whether they did so.

Gudgeon and colleagues sent their on-line survey to 1202 people, of whom 149/202 medical students (74%), 317/650 residents (49%), and 202/350 staff physicians (58%) responded. Most respondents reported having been ill with symptoms of a respiratory tract infection for 1-2 days or more. Students had, on average, 1.9 more days of illness than residents, who in turn reported 0.9 more illness days than staff physicians, rates that were significantly different. In all three groups, participants reported coming to work when they were sick. Sixty percent of staff physicians indicated that they worked more than 80% of the time when they were sick with a respiratory tract infection; the corresponding proportions of residents and medical students who worked while ill were 51% and 48%, respectively.

Reasons given for staying home from work when ill were similar among the three groups: feeling too sick to work, being concerned about transmitting illness to others, and having obvious symptoms of a respiratory tract infection. However, reasons offered for coming to work despite the illness varied among the groups. Medical students cited extrinsic factors such as a requirement that they produce a note from a physician to be released from duties, and difficulty obtaining such notes to satisfy university requirements. In contrast, staff physicians most often invoked intrinsic factors such as concern for delivering patient care; this was especially true for surgeons, who cited concerns about having to reschedule procedures.

To explore possible factors influencing the decision to stay home or come to work while ill, the authors asked whether the respondents believed in the legitimacy of a colleague's sick day. Substantially fewer students and residents (45% and 49%, respectively) than staff physicians (79%; P < 0.001) agreed that the absence was justified. Residents were also more likely to feel annoyed by the absence of a colleague than were medical students or staff physicians. Surgical residents and staff were more likely to come to work when ill than were their internal medicine colleagues (78% vs 50%; P < 0.001); surgeons also reported a higher threshold for staying home than did the internists, and were less willing to cover a colleague's workload because of illness.


This concise (one-page) report confirms several previous studies indicating that as many as 80% of physicians come to work when they are ill. The authors use the term "presenteeism" — in contrast to "absenteeism" — to describe this phenomenon. They point out that, like other health care workers, physicians are aware that respiratory tract infections are both easily transmitted and a serious problem, especially in the first few days of illness. They urge health care workers who are ill to either stay home or take deliberate precautions (e.g., mask, frequent hand washing, and avoidance of certain patients) to avoid infecting others. They also suggest system changes to make it easier for medical students to be absent when sick, and the development of coverage mechanisms to accommodate the workload of absent residents.

"Presenteeism" can be as big a problem during epidemic influenza or other rampant respiratory tract infection as staff absenteeism. There is no question that absence from work on the part of physicians and other health care workers causes problems for those who are not sick, but it is also important that staff not risk transmitting illness to both patients and colleagues by coming to work when they are ill. For "presenteeism" to be avoided, individual staff members have to be aware of the need to stay home if they fall ill. The system should not present barriers to staying away from work in such circumstances, and must also make the necessary plans and adjustments to continue functioning when this happens.