“Stay home if you feel sick!” – and why we don’t do that

by Carolyn Thomas     @HeartSisters

“Don’t go to work when you feel sick!   Stay home if you have symptoms!”

This sounds like plain old common sense advice when it comes from public health experts during a pandemic. Most people, however, WILL go to work sick if they don’t have employee benefits like paid sick leave. And among healthcare staff, we know that even those lucky enough to have a good benefit package will often go to work when they’re ill.  Here’s why: .     .           .

Many researchers have examined this. One interesting study of hundreds of healthcare professionals working in a large Pennsylvania hospital found that, although 95% of the respondents believed that working while sick would put their patients and colleagues at risk, more than 80% of them reported doing so at least once during the previous year.(1)  Over half had gone into work despite being sick 2-4 times that year, and one in ten reported working with severe symptoms more than five times during the previous year.

Coming in to work even when you know you’re too ill to perform well is called presenteeism. It’s the opposite of absenteeism, which means choosing to stay home from work (yes, occasionally even when feeling fine!)

Employers tend to worry about absenteeism far more than presenteeism.(2)  But as Kim Siddall wrote in Benefits Canada last year:

“Presenteeism is insidious. It can be difficult to measure or plan for. And it’s more disruptive than absenteeism, because it can lead to resentment from team members who are picking up the slack. But some experts clock the cost of presenteeism at three times the cost of absenteeism.”

Presenteeism is on the rise, which suggests that more people are feeling compelled to go to work sick. A UK survey 10 years ago found that about one quarter of employers had observed their staff showing up at work despite being obviously ill. But the most recent survey suggests that over 85% of employers are now seeing  this.

As physician Dr. Doug Wright, medical director at Aviva UK Health, told BBC News at the time:

“Presenteeism is driven in part by an increased ‘always-on’ culture, and it poses a genuine threat to overall organizational performance through the adverse impact on productivity and morale in the workplace.”

If you’ve ever dragged your sickly self to the office when you knew you should have been home in bed, you already know how feeling sick can affect the quality of the work you are able to do.

The healthcare professionals in the Pennsylvania study included physicians, certified registered nurse-practitioners, physician assistants, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives. These people reported that they had come to work even with significant symptoms, including diarrhea (30%]), fever (16%]), or “acute onset of significant respiratory symptoms” (55%).

So, given their keen awareness of the medical risks to other people if they went to work sick, why did these healthcare professionals do it?

Their primary reasons for working while sick included:

  • not wanting to let colleagues and patients down
  • extreme logistic challenges in finding coverage to replace them
  • a strong cultural norm to work through sickness
  • concern that leadership would not support them if they did not work
  • belief that no one else could fill their roles
  • guilt about having to even ask for coverage
  • fear of stoking resentment in others for missing work due to illness
  • unsure about what “too sick to work” actually means

In fact, even in workplace settings where a generous sick relief policy was already well established, many respondents admitted that they feel reluctant to use it.

As the Pennsylvania study’s lead author Dr. Julia Szymczak explained:

“Some respondents described a complete absence of a sick relief system in their clinical area. Others were aware that their area had a sick relief policy, but reported it was not used in practice. Others suggested that their clinical work area lacked enough staff to make designing a sick relief system feasible. They reported having extreme difficulty finding coverage when they suddenly become symptomatic.

“Many respondents, especially physicians, perceived that increasing production pressures pushed them to work while sick. They explained that the realities of clinic scheduling (appointments made months in advance, patients traveling from far away to receive care, or needing to achieve volume quotas) made taking sick leave nearly impossible.

“Many also suggested that, despite their belief that working while sick is risky, they found working was easier than staying home owing to the numerous logistic challenges associated with taking sick leave.”

The Pennsylvania respondents recalled criticism from their clinical colleagues about those who do take sick leave, stories of working (or seeing others work) while “so ill that they needed intravenous hydration”, and the general impression of an unspoken understanding that physicians and other healthcare professionals should “buck up” and go back to work, even with severe symptoms.

Many of the physicians studied described working while sick to be part of their professional identity (e.g. stating simply, “physicians do not take days off”) or that calling in sick was “unprofessional”.

Dr. Szymczak’s study also found minimal differences between the physician and non-physician responses, suggesting that non-physician healthcare professionals “may have absorbed many of the same behaviours and social norms related to working sick, as have physicians”.

We’re in the throes of a longterm global pandemic right now, despite the sweeping claims about the “success” of COVID-19 containment (even as hospitalization and death rates continue to spike once again in many regions). We’re seeing uninformed politicians insisting they know more than expert scientists who have devoted their entire careers to the study of infectious viral diseases.

And we are also seeing the devastating effects on vulnerable populations that can occur when healthcare professionals go to work sick.

Here in Canada and elsewhere, we’re seeing what happens when staff at longterm care residences for seniors go to work despite COVID-19 symptoms, and worse – when they continue to work at more than one facility, thus helping to spread the virus among vulnerable seniors living at other venues, too. The common practice of allowing multiple work sites wasn’t banned until mid-April in Canada. Longterm care residents represent 81% of all reported COVID-19 deaths in Canada so far, many of those linked with inadequate staffing, echoing the Pennsylvania study’s findings that “not wanting to let colleagues and patients down” can make calling in sick almost impossible.

The lessons learned by the Pennsylvania researchers’ about how to address this issue of presenteeism in health care were published in pre-COVID19 days, yet they sound familiar to us now.

And as Dr. Szymczak‘s study suggests, simply offering paid sick leave to healthcare workers isn’t enough:

“Given that frequent exposures to infectious diseases are a pervasive occupational hazard for healthcare workers, realistic and clearly defined sick leave policies and infection control measures (duty reassignments, telehealth arrangements, and mask use for symptomatic staff) must be developed to minimize the risk that infectious pathogens are transmitted between healthcare workers, or from healthcare workers to their patients.

“These policies must take into account the reality that many physicians and other healthcare professionals may feel compelled to work with infectious symptoms because of the factors identified in this study.”

As she concluded, this is a complicated reality to address, given that so many of the people studied reported feeling “concerned with not appearing weak in front of colleagues” if they stayed home when sick:

“These systemic, logistic, and cultural factors combine to create a climate in which many healthcare professionals perceived that they have no choice but to work while sick despite recognizing that this choice puts patients at risk.”

  1. Julia Szymczak et al. “Reasons Why Physicians and Advanced Practice Clinicians Work While Sick:” JAMA Pediatrics. 2015;169(9):815-821.
  2. Goetzel RZ et al. “Health, absence, disability, and presenteeism cost estimates of certain physical and mental health conditions affecting U.S. employers.” J Occup Environ Med. 2004;46(4):398-412.

Image:  Marisa04, Pixabay  

      Q:  Is coming to work despite severe symptoms a bigger problem for society than calling in sick when you’re not?

NOTE FROM CAROLYN:   I wrote much more why we try to ignore serious symptoms in my book, A Woman’s Guide to Living with Heart Disease . You can ask for it at your favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press  use their code HTWN when you order to save 30% off the list price.


See also:

How to tell if you’re as indispensable as you think

Scope creep: when NO means maybe, and maybe means YES

When you ignore pain because you’re used to it

What’s your ‘being sick’ style?

Are you a priority in your own life?

11 thoughts on ““Stay home if you feel sick!” – and why we don’t do that

  1. I really appreciate the content in this article.

    Early on in my career, especially since it was a traditional M-F, 9-5 in-office environment, there was a sense of bravado to tough things out and go to work every day regardless of how you feel.

    Now that I’ve established myself and have a greater appreciation for the long-term view, I am less likely to tough it out if I am unwell or need a mental health day to recharge. I’ve become more respectful of my co-workers, myself and want to make sure I am giving my all at work.

    I do recognize, though, that I am fortunate that I work for an organization and leaders who treat their colleagues with respect.


    Liked by 1 person

    1. Hello Don – your past experience is very similar to my own: it was considered heroic to drag yourself to work from your deathbed if it meant not letting down the rest of the team at work! The hospital nurses I worked alongside for years used to joke that when they’re short-staffed, “the nurse who is puking the least is the one who will come in”. That’s just a dreadful choice to make!

      Employers do need to be able to shift their priorities to acknowledge staying home when really ill as a sign of respect for colleagues and our own health. Not sure if all are quite there yet!

      Take care, stay safe out there. . .


  2. Back to my career days when coming in and never ever taking a sick day was seen as heroic… I worked remotely and when I finally did run a 2400 person company, people were docked for coming in sick. It’s never a good idea – yet the loss in job productivity quadrupled when someone in the US brought their flu to work!

    Why would anyone want to have an office full of sneezing coughing wheezing sweaty half-there employees I’ll never know. It was like they who owned the presentation owned the work!

    Good lord. We are a selfish generation.

    Liked by 1 person

  3. This is a really good and eye opening post! I am one that certainly can relate to this, as I have been guilty in the past of going into work even when I have been sick, mainly due to the fear of getting looked down upon, and the fact that I don’t want to let my colleagues down! This was a post I really needed to read to remind myself that there is no point going to work and producing low quality work when I am sick – so thanks for sharing!

    Feel free to read some of my blogs as well 🙂

    Liked by 1 person

    1. Hello Niraj – glad you enjoyed this. There are probably very few of us who have NOT done exactly what you did (going in to work despite feeling sick). Poor performance is one hazard of doing so, and so is the risk of spreading your sick germs/viruses to others around you at work.

      Take care, stay safe!


  4. Hello Carolyn,

    I laughed when I saw my former ICU nurse self as feeling every single one of those pressures to go to work when not well….

    I also remember trying to staff my ICU when 3 people on the night shift called in sick on short notice…I couldn’t help thinking “Are they really that sick?”

    I would love to see the breakdown of how presenteeism is 3 times more expensive than absenteeism. Healthcare professionals like dealing in facts and maybe having a set of facts that they can use to justify staying home when ill would help.

    The culture is to blame and yet both healthcare professionals and patients contribute to that “Superhero, saving the world, indispensible culture.”

    Every time I see healthcare workers in the pandemic being called “heroes”, I cringe…THAT is something me very large shoes to fill…, I want to yell at the TV… “Hey the grocery store workers and home delivery workers and Uber drivers are all heroes …” exposing themselves to the virus while providing us services so we can stay home.

    I got over my indispensible, what will others think of me, dragging myself to work or family gatherings or whatever when I was forced by my heart to go on disability…Now I am VERY good at it 😎

    Thanks for your Sunday column, I look forward to it every week…..

    Question, if you felt too ill to write your column would you take a break? Or make yourself push through? LOL

    Liked by 1 person

    1. Jill, you’ve been on BOTH sides of this ‘too sick to come to work’ scenario! I recall the Unit Clerk on our palliative care ward (who was in charge of staffing nurses ) saying that she just keeps calling nurses to fill a cancelled 12-hour shift, one after another, until she reaches “the one who is puking the least!”

      That stat (“three times greater cost” of presenteeism vs. absenteeism) might actually be an understatement. The Harvard Business Review cites the the American Productivity Audit, a survey done by Dr. Walter Stewart at Geisinger Health System, which calculated the total cost of showing up sick to work in the United States alone to be more than $150 billion per year.

      Although comparative studies are tricky because measurement standards often differ depending on the industry being studied, in a 2004 review of on-the-job research published in the Journal of Occupational and Environmental Medicine, estimates range from less than 20% of a company’s total health-related costs due to presenteeism to more than 60%. Yikes!

      Re: writing my Sunday columns: I don’t “push through” anything these days (just not able to on a ‘bad’ day!) I learned this the hard way! I start the column’s draft days or even weeks in advance (just throwing out ideas and a basic theme) and continue to edit it down to size on my ‘good’ days (my blog host WordPress stops counting at 25 revisions – so each draft always says “revised 25 times…”) until each one’s ready to pre-schedule; I rarely if ever need to write during the weekend leading up to Sunday morning’s publication!

      Take care, stay safe… ♥


  5. As I read this, I also thought of what teachers will be facing when schools open.

    It’s another situation where infected staff can expose many others to their illness. There’s a culture where working sick is endemic, and even if you can find a substitute (deeply suspicious that substitutes will no longer be willing to work given the risks), preparation for them is so complicated that it’s usually easier to just go to work.

    Nearly all of the reasons listed by the Pennsylvania physicians apply to teachers’ work environment. And what a tragic mess it will be when/if sick teachers end up being responsible for the spread of COVID-19 to our children.

    Liked by 1 person

    1. Such a good point, Charlotte! Teachers by nature (and expectation!) are used to coming to class when sick.

      And really, is there a more effective petri dish of contagion than a bunch of hacking/sneezing/snotty-nosed kids whose parents still send them to school? It’s a chicken-and-egg problem: parents need to keep sick kids at home, and teachers need to stay home when they get sick…

      I don’t have much hope for either scenario…
      Take care, stay safe… ♥


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