MedWire News: Doctors work when sick to avoid letting down their patients and colleagues, reveal survey results published in the Archives of Internal Medicine.

Of the 150 resident physicians questioned, 51% admitted to having worked in the past year while suffering flulike symptoms, and 16% had worked at least three times, report Anupam Jena (Massachusetts General Hospital, Boston, USA) and co-workers.

Most common reasons cited for "presenteeism" were obligations to patients (56%) and colleagues (57%), with 12% of residents concerned that co-workers might think them "weak" for taking time off, and 8% feeling pressured to repay colleagues for covering clinical duties.

Second-year residents were more likely than first years to work while sick (58 vs 51%), and cite patient responsibility as a barrier to sick leave (60 vs 46%). This greater level of presenteeism reflects the responsibility second-year residents have in unifying care for a team's patients, Jena et al say.

With 9% of residents believing they had transmitted disease to a patient, and 21% believing their colleagues had done so, the researchers suggest the ethical balance between protecting patients and meeting commitments is currently weighted towards the latter value.

"In addition to adequate systems of coverage and occupational health guidelines regarding working when ill, faculty should ensure that residents are taught that refraining from work while ill is the best and most professional way to ensure responsible and safe care for patients," the team concludes.

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