Do You Suffer From Presenteeism? Here are 9 Signs to Know – by Clark Gaither, MD, FAAFP

Most of us know firsthand the loss of productivity and impact that absenteeism has in the workplace. It is not a completely unknown or foreign concept. When we take time out of work for being sick, we may actually feel guilty for being absent knowing the burden it will place on someone else who will have to do the work in our stead. We know this from experience. When one of our coworkers is out sick, we are the ones onto which their responsibilities fall, the ones who are asked to do their work until they return.

Alternatively, in considering whether or not to call in sick, we may be filled with dread knowing once we are well, all our work will be piled up and waiting for us upon our return. We may also stop to consider the negative impact it may have on the people we serve—patients, clients or customers—who count on us to be there when they need us.

The high costs of absenteeism can be easily calculated, but few of us in healthcare have either heard of or considered the higher costs of presenteeism. Presenteeism, which is a largely unknown and foreign concept, is defined as working despite being physically sick, mentally ill, injured, or exhausted.

Presenteeism isn’t just a trait confined to workaholics. Anyone can suffer from this condition but certain professions are at a higher risk. As you might surmise, healthcare is one arena where presenteeism is rampant, especially among physicians.

Throughout residency training, physicians are inculcated with the notion that, above all else, the patients’ needs come first and their personal needs should be further down on their list of priorities. Residents are often in competitive programs where illness is viewed as a sign or signal of weakness.

Whether implicitly stated or by inference, residents are expected to come in and work while sick or exhausted and, more often than not, they do. This attitude is carried over into medical practice and it isn’t healthy.

The over-worked, over-extended, over-tired or even ill provider comes to view themselves as indispensable and irreplaceable. It becomes much easier for them to justify the use of mood altering substances or behaviors such as alcohol, narcotics, benzos, gambling or sex in an attempt to make themselves feel better because they “deserve it”, “need it to keep going”, or “ I have earned the right.”

Other causes of presenteeism include:

  • Workaholism – as already mentioned, working obsessively/compulsively.
  • People whose self-esteem is based on work performance.
  • Workers who need the money and feel they can’t afford to take time off from work, even when sick.
  • A workplace where presenteeism is expected or rewarded.
  • High physical workloads or stress levels.
  • Poor diet and lack of exercise.
  • Low emotional fulfillment.
  • Unbalanced living.

As good as physicians are at caring for others, as a group they are terrible at taking care of themselves. Many providers, and the people they serve, will watch as their own vitality slowly
dissipates and overall health deteriorates, never taking the time to seek treatment or allowing themselves to heal properly following an illness or injury.

This physician is present and engaged with his young patient.

There are many reasons for this. Even today, with all of our knowledge concerning mental health issues and addictions as treatable illnesses, shame and stigma still play a part in providers avoiding seeking help. As a result, too many suffering providers choose suicide over self-care.

There are studies which show presenteeism costs businesses more than absenteeism due to lost productivity. This is especially true in healthcare when providers work sick, injured or exhausted which inevitably leads to:

  • Deterioration in mental and physical health and abilities of the provider.
  • Increases risk to patients due to infection, injury or medical errors.
  • Increases risk to other employees due to injuries or the spread of infection.



Are you suffering from presenteeism? There is a simple way to find out. Answer the following questions and check all that apply:

      • Do you often work sick?
      • Have you worked while injured?
      • Have you presented for work exhausted when you should have taken a day off to rest?
      • Are you hesitant to take time off to go to the doctor?
      • Do you feel compelled by your employer to work while sick or injured?
      • Do you feel your self-worth is tied to your job?
      • Do you obsess over work or feel compelled to work, even when you are away from work?
      • Do you avoid taking sick days due to loss of wages?
      • Do you choose others over taking proper care of yourself or attending to your needs—proper diet, exercise, adequate rest?

If you answered to the affirmative to two of these questions you may have, or may be developing, presenteeism. If you answered to the affirmative to three or more of these questions then you definitely have a problem with presenteeism.

If you would like to avoid the progressive and damaging effects of presenteeism then a course change is in order. The remedies for this are numerous and varied. At the outset, the most basic decision you can make to combat presenteeism is to avoid working sick, injured or exhausted.

If you do not have a primary care physician then obtain one and see them as needed and when recommended. This is especially true for providers who should never try to be their own physician.

Sir William Osler, the father of modern medicine, famously said, “The doctor who treats himself has a fool for a patient.” For emphasis I added, “The physician who treats himself has an idiot for a doctor as well as a fool for a patient.” You can never be objective when you are in fact the object.

Do you exhibit the characteristics of presenteeism? Do you have a physician that you see regularly? If not, why not? If you have questions, please contact NCPHP at 919-870-4480.