When you go to the GP or to hospital, the last thing you want is to be treated by someone who is ill themselves. This would mean you are at risk of contracting the infection, especially if you are already sick and therefore more vulnerable, as well as receiving poor treatment from someone who is unwell. Doctors and nurses know this all too well, and yet research shows that large numbers are going to work and treating patients when they are sick, even contagious.

It is, to some extent, obvious why doctors and nurses get sick more often: they come into contact with sick people continuously. However, the picture is more complicated than this, and there are also a number of reasons why health workers present to work sick even though they know the wider risks in doing this.

The Extent of the Issue

According to an indepth 2014 study in  Philadelphia, 83% of doctors and nurses surveyed had come to work sick in the past year, even though almost all (95%) said they believed working while sick put patients at risk. Many even said they had presented to work ill most than once, and up to five times in the past year, and included severe symptoms such as fever and diarrhoea.

This seems to be a wide-ranging problem, with similar reports from across the US and internationally. Increasing numbers of health care workers have been expressing concerns about this issue and calling on management and the Government to take action.

Why is this Happening?

It seems bizarre that if doctors and nurses know they are putting their patients at risk they would continue to go to work and treat people while they are sick themselves. There are many reasons why they do this, mostly linked to larger, systematic problems. The key reasons are fear of punishment, strict attendance policies and lack of staff coverage making it very difficult for health workers to take sick leave.

In the Philadelphia study, nearly 95% of respondents said they had come to work sick because of staffing concerns, while 92% didn’t want to let patients down. Many also said that it is very difficult to get coverage to ensure patients are looked after if they are away sick, and that there was an expectation in the hospital that workers should present unless they were “remarkably ill”, as well as it being unclear when workers were too sick to come to work. All of these factors created a sense of guilt and duty that meant doctors and nurse felt like they had to present to work even when quite ill.

How to Address the Problem

The issue of medical workers present to work when ill is a complex problems, and there for there are no easy solutions. It requires a nuanced approach that should include the following steps:

1) Health care centres should have clear policies on coming to work sick. Because uncertainty has been shown to be a major reasons why health care workers present to work when sick, clarifying what is “too sick to work” will stop this from happening to a large extent. This will also address some of the problems of doctors and nurses feeling guilty if they call in sick, as there are clear policies to follow.

2) It is also important that hospitals and other health care centres make it easier for workers to take sick time. It is not enough to simply have policies in place that tell doctors and nurses to take time off when sick, management must also take practical steps so that they can actually do that. This includes allowing adequate paid sick leave so that workers don’t risk losing salary if they choose to protect patients’ health by staying at home. It is also important to have systems in place that ensure adequate coverage if someone needs to take time off.

3) Ensure exemplary hygiene in hospitals and other medical facilities. Proper hygiene practices should be implemented 100% of the time to limit the spread of infection. Management must support and promote these practices through setting up adequate systems to support hygiene and addressing any breaches immediately.

4) Implement mandatory flu shots. One of the biggest infections in doctors and nurses, as with the general population, is the flu during the winter months. The flu shot, though not a guarantee, protects people from the majority of flu strains each year and so can go a long way to stop people from getting sick. Although many health care facilities encourage workers to have a flu shot each year, it is generally no mandatory. Making flu shots mandatory for all health workers could make a big difference.