By Dr Volker Hitzeroth, Medicolegal Consultant, Medical Protection

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A survey recently undertaken by Medical Protection in South Africa has found that the overwhelming majority of doctors surveyed have continued to work despite not feeling mentally well enough to do so.

This practice is known as ‘presenteeism’ whereby doctors continue to work, but because of illness are not fully functioning in their professional roles.

Presenteeism can be extremely concerning as there is increasing evidence that shows the presence of unwell doctors at work may result in decreased productivity and lead to poorer outcomes. This is before even considering the impacts on the employee who continues to work and not seek treatment for their condition, potentially worsening their recovery and leading to longer-term issues.

It is clear from the findings of our survey that a culture of presenteeism is prevalent among the South African healthcare profession, and extends to mental health.

Of the 802 doctors who participated in the survey, almost three-quarters (72%) said they have continued to work despite not feeling mentally well enough to do so.

The reasons for doing so were varied and are largely reflective of the wider challenges faced by the medical profession in South Africa.

For example, almost half of respondents (49%) said they continued to work despite not feeling mentally well enough because their patients relied on them, with 45% also saying they felt pressured due to increasing patient workload.

Two in five (40%) said taking time off due to mental wellbeing issues was simply not acceptable at their work, which illustrates a challenging employment culture and suggests the need to increase awareness and research into mental health and its impact in healthcare. Nearly two in five (38%) said financial pressures were the reason why they had to keep working despite not feeling mentally well enough, which shows the real financial strain practitioners in private practice are under.

Presenteeism can come at a cost, and within the healthcare sector that can mean poorer patient care or worse clinical outcomes.

Respondents to our survey shared their personal experiences on how presenteeism has affected them and their patients. Many said continuing to work when not feeling mentally well enough had contributed to a lack of empathy with patients (61%), loss of concentration (58%), being more fearful of making mistakes (46%) and practising defensive medicine (38%).

Over half (55%) also suspected that it may have contributed to a lower standard of patient care and a quarter (26%) suspected it may have contributed to a missed or incorrect diagnosis.

When mental wellbeing is poor, a practitioner should feel able and supported to take time off to recuperate or seek appropriate support.

Not doing so can exacerbate the problem and also result in a practitioner having to take more time off over the longer term, or even leaving the healthcare profession altogether.

What is equally worrying are the factors that appear to be driving this culture – in particular those doctors who feel that taking time off due to mental wellbeing issues is not acceptable at their work, and those who have no choice but to work due to financial pressures – a particular problem for those in private practice.

More needs to be done to address the factors driving this.

A good start would be to consider a range of measures that enable and support healthcare practitioners to take time off when they are too unwell to work. This includes looking at ways to build capacity to allow doctors to recuperate when they need to.

Indeed, an overwhelming majority (89%) of those who took part in our survey believed such measures would be helpful in reducing presenteeism, although of course in reality current staff shortages make this challenging.

MPS would also like to see greater education about presenteeism and the risks associated with it – to both the doctor and the patient – and more local mental wellbeing resources established so that doctors working in public hospitals or private facilities can access support early on.

Without further action, I fear the culture of presenteeism and the problems it leads to will only exacerbate.

*MPS offers counselling to South African members experiencing work-related stress, or stress that they feel could impact their practice. More information is available at https://www.medicalprotection.org/southafrica/help-advice/counselling-service

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This article was originally published in Juta Medical Brief and is republished with permission.