Doctors are notoriously reluctant to take time off when we are sick. This is not something that is distinct to the UK; in fact, it is something we see among members we support around the world.
When I was at medical school, education on self-care was extremely limited. Even now — despite some improvement in the curricula such as the inclusion of stress management techniques — the long hours and high stakes associated with the medical profession still drive a culture of self-sacrifice.
Add rotation shortages and pressure to clear waiting lists to the mix, and it is easy to see how our own health and wellbeing is pushed aside to ensure patients are getting the safest care possible.
A Culture of Self-Sacrifice in Medicine
At Medical Protection Society (MPS), we recently surveyed over 1000 doctors in the UK about presenteeism in the medical workforce — particularly in relation to continuing to work while not feelingmentallywell enough to do so.
Nearly three quarters of respondents (73%) said they continue to work despite not being mentally well enough. There are several reasons for them doing so, including feeling guilty for adding to colleagues’ workloads (60%), because of staff shortages (50%), because patients rely on them (42%), or just because it is what is expected of them (47%).
Anonymous comments left by the doctors surveyed also indicate that some struggle into work due to the “shame” at having to state mental wellbeing as a reason for taking time off or because they are fearful it will jeopardise career progression.
One doctor commented: “You are struggling the day and night before your shift, and you’ve cried the entire night, but you can’t call in sick. Because when they ask you what’s the reason for calling in sick, no one wants to say it’s a personal reason with mental health. Instead, you opt to go work.”
Disappointingly, more than a quarter (27%) said taking time off for mental wellbeing issues is not “acceptable” where they work.
Breaking the Stigma Around Mental Wellbeing
Clearly, much more needs to be done to enable and support all healthcare workers to take time off to recuperate or seek support for mental wellbeing issues — without guilt, fear, or stigma. Not doing so could exacerbate the issue, result in them taking more time off in the longer term to recover, or even leaving the medical profession altogether.
Despite the best intentions, working while not being mentally well enough can also impact patient care, and our survey shows the variety of ways this can manifest. For example, many of the doctors who took part said it had contributed to a lack of empathy with patients (63%), a loss of concentration (63%), or practising defensive medicine (42%).
One survey respondent commented “I tend to struggle more with decision making and my reflex is to take longer, follow up more, or investigate more. This can over medicalise someone and tends to increase my workload and risk of burnout.”
Almost half (46%) suspected that working while not mentally well enough may have contributed toa lower standard of patient care, and around one in ten (12%) felt it may have led to a missed or incorrect diagnosis.
Presenteeism can also have a negative impact on relationships and teamwork. Almost a third (32%) said it had contributed to a breakdown in relationships or conflict with colleagues, while a similar proportion (28%) said it had contributed to a negative impact on team functionality.
Creating a Supportive Healthcare Environment
There are no quick fixes for presenteeism, particularly in a profession where it is so deeply entrenched in the culture. Tackling some of the contributory factors — such as the chronic lack of capacity and resilience in the system — is complex.
There are, though, steps that can and must be taken to create more supportive environments, and accessible mental wellbeing support is key. One comment from a doctor who participated in the survey sums up the accessibility predicament:
“Management have said there is mental health support available; however, it’s for a very short period at a specific time for a couple hours on a specific day. I think this is very limited. It’s difficult to keep mental health struggles limited to a specific time and day.”
Those working in both the NHS and private healthcare settings should at the very least have counselling and peer support networks available to them when they need it. This would help to tackle issues early on and enable them to continue to care for patients safely.
Healthcare professionals should also have access to confidential, specialist help outside of their place of work, without fear of repercussion from their employers. We know national services like NHS Practitioner Health — which has funding until Spring 2026 — provide a vital lifeline for many who are struggling to cope.
One year ago, NHS England initiated a review into the provision of mental wellbeing support for NHS staff. The abolition of NHS England and restructuring of how the NHS is managed must not delay the implementation of a plan to ensure key support services are properly funded and safeguarded.
Investment in comprehensive mental wellbeing support can play a critical role in retaining the medical workforce. It is an issue that requires rapid action and long-term thinking, and at MPS, we will continue to make the case for this on behalf of the profession.
I would like to remind MPS members that they have access to a counselling service as part of their membership, for work-related issues such as stress, burnout, anxiety, and conflict. Members can access telephone support 24 hours a day, 7 days a week, and face-to-face counselling sessions can also be arranged. The service is completely confidential and independent of MPS. More information can be found at www.medicalprotection.org/uk/wellbeing
This article is published as part of an editorial collaboration between Medscape UK and Medical Protection Society that aims to deliver medicolegal content to help healthcare professionals navigate the many challenges they face in their clinical practice.
Professor Dame Jane Dacre is president of MPS. She is a physician and educator by background and is a past president of the Royal College of Physicians of London. She is also special advisor and chair of the Expert Panel for the Health and Social Care Committee and Independent Chair of the Advisory Board for the Implementation Group for the reduction of the Gender Pay Gap in Medicine.
Professor Dame Jane Dacre has disclosed no relevant financial relationships.
MPS membership provides the right to request access to expert advice and support on clinical negligence claims, complaints, GMC investigations, disciplinaries, inquests, and criminal charges such as gross negligence manslaughter.