Madrazo Lorenzo, Choo-Foo Jade, Yu Wenhui, LaDonna Kori A, Domecq Marie-Cécile, Humphrey-Murto Susan
Department of Medicine, University of Ottawa, Ottawa, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, Canada.
Med Educ. 2025 May;59(5):469-483. doi: 10.1111/medu.15538. Epub 2024 Oct 2.
Illness presenteeism (IP)-characterized by individuals working despite being sick-is a prevalent and complex phenomenon among physicians and trainees amidst competing priorities within medicine. The COVID-19 pandemic and growing attention to physician and trainee well-being have sparked renewed interest in IP. We conducted a scoping review to explore what is known about IP: more specifically, how IP is perceived, what approaches have been used to study the phenomenon and how it might have changed through the COVID-19 pandemic.
The Arksey and O'Malley scoping review framework was used to systematically select and summarize the literature. Searches were conducted across four databases: Medline, Embase, PsycInfo and Web of Science. Quantitative and thematic analyses were conducted.
Of 4277 articles screened, 45 were included. Of these, four were published after the onset of the COVID-19 pandemic. All studies framed IP as problematic for physicians, patients and health care systems. Dominant sociocultural drivers of IP included obligations towards patients and colleagues and avoiding the stigma of appearing vulnerable or even temporarily weak. Structural factors included heavy workload, poor access to health services and lack of sick leave policies for physicians. The pandemic does not appear to have affected IP-related causes or behaviours. Proposed solutions included both educational interventions and policy-driven changes.
Despite being viewed in the literature as largely negative, IP remains highly prevalent among physicians and trainees. Our review highlights that IP among physicians is fraught with tensions: while IP seemingly contradicts certain priorities such as physician wellbeing, IP may be justified by fulfilling obligations to patients and colleagues. Future work should examine IP through diverse theoretical lenses to further elucidate its complexities and inform nuanced individual and systems-level interventions to minimize the negative consequences of IP.
疾病出勤主义（IP）——表现为个体在患病时仍坚持工作——是医生和实习生中普遍存在且复杂的现象，医学领域存在诸多相互竞争的优先事项。新冠疫情以及对医生和实习生福祉的日益关注引发了对疾病出勤主义的新兴趣。我们进行了一项范围综述，以探索关于疾病出勤主义的已知情况：更具体地说，疾病出勤主义是如何被认知的，研究该现象采用了哪些方法，以及它在新冠疫情期间可能发生了怎样的变化。
采用阿克斯和奥马利范围综述框架系统地筛选和总结文献。在四个数据库进行检索：医学文献数据库、Embase、心理学文摘数据库和科学引文索引数据库。进行了定量和主题分析。
在筛选的4277篇文章中，纳入了45篇。其中，4篇是在新冠疫情爆发后发表的。所有研究都将疾病出勤主义视为对医生、患者和医疗系统存在问题。疾病出勤主义的主要社会文化驱动因素包括对患者和同事的义务，以及避免显得脆弱甚至暂时虚弱的污名。结构因素包括工作量大、获得医疗服务的机会少以及医生缺乏病假政策。疫情似乎并未影响与疾病出勤主义相关的原因或行为。提出的解决方案包括教育干预和政策驱动的变革。
尽管在文献中疾病出勤主义大多被视为负面，但在医生和实习生中仍然非常普遍。我们的综述强调，医生中的疾病出勤主义充满了矛盾：虽然疾病出勤主义似乎与某些优先事项如医生福祉相矛盾，但通过履行对患者和同事的义务，疾病出勤主义可能是合理的。未来的工作应通过不同的理论视角来研究疾病出勤主义，以进一步阐明其复杂性，并为细致入微的个人和系统层面的干预提供信息，以尽量减少疾病出勤主义的负面影响。
