Nearly two thirds (63%) of doctors in Ireland say they have continued to work despite not feeling mentally well enough to do so according to a survey - with many citing pressure to clear waiting lists, staff shortages, the guilt of adding to colleagues’ workloads, and feeling that taking time off for mental wellbeing issues is not deemed “acceptable” where they work.

The Medical Protection Society (MPS) surveyed 548 doctors across Ireland about presenteeism in the medical workforce. Over half of respondents (56%) have continued to work despite not feeling mentally well enough because they felt guilty adding to colleagues’ workloads, while two in five (42%) said it was because their patients relied on them. 44% cited staff or rota shortages and 31% cited the pressure of clearing waiting lists. 

46% of respondents said taking time off for mental wellbeing issues was not deemed acceptable in their workplace.

Many of the doctors who took part said working when not feeling mentally well enough had contributed to a lack of empathy with patients (64%), a loss of concentration (67%), being more fearful of making mistakes (59%) and practising defensive medicine (48%). Half (50%) also suspected it may have contributed to a lower standard of patient care, and one in five (19%) felt it may have led to a missed or incorrect diagnosis.

MPS, which represents the interests of over 16,000 healthcare professionals in Ireland, said much more needs to be done to ensure doctors feel able to take time off to access mental wellbeing support when they need it, without guilt or stigma.

Dr Rob Hendry, Medical Director at MPS, said: “Doctors are notoriously reluctant to take time off when they are sick, and it comes as no surprise to me that they are putting their patients’ and colleagues’ needs above their own – particularly during a time of extreme pressure on resources.

“It is however worrying that such a large proportion of doctors say they continue to work despite not feeling mentally well enough to do so. When mental wellbeing is poor, a doctor should feel able and supported to take time off to recuperate or seek support. Not doing so could exacerbate the issue, result in them taking more time off in the longer term, or even leaving the medical profession altogether.

“Working despite not being mentally well enough so can also impact on patient care and our survey shows the ways this can manifest - from lack of empathy and concentration, through to a negative impact on team functionality, or a missed diagnosis.

“What is equally concerning is that nearly half of doctors feel that taking time off for mental wellbeing issues is not deemed acceptable where they work.

“Presenteeism is a complex issue to solve - particularly in a profession where it is so deeply ingrained in the culture - but it is clear that more needs to be done to enable and support all healthcare workers to take time off when they are too unwell to work, without guilt or stigma.

“This includes considering a range of measures to build in additional capacity. 94% of those who took part in our survey believed such measures would be helpful in reducing presenteeism.

“The provision of accessible mental wellbeing support resources is also key. Those working in both HSE and private healthcare settings should have counselling, peer support networks and specialist support available as standard. This would help to tackle issues early on and enable doctors to continue to care for patients safely.

“We hope the new Government will look closely at the issue of doctors’ mental wellbeing – it is critical in retaining the medical workforce and requires long-term thinking.

“We would like to remind MPS members that they have access to an independent counselling service as part of their membership.”

Doctors who participated in the MPS survey commented anonymously:

“We are all aware of the risks of presenteeism. We continue to show up because we care about our patients and our colleagues and know they will suffer more if we are not present. We need more staff to be able to take time off when needed!”

“If the system had more built-in resilience to cope with doctors taking sick time off, it would be a great help. We have all seen and experienced the strain it puts on us and our colleagues when folks are off sick - none of us want to be the cause of that strain.”

“I'm aware that if I'm not mentally on top of things I am more likely to make mistakes in patient care or forget to follow up on patients. I really worry about this and worry about patients’ wellbeing and my own medico-legal risk - but most of all I dread that feeling I get when I realise I have forgotten to do something. It really increases my stress and undermines my confidence.”

“All my colleagues are fully stretched. If I take time off, I just make it worse for them.”

“In my practice there is a very strong culture of presenteeism which makes it difficult to take time off unless you are unable to get out of bed.”

“Waiting list to see me is 12 to 18 months, I can't let people down. There are no slots to reschedule them so if I don't come in they won't get seen.”

“My employers are Neanderthal in their attitude to mental wellbeing.”

“I have, at my worst, considered suicide but never did I consider taking time off work. Only as I write that looking back I realise how crazy that sounds.”

“I have gone to work despite feeling mentally unwell, but I have pushed my mental health issues aside as I feel this is expected of me, and that I am obliged to look after other people over my own health.”

“In many cases, there are no other qualified personnel to cover for you if you decide to take time off, yet the work still needs to be done. The fear of potential consequences can make taking time off feel impossible.”

"My main concern is making a mistake that seriously affects patient outcomes that would have been avoided if I had been well. This leads to increased time writing notes, double checking etc. It leads to rumination and anxiety regarding patient interactions, negatively affecting my mental health."

“Lack of empathy, poor bedside manner e.g. being rude or curt to patients, poor communication, rushing history-taking.”

“I find the doctor-patient detachment boundary tends to break down. I then am more likely to make emotionally loaded decisions as opposed to when I am mentally in a good place.”

"I think a huge problem for doctors is fear. Fear of seeking help for one's mental or physical health. Admitting that you have a problem could have a deleterious effect on your future career.”

ENDS

MPS counselling support service:

Confidential counselling sessions and wellbeing resources are included as one of the benefits of MPS membership at no additional cost. To access the confidential counselling see www.medicalprotection.org/ireland/wellbeing

For further information about this press release contact [email protected]

548 MPS members participated in the survey which took place in November 2024. Key findings:

• 63% of respondents said they have gone to work, or continued to work, despite not feeling mentally well enough to do so
• 56% have done so because they felt guilty adding to colleagues’ workloads
• 42% have done so because their patients rely on them
• 31% have done so because of pressure to clear waiting lists
• 44% have done so because of staff/rota shortages
• 46% of respondents said taking time off work for mental wellbeing issues was not considered acceptable at their work
• 64% said working while not feeling mentally well enough to do so has contributed to a lack of empathy with patients
• 67% said it has contributed to a loss of concentration
• 59% said it has contributed to them being more fearful of making mistakes
• 48% said it has contributed to them practicing defensive medicine
• 47% said has contributed to an increased concern about medicolegal issues
• 34% said it has contributed to a breakdown in relationships or conflict with colleagues
• 31% said it has contributed to a negative impact on team functionality
• 50% said it may have contributed to a lower standard of patient care
• 19% said it may have contributed to a missed or incorrect diagnosis
• 12% said there had been no effect on patients
• 89% said introducing measures to ensure the healthcare system has the capacity to allow doctors time off if needed may reduce instances of presenteeism
• 86% said it would be helpful having greater promotion of wellbeing services to medical professionals.

About MPS

The Medical Protection Society Limited (“MPS”) is the world’s leading protection organisation for doctors, dentists and healthcare professionals. We protect and support the professional interests of more than 300,000 members around the world. Membership provides access to expert advice and support and can also provide, depending on the type of membership required, the right to request indemnity for any complaints or claims arising from professional practice.

Our in-house experts assist with the wide range of legal and ethical problems that arise from professional practice. This can include clinical negligence claims, complaints, medical and dental council inquiries, legal and ethical dilemmas, disciplinary procedures, inquests and fatal accident inquiries.

Our philosophy is to support safe practice in medicine and dentistry by helping to avert problems in the first place. We do this by promoting risk management through our

workshops, E-learning, clinical risk assessments, publications, conferences, lectures and presentations.

MPS is not an insurance company. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association.