title: What makes physicians go to work while sick: a comparative study of sickness presenteeism in four European countries (HOUPE).
abstract: OBJECTIVE
  Sickness presenteeism is common in the health sector, especially among physicians, leading to high costs in terms of medical errors and loss in productivity. This study investigates predictors of sickness presenteeism in university hospitals, which might be especially exposed to competitive presenteeism. The study included comparisons of university hospitals in four European countries.
  
  
  METHODS
  A cross-sectional survey analysis of factors related to sickness behaviour and work patterns in the field of academic medicine was performed among permanently employed physicians from the HOUPE (Health and Organisation among University Physicians Europe) study: (Sweden n = 1,031, Norway n= 354, Iceland n = 242, Italy n = 369). The outcome measure was sickness presenteeism.
  
  
  RESULTS
  Sickness presence was more common among Italian physicians (86%) compared with physicians in other countries (70%‑76%). Country-stratified analyses showed that sickness presenteeism was associated with sickness behaviour and role conflicts in all countries. Competition in the form of publishing articles was a predictor in Italy and Sweden. Organisational care for physician well-being reduced sickness presenteeism in all countries.
  
  
  CONCLUSIONS
  Sickness presenteeism in university hospitals is part of a larger behavioural pattern where physicians seem to neglect or hide their own illness. Factors associated with competitive climate and myths about a healthy doctor might contribute to these behaviours. Importantly, it is suggested that managers and organisations should work actively to address these questions since organisational care might reduce the extent of these behaviours.
authors.affiliation: Karolinska Institute, Stockholm, SWEDEN; mgu@psychology.su.se.
authors.forename: Marie
authors.initials: M
authors.lastname: Gustafsson Sendén
authors.forename: Lise Tevik
authors.initials: LT
authors.lastname: Løvseth
authors.forename: Karin
authors.initials: K
authors.lastname: Schenck-Gustafsson
authors.forename: Ann
authors.initials: A
authors.lastname: Fridner
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004526:Efficiency; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007055:Iceland; D007558:Italy; D008297:Male; D008875:Middle Aged; D009664:Norway; D016272:Occupational Health; D010819:Physician's Role; D010820:Physicians; D018582:Sick Leave / Q000706:statistics & numerical data; D012803:Sick Role; D011795:Surveys and Questionnaires; D013548:Sweden