The Unproductive Practice of Presenteeism

If you have never heard the term presenteeism before, I’ll bet you are a bit confused.

After all, aren’t we supposed to be present and mindful and all that?

Presenteeism is a term for working while sick.

Absenteeism is a term for not working while sick.

I’d like to throw a memory bomb your way. Think back to last allergy season. How many days were you working through congestion, sneezing, coughing, headaches, etc.?

Seriously, how many?

You know you felt awful. You worked anyway.

How productive were you? On a scale of 1 to 5, with 1 being completely unproductive and 5 being “in the zone,” where did you fall?

If you played the numbers game with me above, you just participated in a research study on presenteeism (with a sample size of one).

Wellness programs in organizations are wonderful things. They often measure their success using metrics such as:

  • Reduced absenteeism
  • Reduced health care costs
  • Increased preventive healthcare service utilization

I wonder how many organizations track the impacts of presenteeism. My unscientific guess is “not many.”

The first reason is that productivity losses due to presenteeism are primarily measured through self-report. I tell you when I worked while sick. I tell you how productive or unproductive I was. While self-report measures are used quite a bit in leadership assessments and the like, they garner skepticism in some spheres.

The second reason that presenteeism is rarely measured is that several of the larger research studies were sponsored by pharmaceutical companies. Big Pharma may garner skepticism for other reasons.

Those two factors may cause HR departments to give this body of research the side eye.

However, you and I know the impact that working while sick has on our productivity. We feel miserable and likely perform miserably. So, that’s where I want to focus the remainder of this article.

We may not be able to change how our employers view presenteeism, but we can examine it for ourselves and our teams.

What type of worker is prone to presenteeism?


Here’s another game. Answer the following questions.

What type of person is more likely to work while sick?

  • A regular/permanent employee or a temporary/seasonal one?
  • Someone working in a privately owned hospital or in a public hospital?
  • Someone who sees their work as “a means to an end” or as a calling?
  • Someone who knows they can be replaced, or someone who feels irreplaceable?
  • A person with a poor diet and less emotional fulfillment, or someone who is physically fit and reports overall emotional wellness.

To answer these questions, I’ll tell you about a fictional person named James. James is a full-time employee at a public hospital who feels that his work contributes to the greater good and is part of his identity.

James has worked at the hospital for many years, and his team feels more like family. He has a lot of responsibility in his department, and when he goes on one of his very infrequent vacations, he spends most of his “days off” checking work email. While at work, he grabs whatever food he can from vending machines and goes home exhausted every night.

James has had perfect attendance for the past three years. James has major depressive episodes three to four times per year. People call him, “The Machine.”

James shows all the risk factors for presenteeism.

Here are the productivity-related implications for James (and the hospital!) when he works while sick:

  • His decision-making is impaired.
  • He works more slowly.
  • He is irritable with colleagues and patients.
  • He is more likely to have a workplace accident.
  • If his illness is communicable, other people may become sick.

Are you James (or someone like him)?

Scholars doing research on presenteeism typically focus on chronic illnesses such as:

  • Allergies
  • Asthma
  • Depression
  • GERD (gastroesophageal reflux disease)
  • Irritable bowel syndrome
  • Migraine headaches
  • Musculoskeletal conditions

The illnesses listed above have larger impacts on presenteeism.

Other health conditions tend to have almost equal effects on both presenteeism and absenteeism.

To better manage your own productivity losses due to presenteeism, consider the following:

  • Working while sick is not a badge of honor, even if other people at your organization seem to think so.
  • Workaholics may be less likely to seek medical care for what they deem “annoyances.” Feeling like heck is not a cost of doing business.
  • Challenge yourself to get your regular checkups with your healthcare provider. Know what health-related issues affect you. Knowledge is power.
  • If you feel that there is “something wrong” with your body, advocate for yourself with your healthcare providers and your employer. Some conditions such as irritable bowel syndrome are frequently misdiagnosed.
  • Get your flu shot. Programs providing free flu shots at work are the most successful workplace presenteeism (and absenteeism) prevention initiatives in history. Personally, I’d add COVID shots to this recommendation as well.

Oh, and, maybe…just maybe…rest when your body needs you to?

I scoured the 250+ articles on my blog, and want to offer the following posts for further reading on the important topic of health and work:


In my two-hour seminar, Confront Your Time Thieves…interruptions, procrastination and, oh yeah, distractibility, I talk about how we should strive to reduce our time thieves. We will never eliminate them altogether, and efforts toward that extreme goal will be unproductive. After all, we are human.

My philosophy with absenteeism is similar. We should strive to reduce unnecessary absences – for ourselves and for our organizations. But, when we overreach with absence-prevention programs or cultures, we are likely to increase presenteeism.

And presenteeism isn’t the goal – at all.

Dr. Melissa GratiasMelissa Gratias (pronounced “Gracious”) used to think that productivity was a result of working long hours. And, she worked a lot of hours. Then, she learned that productivity is a skill set, not a personality trait. Now, Melissa is a productivity expert who coaches and trains other businesspeople to be more focused, balanced, and effective. She is a prolific writer and speaker who travels the world helping people change how they work and improve how they live. Contact her at or 912-417-2505. Sign up to receive her productivity tips via email.



  1. Carolyn Brackett

    Great article, very informational.

  2. Joyce Teal

    Melissa, I had to laugh while reading “working while sick!” As an educator for 25+ years, working while sick is a way of life. Being absent means creating lesson plans for a substitute (assuming there is one available) and creating plans that can be used by other teachers who may cover your class throughout the day on their planning period. It is a LOT more work to be absent than to come to teach when sick. As long as we am not contagious, teachers go to school. It is much easier to rework our plans as we go through the day so it isn’t as stressful as creating plans for a substitute. Yes, this means sleeping all weekend or going to bed as soon we get home from school – ignoring our own families in the process which is about as stressful as plans for a substitute. I realize education is a bit different than most business settings. Hospitals are similar to education because when someone is absent, there may not be someone to take their place.
    I have worked in business and totally understand “working while sick.” Having a coworker who is not performing at their best when we are trying to get a project done, slows everyone else and the project. A day off work is sometimes the best way to increase your productivity.

  3. Sarah C Westcott

    Such a great topic! Interestingly, there are corollaries in the financial wellness space with both absenteeism and presenteeism too. For example, 30% of employees admit to being distracted by finances while at work, which translates to an average of 20 hours a month in lost productivity per financially stressed employee! That’s an estimated 5,000 per employee per year! Corresponding absenteeism adds an additional $300/day in lost productivity! That’s why health – both physical *and* financial – matters so much, both at the individual and the corporate level!


Submit a Comment

Your email address will not be published. Required fields are marked *

Like what you read?

Get new posts directly in your inbox!

You might also like these posts…

Enjoying these posts? Make sure you dont miss any!

If you enjoy my blog posts and want to make sure you never miss one - sign up for my newsletter! When you do, you'll also get instant access to my FREE webinar on interruptions in the workplace.

Interruptions can kill productivity. With one “Got a minute?” from a coworker or one stray thought swirling in your brain, the flow of your work can be completely disrupted.

The trouble is that few people have concrete strategies to get back on task quickly after an interruption. Some people completely lose focus…for hours! If you have tried reducing interruptions, but they still impact your ability to be effective at work, this free webinar is for you.