A BMA survey of more than 3,500 doctors and medical students reveals the fear of letting down colleagues or patients and concerns with discrimination or unfair treatment are among the factors driving many doctors to continue working at the expense of their own health.

The findings, which can be found in The Cost of Carrying On report, show 81% of respondents said they had worked, trained or studied while not feeling well enough to do so at least once in the previous three months.

When citing their reasons for doing so, 71% said that wanting to support their colleagues was the main factor, with 59% worried about letting down patients and 40% owing to general concerns with understaffing in their workplaces.

When queried about their concerns with the effects presenteeism had on performance in the workplace, 60% admitted to worrying about making mistakes, while 57% felt less able to make complex decisions and 56% said they feared their quality of care to patients would be diminished.

The survey reveals that presenteeism also affects the productivity of healthcare staff, with 48% of respondents saying they felt less able to deliver all work, and 40% less able to take on additional responsibilities.

The survey also assessed participants using the Oldenburg Burnout Inventory and found that 93% were scored as at risk of burnout based on their responses.

The report calls on the Government to achieve improvements in working conditions and commit to ensuring safe staffing promised in its 10-Year Workforce Plan, particularly through the expansion of foundation and specialty training places.

The report also calls for employers and medical schools to adopt and implement BMA initiatives, such as the mental wellbeing charter and fatigue and facilities charters.

Other recommendations include accelerated adoption of flexible working, establishment of a universal occupational health service in the NHS, and ending the use of absence monitoring tools such as the Bradford Factor.