Being diagnosed with breast cancer meant I had to step away from my GP clinic for the first extended period of my career, apart from maternity leave. I knew pausing the job I love would be difficult. What I hadn’t expected was how uncomfortable being off work would feel, and the way it challenged my identity as a person who shows up and keeps going. I realised how tightly I had tied my sense of worth to productivity. How deeply I believed that being dependable meant always being present.
Working in the NHS and being acutely aware of the pressures we are under made it even harder. The healthcare service runs on the goodwill of overstretched staff. Patients need you, your colleagues need you, the system needs you.
Stepping away because of a life-changing illness forced me to confront something I have seen repeatedly over nearly two decades in medicine, in conversations with friends and colleagues, and in my own discomfort: how intolerant we are, culturally, of people being unwell.
You see it in subtle ways. The raised eyebrow when someone is off “again”. The comment about how “we’re all tired”. The suggestion that perhaps they could check emails “if they feel up to it”. The quiet praise reserved for those who never take a day off.
Over time, those signals are absorbed and internalised: “I can’t take time off”; “I feel guilty resting”; “I should just push through.”
When someone has been signed off by a doctor, they often feel they need to justify it to colleagues, managers, sometimes even to friends – to prove the illness is serious enough, as if the rest must be earned.
The language itself betrays us. We call it “sick leave” – as though it’s a break, a holiday or a pause from real life. There is nothing leisurely about recovering from illness. Rebuilding enough energy, concentration and emotional steadiness to return to work is often the most gruelling part.
The problem is that we have normalised pushing on while unwell. We admire people who “battle through” work. We turn up to work when we are physically or mentally not well enough to function properly. There’s even a name for it: presenteeism. But in reality, it rarely serves anyone well.
When you’re unwell, you’re slower, more distracted and more depleted. Recovery drags on and small mistakes creep in. Eventually, people burn out – sometimes underperforming for months, sometimes ending up off work for far longer than if they had paused earlier. It doesn’t strengthen workplaces, it quietly drains them.
And biologically, it makes very little sense. Healing is an active, energy-intensive process. The immune system requires adequate sleep, reduced stress hormones and proper nutrition to function well. When we override fatigue and push through, cortisol and adrenaline remain elevated. In the short term, that can mask symptoms, but in the long term, it slows repair. We cannot out-discipline physiology.
I have explained this to patients countless times. But it took a cancer diagnosis to force me to confront how deeply I had internalised the message that stopping equals weakness. That rest is indulgent. That being needed is proof of value. It isn’t.
Part of what made my time off so psychologically challenging was recognising how uncomfortable I was with stillness. Without the constant feedback loop of being useful, I felt untethered. It made me realise how many of us measure our worth by output. Parents feel it. Carers feel it. Professionals feel it. The ones who usually hold everything together feel it most acutely.
But illness does not respond to guilt. In fact, guilt compounds strain and keeps the nervous system on high alert. It prevents true rest.
What shifted for me was understanding that stepping back wasn’t letting anyone down. Instead, I had a responsibility to recover properly, to return to my patients well, present and safe, rather than exhausted or distracted. And I had a responsibility to my family and to myself too.
We talk a lot about duty of care in medicine. We are taught it relentlessly: duty to patients, to colleagues, to the system. What we are not taught, as clearly, is duty of care to ourselves. Yet the two are inseparable.
A doctor who is unwell and pushing through is not a hero. A parent who never rests is not superhuman. A professional who refuses sick leave is not more loyal. They are often just depleted.
Reframing sick leave as a responsibility rather than failure requires a cultural shift. It is a responsibility to heal properly so that we can return sustainably. It means trusting medical advice when someone is signed off. It means managers modelling healthy behaviour and boundaries. It means allowing recovery without interrogation. It means teaching our children that rest is part of health, not the opposite of productivity. It also means accepting that we are not machines.
I won’t pretend it was easy. There were moments I questioned myself and wondered if I should be back sooner, when I felt guilty watching others carry on without me. But illness strips things back quickly and clarifies what matters.
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If there is one thing I have learned from being on the other side of the consultation table, it is this: pushing through might look strong, but knowing when to stop is often braver.
So, if you are off work and recovering from illness, surgery, burnout or something no one else can see, you are not letting anyone down.
You are doing the work your body requires. And when you return – properly rested and properly healed – you will give back in a way that endurance alone could never sustain.
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