Dr Ting highlights a potentially important limitation of our survey of presenteeism among resident physicians1: the desire of survey respondents to report socially desirable reasons for working when ill, such as altruism toward patients and colleagues. While we agree that this bias likely exists, we believe its magnitude is small for several reasons. First, we would expect social desirability bias to exist primarily in surveys that are not conducted anonymously. Second, while residents may be more likely to report altruistic reasons for presenteeism because their attendance at the conference is known to their residency program, we believe this to be unlikely. For this to occur, residents would have to believe that the aggregated results of the survey would be seen by their program directors and would result in sanctions, despite no links to an individual resident's survey response. Third, in a national, mail-based, anonymous survey of residents in 2009, we found nearly identical rates of presenteeism.2 This provides empirical support that social desirability bias in our current survey is not large.
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