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It's cold and flu season, that time of year when a couple of eternal philosophical questions arise: "When am I sick enough to call in sick?" and "Do I need a sick note?"

The answer to the first question is pretty straightforward, at least in theory. Workers should stay home from work when:

*They are unable to carry out their duties properly;

*They are contagious and put others at risk;

*Resting at home will help alleviate the condition and speed recovery;

*They are undergoing treatment that could imperil the well-being of others – for example, a heavy-equipment operator who is taking medication that makes her drowsy.

In practice, however, most people go into work even if they are sick. There are several reasons for this, ranging from cultural to financial.

We live in a work-obsessed society, where taking time off to recover from illness can be perceived as a sign of weakness.

Many workers also drag themselves to the job, even when they are under the weather, because they don't want to burden others, or let the side down.

And for many, a sick day is a non-starter because it creates a financial burden. Among the growing ranks of casual, temporary, part-time and self-employed workers, not working means not being paid and, in many cases, the real risk of losing a job.

This is particularly true for low-wage workers, such as those in the food-services and health sectors. And if the notion of feverish, sneezing cooks and care providers is not a comforting thought, consider that no jurisdiction in Canada mandates pay for days missed while ill.

Of course, many businesses – and unionized shops, in particular – provide paid sick leave, especially for full-time workers.

According to Statistics Canada, full-time workers take, on average, 7.4 days of sick leave annually – ranging from a low of 6.1 days a year in Alberta to a high of 9.6 days in Quebec.

Stated another way, on any given day in Canada, about 8.1 per cent of the work force is off sick. These rates vary a lot by where people work, from 5.2 per cent in the private sector to 10.5 per cent in the civil service.

But before you jump to conclusions about lazy, faking civil servants, consider that a) they tend to be unionized so they have sick days that they can use without a financial penalty and b) they also tend to have the strictest rules about how sick days can be claimed.

This brings us to the thorny issue of the sick note. Many employers demand that any worker claiming a sick day obtain a doctor's note confirming that they are indeed ill.

Professional groups such as Doctors Nova Scotia and the Ontario Medical Association have denounced this practice as wasteful and harmful, and they're right.

When people are sick, especially with infectious respiratory diseases, the last thing you want them doing is sitting in a doctor's office exposing others to their germs, not to mention that it's often a waste of doctors' time (and public dollars in a taxpayer-funded medicare system) to diagnose conditions that require little more than bed rest.

It's also paternalistic to expect physicians to act as truancy officers for businesses.

Let's acknowledge that there are a small minority of fakers who will take sick days when they aren't sick. But the reality is that most cheaters will find a way to cheat, and onerous rules will mostly harm those who are legitimately ill.

Remember, too, that requesting a sick note is not an insured service under medicare, so doctors can – and many do – charge fees, which can range from $10 to $40, which again burdens low-wage workers most.

The toll of absenteeism is nothing to sneeze at: Sick workers cost the economy an estimated $16.6-billion a year in lost productivity.

What is more difficult to measure is the productivity lost through "presenteeism" – when workers are physically present but underperforming because they are sick. By some estimates, presenteeism is about three times as costly as absenteeism.

This is not an issue that will be resolved with simplistic, petty bureaucratic measures such as sick notes, but by implementing thoughtful workplace health policies that allow workers to get well before coming back to work, not to mention encouraging them to maintain good health in the first place.

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