We are sick of sick notes

By Vamini Selvanandan

There is one thing doctors and patients can readily agree upon: we both hate sick notes. Patients loathe waiting long hours in overcrowded waiting rooms to request a note and doctors detest the added burden on the healthcare system in providing one.

Sick note policies increase use of scarce healthcare resources as employees are forced to visit the emergency room or their family physician’s office for the sole purpose of getting a sick note. Sitting unnecessarily in waiting rooms with minor viral illnesses, they put other vulnerable patients - like the frail elderly, pregnant or immunocompromised - at risk of serious complications.

Having to obtain a sick note also creates a strain on the worker, and does not respect a person’s right to rest when they are sick. The World Health Organization and the Public Health Agency of Canada advise people with the flu to stay home to recover and prevent infecting others. Common colds and gastroenteritis are also self-limiting illnesses which get better without medical treatment.

So why do employers insist on sick notes? It appears that some feel it as an effective way of policing employee absenteeism. Either by having a doctor verify illness in an employee or by creating a barrier for employees to taking days off when they are sick, they feel that it will improve employee attendance and ultimately, business productivity and profit.

But this logic does not bear out. Doctors do not verify minor illnesses in patients through testing or other objective means before providing sick notes. They simply listen to the patient and believe the symptoms that patients report. Trust is central to the doctor-patient relationship and doctors do not take on the role of policing or disciplining truant employees. Such responsibilities lie squarely with the employer or their human resources department.

Creating barriers to employees staying home when sick can also backfire. A recent study showed that 82% of Canadians would rather go to work sick than get a sick note. Slower recovery and increased infections of customers and co-workers can lead to workplace outbreaks of disease and seriously affect a business’s bottom-line. When a critical number of employees get sick, businesses temporarily shut down operations or reduce their hours or services.

Not surprisingly, several physician organizations are pushing back against sick note policies. The Canadian Association of Emergency physicians is advocating for a ban on sick note requirements by employers and schools through federal or provincial legislation. The Canadian Medical Association and the Ontario Medical Association are also taking a stand against sick notes. In 2023, Doctors Nova Scotia succeeded in getting provincial legislation to limit employers to asking for a sick note only if an employee has been absent more than 5 days or absent twice within the previous year.

Paid sick leave is an alternative policy to requiring sick notes and has benefits for workers, employers, and society. Most Organization for Economic Co-operation and Development (OECD) countries have national permanent paid sick leave policies, but Canada is a laggard by comparison. In 2020, fifty-eight percent of Canadian workers reported not having paid sick leave, and this number increases to seventy-five percent among those making less than $25,000 per year. Workers in precarious jobs at hotels, restaurants, and grocery stores are less likely to have paid sick leave than those in secure office jobs.

Paid sick leave increases income security for workers, protects public health, and helps business continuity by reducing disease transmission in the workplace. It is also an effective strategy for recruitment and retention of employees, making them feel valued and less likely to turnover. Paid sick leave reduces costs of training for rehires and saves money in the long run for businesses. Research shows that concerns of abuse of sick leave policies are unfounded: 45% of workers with paid sick leave did not take even a single paid day off work in the previous year.

We may not be directly affected by sick note policies or already have paid sick days ourselves, but we all have a stake in this matter. If we want to ensure a sustainable healthcare system with timely access for all those who have medical needs, we need to make our opposition to sick notes heard in workplaces and ask our provincial government to ban sick note requests by employers.

If we want to remain healthy and safe as customers and clients, we need to advocate for paid sick leaves for workers so they may stay home and not spread infections. If we want to increase productivity and profit as business owners, we must build healthy relationships with our workers and show that we value and trust them by providing paid sick leave and not requiring sick notes.

Businesses, healthcare workers and governments should work together to ensure a quick and painless demise of the sick note.

Vamini Selvanandan is a rural family physician and public health practitioner in Alberta.