Asking an employee to get a sick note is a ‘public health risk,’ experts say

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With flu season rearing its ugly head, the hotly debated topic of whether employers should be able to require sick notes for missed work has returned.

The Canadian Medical Association (CMA) has called the practice a “public health risk” — and there’s data to support those fears.

2018 survey conducted by IPSOS found that eight in 10 Canadians would go to work sick if their employer required sick notes for minor illnesses.

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To Dr. Gigi Osler, this reality presents a number of risks for sick people and the general public alike. She’s an ear, nose and throat surgeon and the former president of the CMA.

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“Requiring sick notes … introduces an unnecessary public health risk, if you now have sick people who would’ve otherwise stayed home going to doctor’s offices, walk-in clinics or emergency rooms just to get [one],” Osler said.

“If someone has an illness like the flu or a cold, our medical advice would be to stay at home, rest, recover and not go out in public.”

The risks are worse for Canadians who are precariously employed, as well as those without immediate and easy access to health care.

Sick notes pose a threat

The Decent Work & Health Network (DWHN) advocates for better employment conditions in Ontario. They believe workplace policy directly impacts employee health, and members have expressed concern over sick note policy.

“Work is one of the biggest things that Canadians spend their lives doing. It has a tremendous impact on their health,” said Dr. Kate Hayman, an emergency doctor at the University Health Network in Toronto and a member of the DWHN.

“We consider work to be a major social determinant of health … and that workplace policy really impacts people’s health.”

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The DWHN firmly believes requiring a sick note presents a danger to both sick people and the public.

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“From my perspective in the E.R., we worry when people are coming in sick with viral illnesses or infectious diseases,” Hayman said.

“We see a lot of people who are immune-compromised because of their chronic conditions. If a worker is coming to get a note because their employer requires it and they’re coughing and sneezing in the waiting room, that puts other people at risk.”

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Ultimately, Hayman believes that requiring a sick employee to obtain a sick note also places undue pressure on an already strained health-care system.

“Having good job protections when you’re sick can actually decrease emergency room utilization,” she said.

“Paid sick days actually help prevent emergency department visits.”

This is an accessibility issue

There are a number of roadblocks that can prevent access to obtaining a sick note from a physician.

For starters, some people don’t know where to get one. But even for those who do know where to go, whether they can do so in a timely manner is of concern.

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“There are definitely people who don’t have access to their primary care provider in the amount of time they need to get documentation,” said Hayman.

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“Then, of course, there’s the financial cost,” she said. “The amount that a health provider charges for a sick note varies drastically, from free to much higher.”

Some people will also need to take public transit to get the note — a service that will cost them more money, time and energy, all things a sick, low-income employee probably won’t have.

“That’s a huge out-of-pocket expense, particularly for a minimum wage worker.”

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Osler said this places an “unfair financial burden” on sick employees.

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“[They] may be losing their day salary or wage because they’re sick,” she said. “They may have to pay the cost of transportation to get there, as well as pay for the cost of the sick note.”

For many people, as revealed by the IPSOS poll, getting a sick note can be more difficult than simply going to work sick — which can lead to longer leaves of absence over time.

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“People who are under considerable physiologic stress — for example, with the flu … may be more likely to have a workplace injury, which could potentially be catastrophic,” said Hayman.

Working while sick can also make other employees sick, increasing the number of absences taken across teams. It’s ultimately counter-productive.

“Think about how contagious … the common cold is,” said Osler. “As an employer, instead of having one person in the workplace sick, now you’re looking at multiple people getting sick.”

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What’s the solution?

In an effort to alleviate the pressure placed on employees, some doctors have begun charging employers directly.

While Hayman agrees the onus to pay for a sick note shouldn’t be on the employee, she doesn’t think having employers pay is much of an improvement.

“It still doesn’t solve the issues of placing an undue burden on someone who should be resting at home,” she said.

“It doesn’t actually help to alleviate the burden on the health system or decrease the risk associated with that person being in a waiting room, potentially spreading their illness.”

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In Hayman’s view, paid sick days are decent alternative.

A 2016 study looked at the impact of allowing workers paid sick days by analyzing the results of the Earned Sick Time Act, which took effect New York City in 2014.

Critics of the law argued that employees would abuse the entitlement and that it would result in a cost burden on employers. However, researchers found that those fears were proven “unfounded.”

“It didn’t have a large impact on workplaces, and it had a positive impact on workers,” said Hayman. “Workers weren’t taking all of the sick leave they had access to — they were taking sick leave when they needed it to get better and avoid infecting others.”

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Whether there’s a better alternative to the current sick-note model remains unclear, although Hayman said some Canadian universities are moving in the right direction with a “self-verification” option for students.

“Some universities … as part of their mental health strategy … have now launched a self-verification of illness, which essentially means the student just reports that they’re sick, but they don’t have to go see a doctor,” she said.

“They fill out a form that says ‘I’m sick.'”

“The feeling is that, particularly for students who have a lot of mental health reasons for missing things, this will potentially help to alleviate some of the stress.”

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