It’s 2:30 a.m. and a woman is waiting in an ER exam room. She’s just finished her shift as a server. It was a long night, worsened by a new headache and cough. She’s worried about her upcoming shift. If she doesn’t go, her next paycheque might not cover rent. If she goes, she’ll feel horrible and risk spreading her illness to coworkers and customers.

This story isn’t about any one person. Her situation fits neatly into a gap that many experience: she shouldn’t be at work because she’s sick, but if she doesn’t work, she won’t be paid.

Even if she could afford to take a few days to recover at home, her employer requires that she get a “sick note” — a medical certificate documenting absence from work due to illness. Her local clinic charges a fee for this, so she’s waiting in the ER.

Employers may not realize the harms of requiring a sick note for short illnesses. However, as a recent flurry of social media attention highlights, this practice is problematic for many reasons.

First, it’s a poor use of health care and puts the public at risk. In flu season, waiting rooms are already busy with patients, including people with lower immunity, babies and pregnant women. When someone contagious visits just for a sick note, it exposes people to infection and creates delays for others who need care. Most people who have common viral illnesses, such as mild colds and flus, should be resting at home, not suffering at the doctor’s office.

All too often, sick notes don’t benefit the patient, but are a service employers expect free of charge. Since public health insurance doesn’t cover them, either health providers or patients pay the price. Requiring private payment from folks already disadvantaged by chronic illness, low income or precarious work is a “double blow” — unwell and out-of-pocket.

Sick notes set up skewed incentives for everyone. For employers, they hinder trust with workers and replace effective management, which are important for retention, safety and productivity. For health institutions, they may be seen as a source of income. For patients, it means they don’t take medical leave when they’re truly unwell: 8 out of 10 Canadians said they would go to work while ill instead of getting a sick note.

Besides being unpopular, sick notes are unreliable and, economically speaking, inefficient. They’re used to “prove” someone is sick, but for many short-lived illnesses there’s simply no way to accurately confirm them. They allow employers to decide how health services are used, instead of you and your health professional.

Clearly, sick notes are a lose-lose proposition. Some argue employers should be billed for them. But why pay for something unproductive when you can invest in healthier workplaces with paid sick leave? Last year, 900,000 employees of federally regulated businesses were granted three days of paid personal leave. This covers only 6 per cent of workers. Instead, all employees should have the basic protection of paid sick days.

In 2020, sick notes have no place in the office, neither the doctor’s nor the employer’s. They’re just a bad habit and a risk to our health. Tell your friends, coworkers, employees and elected representatives that it’s time to break this habit: our resolution for 2020 is to put an end to sick notes.

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Edward Xie is an emergency physician and assistant professor at the University of Toronto. @DrEdwardX

Monika Dutt is a public health and family physician in Sydney, N.S., and a board member with Canadian Doctors for Medicare. @Monika_Dutt