The average adult gets between four and six viruses a year, the kind that gives you a fever, a hacking cough and a streaming nose. Then there is the occasional bout of migraine, gastroenteritis or cystitis. In a motivated hard-working team, nobody wants to dump on their colleagues by taking time off, but it may be essential. If you are vomiting every 20 minutes, the case for taking a day off may be more obvious than if you have a dreadful migraine, but no less deserving.
But as of now many new employees at Tesco, the supermarket chain, will have to carry on regardless. Tesco yesterday announced a pilot scheme to ban sick pay for the first three days of any illness. The ban is designed to reduce absenteeism and stop people "taking a sickie".
Anyone who runs a small business will be sympathetic to the problem. Anthoulla Kyprianou runs a company supplying nuts and snacks. "I adopted a similar policy with my business last year. It was always the same staff taking days off and coming in late and getting paid, whereas the loyal staff who were never sick were being treated normally but with no congratulations for their efforts."
Usdaw, the shop workers' union, supports Tesco's pilot scheme, which is being carried out in newly opened stores. But there is a risk that the effect of the new measures will be to discriminate against people who really need to take sick leave and will spread germs rather than lose pay, and also give the wrong message to people about looking after their bodies.
Recent research shows that GPs in the UK don't use the sickness certification system according to national guidelines, but develop individual strategies to deal with certification requests. A study published in the British Medical Journal this year found that most GPs didn't want to refuse requests for certificates. The doctor-patient relationship is founded on mutual trust and if the doctor regards every request with suspicion, the trust is quickly undermined and difficult to rebuild. In my experience, unless I actually witness diarrhoea, for example, I may have to take the patient's word for it.
It is also true that people often end up taking a day off because of stress, without actually having a definable illness. I have a doctor friend who calls these her "mental health days". And bosses at Kwik-Fit Insurance in Scotland recently decided that its 900 staff could have two "duvet days" off every year - no questions asked.
As Drs Heath and Nilsson put it, writing in the BMJ last year about sickness benefit: "At its best, work is a source of fulfilment, dignity, social contact, achievement, usefulness, and economic self-sufficiency; at its worst, a source of anxiety, sleeplessness, fear, humiliation, and despair." It may seem reasonable in abstract to penalise somebody for taking time off in these circumstances, but it is different when you are faced with a lawyer having panic attacks because of a bullying senior partner, or a postman who is distraught because his wife is having an affair.
Of course some people do abuse the system, to watch the football, or do their Christmas shopping. But how can Tesco hope to distinguish between genuine and false sickness? And what are the public health implications of this decision? How keen will we be to buy our fish from the man at the fish counter in Tesco if he has a streaming cold or dreadful diarrhoea?
What sort of message does this measure put out - if you are ill, ignore it and keep on working? I can't help wondering if it will backfire - as the people who would have taken a sickie before will now be off for four days instead of one or two, and then pitch up at the surgery asking for a certificate - and we will be no better able to decide whether they are ill than we were before.
