Sick Note for 3-Day Illness
For a patient requiring documentation for a 3-day absence from work due to illness, you should provide the sick note directly at the time of the clinical encounter rather than referring them to their primary care physician.
Rationale for Direct Sick Note Provision
The practice of issuing sick notes directly from emergency departments, urgent care centers, and outpatient clinics was recommended to reduce unnecessary primary care appointments and waiting times 1. This approach can save substantial healthcare resources—an estimated 518,000 appointments and 42,000 GP hours annually 1.
Duration Recommendations Based on Illness Type
When determining the appropriate duration for work absence, consider the following evidence-based timeframes:
- Influenza/Influenza-like illness: Recommend 4 days off work as the median duration 2
- Upper respiratory tract infections: Recommend 2 days off work 2
- Gastroenteritis: Recommend 2 days off work 2
- General viral illnesses: Most require 1-3 weeks for complete resolution of symptoms, though work absence is typically shorter 3
Clinical Assessment for Work Fitness
Patients should be advised to return to work when they meet the following stability criteria (absence of 2 or more of these factors indicates fitness for return) 3:
- Temperature >37.8°C
- Heart rate >100/min
- Respiratory rate >24/min
- Systolic blood pressure <90 mmHg
- Oxygen saturation <90%
- Inability to maintain oral intake
- Abnormal mental status
Important Caveats
- Most patients can self-determine return to work: 82.8% of emergency physicians believe patients can determine when to return to work without formal medical clearance 2
- Avoid excessive medicalization: The requirement for sick notes often reflects employer policies rather than medical necessity 1, 2
- Consider public health implications: During infectious disease outbreaks, exclusion from work serves as an important public health measure 2
Current Practice Gaps
Despite recommendations, only 16-20% of emergency departments routinely issue sick notes, with most lacking clear policies 1. This creates unnecessary burden on primary care and patients 1.