A febrile patient with mild nasal congestion requesting one week off work—should I grant two days of sick leave, a full week, no leave, or always grant leave regardless of the condition?

Sick Leave Duration for Mild Febrile Upper Respiratory Illness

Give 2 days sick leave (Option A) for this patient with fever and mild congestion that responds to antihistamines.

Clinical Reasoning

This patient presents with a mild, self-limited upper respiratory illness that does not meet criteria for extended work absence. The clinical presentation—fever with mild congestion responsive to antihistamines—suggests an uncomplicated viral upper respiratory infection without features of severe illness or complications requiring prolonged recovery 1, 2.

Key Clinical Factors Supporting Short Sick Leave

Severity assessment indicates mild illness:

• No unstable clinical factors are present (temperature >37.8°C with severe symptoms, respiratory rate >24/min, oxygen saturation <90%, or inability to maintain oral intake would warrant longer absence) 1, 2
• Symptoms are controllable with over-the-counter antihistamines, indicating minimal functional impairment 1
• No evidence of pneumonia, severe dyspnea, or systemic complications 1, 2

Natural disease course supports brief absence:

• Common cold and uncomplicated viral upper respiratory infections are self-limited, typically resolving within 3-7 days 1
• Most previously well adults with acute bronchitis or viral URI do not require antibiotics and recover with supportive care alone 1
• The patient's symptoms are mild enough to be managed with symptomatic treatment 1, 2

Why Not One Week?

Granting one week of sick leave (Option B) would be excessive because:

• There is no clinical justification for prolonged absence in mild illness without complications 2, 3
• Research shows that very short-term sick leave (1-3 days) is appropriate for minor illnesses, while longer absences are reserved for health conditions with significant functional impairment 4, 5
• Unnecessarily prolonged sick leave can paradoxically increase future work absence patterns 6

Why Not Zero Days?

Some sick leave is warranted (ruling out Option C) because:

• The patient has documented fever, which indicates active infection and potential contagiousness 1
• Brief work absence prevents workplace transmission of respiratory viruses 1
• Fever >38°C is a clinical indicator requiring at least short-term rest 1, 7

Why Not Automatic Leave?

Automatic sick leave regardless of condition (Option D) is inappropriate because:

• Sick leave decisions must be based on clinical severity, functional impairment, and public health considerations 2, 3
• Indiscriminate sick leave certification undermines medical judgment and can contribute to workplace absenteeism patterns 4, 5

Practical Implementation

Provide 2 days of sick leave with the following guidance:

• Advise symptomatic treatment with antihistamines, antipyretics for fever, and adequate hydration 1, 2
• Instruct the patient to return if symptoms worsen (persistent fever >5 days, new dyspnea, chest pain, or productive cough with purulent sputum) 1, 3
• Explain that most viral URIs resolve within 3-7 days, and 2 days allows for initial recovery while fever subsides 1, 2

Red flags requiring reassessment and potential extension:

• Symptoms persisting beyond 10 days without improvement 1, 3
• Development of severe symptoms (high fever >39°C for >3 consecutive days, severe facial pain, or purulent discharge) 1
• Worsening after initial improvement ("double sickening" pattern suggesting bacterial superinfection) 1, 3