SINGAPORE — Guilt is a familiar companion for Mia (not her real name) every time she takes a sick day from work.

The 26-year-old civil servant uses about one day of sick leave every month or two.

Mia has endometriosis and an autoimmune disease, both chronic conditions that bring physical exhaustion, persistent fatigue and frequent bouts of pain.

Endometriosis is a condition whereby tissue similar to the uterus lining grows outside the organ. It can be especially debilitating, and leads Mia to experience intense bloating, bowel issues and pain that radiates through her abdomen, back and legs.

Still, a nagging voice in the back of Mia's mind often urges her to return to work sooner than her doctor advises, or to simply push through the discomfort with painkillers and a hot water bottle.

While she believes that falling ill is unrelated to one's work ethic and appreciates the understanding of her supervisors, she cannot help but worry that her colleagues may feel frustrated taking over her workload in her absence, or even suspect she is shirking responsibility.

"It's strangely almost more of a pressure I put on myself, very possibly due to an embedded culture in Singapore where taking MCs too often seems to be frowned upon or, at worst, a sign of weakness," she said.

Mia's dilemma is not alien to many here. Second-guessing oneself when taking sick leave has long been an unwelcome side effect of Singapore's efficiency-driven work culture.

Lim, an infotech executive who wanted to be known only by his surname, said he often feels guilty and anxious when taking time off when he is ill.

Despite some supportive managers, he noted, there are still others that view medical certificates as paid leave with excuses, implying that employees are taking advantage of the system.

"The reality is that medical leave is not a luxury, but a necessity. When we are unwell, we need time to recover and seek medical attention," said Lim.

"Taking medical leave is not about taking a break or avoiding work; it's about prioritising our health and well-being."

This awareness of the importance of both mental and physical health is growing, prompting more employees today to take medical leave as needed, said Linda Teo, country manager of ManpowerGroup Singapore.

Sick leave 'abuse' and the reality

Human resources (HR) experts whom The Straits Times spoke to noted that it is uncommon for employees to view sick leave entitlement — which typically is 14 days of paid outpatient leave — as something to be fully "consumed".

Jessica Zhang, senior vice-president for Asia-Pacific at HR company ADP, says most employees do not use up all their sick leave.

The rise of work-from-home arrangements has also blurred the lines between when employees choose to work through minor illnesses and when they should take the necessary rest, the experts said.

Still, concerns persist on the employers' end. Teo said that while employers recognise medical leave is an entitlement, there may still be an unspoken preference for employees to use it sparingly in order to minimise operational disruptions and prevent abuse.

She added that responsible use of outpatient leave is also often seen as a reflection of professional integrity and respect for workplace norms.

For Tan, a 26-year-old marketing executive who wanted to be known only by her surname, sick leave is meant to extend beyond physical illness to include recovering from mental burnout, and no one should feel guilty about maximising the benefit.

She also has no qualms about "faking the MC".

"Just be responsible in terms of taking it on days where you don't have important meetings or deadlines to meet, (so that you don't) end up troubling your colleague to do your tasks," she said.

She added that those who feign illness to gain a sick day off should avoid posting about it online, or telling their colleagues about it.

On the other side of the equation is Eswary.

As someone who is afraid to trouble others, the 62-year-old school administrator, who declined to give her full name, rarely takes sick leave and will continue working as long as her illness is not contagious. As a result, Eswary finds it frustrating when her colleagues max out their sick leave.

"If you take care of yourself, I don't think you can get MCs to that extent (of using up the total number of days) unless you're really unwell," she said, adding that she has often had to cover for absent colleagues.

At her previous workplaces, she encountered colleagues who would openly share that they used sick leave for non-health-related matters — leaving others to pick up the slack.

"You must understand the situation at the workplace. The others have to cover for you, and all of us are also very busy," she said.

It is a conundrum that call centre manager Angie knows all too well. The 52-year-old, who asked to be identified only by her first name, manages a team of 17 and admitted that she sometimes questions the legitimacy of some medical leave certificates.

"Sometimes, I wonder if they are really sick. If they have a doctor's medical certificate, I just have to accept it... but some things, like diarrhoea, you really wouldn't know," she said.

While only one or two of her employees tend to use up their full entitlement, the impact on operations is still felt, she said.

"If you are managing a team, you look at the big picture. For some staff, especially junior ones, they are more concerned about themselves," she said.

Can employers link sick leave and performance?

Angie said most of her other employees are mindful about the number of sick days they take and try to stay healthy, likely because they know frequent absences could hurt their bonuses.

While not a direct component of performance appraisals, Angie said she does consider the frequency of absences when assessing productivity.

This ensures fairness "because those who come regularly are obviously more productive than those who frequently are not around", she explained, adding that her team's work requires being on-site.

HR experts, however, caution against directly equating frequent absences with poor work performance.

While tracking medical leave could deter abuse and promote attendance, paid sick leave is a statutory entitlement, and employees should not be penalised for using it legitimately, said Teo.

Instead, performance should be evaluated based on the quality and outcomes of one's work, rather than the amount of medical leave taken.

If not, employees may be discouraged from taking the time off they genuinely need, leading to presenteeism — showing up for work while ill — burnout and long-term health issues, Teo warned.

Zhang echoed this sentiment, and highlighted ADP's People at Work 2025 Report, which found that 47 per cent of Singapore employees already feel closely monitored at work.

Zhang said that linking medical leave to performance evaluations could heighten stress and distrust in a workplace, which in turn could negatively affect productivity.

"Employers must prioritise psychological safety and foster a culture of trust, ensuring that employees feel that they are supported, not penalised for taking medical leave," she said.

Open conversations key to reducing stigma

To quell employers' concerns over entitlement abuse and ease the guilt employees may feel when taking legitimate sick leave, transparent communication between both parties is essential in preventing misunderstandings, HR experts tell ST.

Employees with chronic conditions, in particular, are encouraged to prioritise their well-being while keeping an open line of communication with their supervisors.

Said ManpowerGroup's Teo: "It may be helpful for them to proactively discuss their condition and leave requirements, providing necessary medical documentation to ensure their employer is aware of their needs and is able to work together with them to provide appropriate support."

Employees can also discuss a separate work arrangement with their supervisors, said Zhang of ADP.

Flexible work arrangements, for instance, can help employees manage their conditions without relying heavily on paid sick leave.

It is also useful for employees to demonstrate how their medical condition does not significantly impact their work, using examples where relevant, Teo advised.

On the other hand, managers are encouraged to approach such conversations with empathy and professionalism, focusing on understanding instead of judging.

Building a trusting environment is essential to fostering a healthy work culture, said Zhang.

"Employees (should) feel able to take medical leave to address their health needs and seek alternative work solutions as necessary, especially for those managing chronic conditions," she said.

Teo said managers must also ensure that these discussions do not create the impression that taking leave for legitimate health reasons could negatively affect an employee's standing in the company or career progression. "The intent should be to offer support, not to question the validity of the leave."

She added that keeping a brief, factual record of such discussions is a sound HR practice, and helps to ensure consistency, transparency and fairness — especially when follow-up actions or arrangements are involved.

This article was first published in The Straits Times. Permission required for reproduction.