Should medical leave affect how we're evaluated at work?

I remember this conversation I had almost a decade ago with a dedicated employee. She was a high performer across most counts, but had maxed out her medical leave entitlements for the year.

The company appraisal form includes a section on attendance and punctuality, in which she scored three out of five.

The employee was upset and felt the score was unfair, given that medical leave was an entitlement.

I explained that while this was true, her frequent absences had resulted in work delays, and that her colleagues had to rush to meet critical deadlines while juggling their own work.

"I didn't mean to fall sick," she protested.

I agreed, but given her attendance record, I kept that score while highlighting other ways she had contributed positively. For me, showing up mattered.

One could argue that medical leave is an entitlement, even when all days are used. Such was a sentiment that recently surfaced in a Singapore Reddit forum discussion on fully utilising sick leave.

The comments section was largely supportive of maximising its usage. Some saw it as an entitlement, while others felt that it had to be reflected in the performance appraisal.

The overuse of MCs (medical certificates) was a concern for business owners, who felt that medical leave was far too accessible via teleconsultations, with one consultation reportedly lasting just 43 seconds.

The question is not so much whether medical leave is an entitlement. Under the Ministry of Manpower's regulation, it is, once certain criteria are satisfied.  

The more pressing question is this: Should absenteeism be a factor in performance reviews?

WHY SHOWING UP MATTERS

As a business owner, I can see both sides of the argument.

On the one hand, my view on showing up has been strongly shaped by my football coach's words: "The best ability is availability."

In the context of team sports – let's stick with football as our example – having a full squad of players available for selection is critical for success in competitions.

Talented players who frequently get injured can put extra pressure on their teammates and sometimes, it's better to have someone more available step in and fill the spot.

The English football team I support, Arsenal, recently had to let go of a player called Takehiro Tomiyasu. He was incredibly talented, but his injury record meant that they needed someone more consistently available.

While the workplace isn't quite like elite sports, the same principles apply.

Having a team member on medical leave frequently can really have an impact on the flow of work and how tasks are shared. It can delay project timelines and often, someone has to step in to fill the gaps. 

Just as it wasn't Tomiyasu's fault that he was injured, employees need to take a leave of absence sometimes. 

However, claiming that availability doesn't influence performance evaluations at all would be misleading, or at the very least, overly simplistic. 

WHEN I WAS THE ONE TAKING SICK LEAVE 

That's not to say I didn't understand where my employee was coming from. I had been on the other side before, way before I became a boss.

On the very first day of my very first job in corporate communications, I couldn't make it because I was hit with severe food poisoning from some bad nasi padang. 

I ended up taking three days of sick leave as advised by my doctor.

I should have been resting fully on those three days. But my bowel discomfort was only matched by the worry of how my absence would be perceived by my colleagues and bosses.

I briefly considered powering through, but quickly realised I would likely spend more time in the restroom than at my desk.

To my boss' credit, she welcomed me on my belated Day One with care and consideration, and even bought me a probiotic drink.

My colleagues were kind, too, and any vaguely accusatory looks I thought I saw were probably just my insecurities projecting.

Had my colleagues or managers been less understanding, returning to work would have been far more uncomfortable than it needed to be.

Of course, I did try to make up for my less-than-perfect first impressions by making my presence felt. 

Not just the performative, speak-up-during-meetings type of visibility, but actively taking ownership over work that I missed out on that was passed on to my colleagues.

PERFORMANCE IS MORE THAN JUST ATTENDANCE 

To be clear, attendance is not the deciding factor in how I evaluate performance. It is a data point, and just one of many.

Another staff member of mine, Gek, had to be excused for close to two months due to a medical situation.

She later maxed out her medical leave and hospital leave entitlements for the year, and the team took on her workload in the interim.

When she came back, fully recovered, she dove right back into the work and was her usual productive self. 

She even seemed to have returned with renewed passion for the work, and took it to another level in terms of complexity and attention to detail.

Much as her attendance record reflected her long absence, she scored very well on all other fronts in her year-end appraisal. Gek ended up with a very high overall grade.

In some ways, Gek's case reminded me of the conversation I had with that other employee almost a decade ago. And if anything, it affirmed the way I think about attendance and performance today.

Performance, to me, is the sum total of availability, effort and ability. If you really show up when you show up, that has to matter, too.

TRUST IS THE FOUNDATION

In the end, trust still matters. Employers should give the benefit of the doubt when employees are absent, and employees should reciprocate by not exploiting that trust.

As an employer, if you can't trust your team, the problem runs deeper than "skiving".

It may be a signal to look into your hiring practices, your company culture and workload distribution. 

Are you hiring the right person for the role? Is the workload distribution feasible and fair? Is the company culture conducive to a frictionless work experience?

As employees, we need to be honest with ourselves and understand that work requires commitment, and that showing up and contributing matter.

We can take time off when we need to, but certain frequently recurring behaviours may require self-reflection and adjustment, especially on the occasions where the circumstances are entirely within our control.

That is why absenteeism is a signal, not a final judgment.

A day or two of medical leave taken, even if inconveniently timed, say very little about an employee.

Sustained patterns, especially when paired with declining output, missed deadlines or disengagement, say far more.

Performance reviews should therefore assess contribution holistically: the quality of work delivered, reliability over time, and how workers show up when they are present. 

A workplace that reduces trust to a spreadsheet will lose good people, but one that ignores absenteeism altogether will struggle to function. 

The balance, as with most things, comes down to common sense, context and fairness.

Kelvin Kao is the co-owner of a creative agency.