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It’s more common than you might think. A Zippia survey reports that 52% of respondents have faked sickness to get out of work.

What's the best way to notify your manager that you won't be in? Whether or not you are actually sick, the process of calling in sick to work is the same. You want to let your boss know as soon as possible and keep the explanation of your illness (or fake illness) very brief.

Will you get paid for the time you are out sick? That depends. The Fair Labor Standards Act (FLSA) does not require payment for time not worked, including sick leave, personal leave, and vacation time. However, many employers provide paid sick days to employees.

A Bureau of Labor Statistics Survey reported that 78% of civilian employees had access to paid sick leave in 2020. The BLS survey reports that, on average, workers in private industry received eight days of sick leave per year. Most workers with paid sick leave receive a set number of days per year. About a third have access to leave through a consolidated bank of paid time off.

It's important to choose the right method for contacting your boss. While people use the phrase “call in sick,” you might not actually need to call your boss on the phone. Instead, you might send an email, a letter, or even a text. The Zippia survey reports that 53% of workers call in sick on the phone, while only 25% send a text.

Regardless of why you’re calling in to work, observe a few guidelines:

Let your boss know about your illness as soon as possible. If you are feeling ill the night before and know you won’t make it in to work, you can send your boss a message that evening. Otherwise, tell your boss first thing in the morning.

Don’t go into great detail about your illness. No one wants to hear the specifics of your flu or stomach virus. Keep your message short and to the point.

Consider sending another message to your department or team, letting them know that you will be absent. This is especially important if you are working on a team project or have a deadline coming up. Make sure they know you will not be available that day.

Let your employer (and perhaps your team members) know if you will be able to respond to email or do any other work while you are home sick. If you are too sick to check your email, say so.

Similarly, let your boss and your team know if there is any information they will need to know for that day. For example, you might tell your boss, “I am sorry I am missing the staff-wide meeting at 2 p.m., but Ellen should have all of the data from our department.” This kind of information will keep others from struggling in your absence.

Make sure you know whether your company requires you to complete any sort of follow-up documentation. For example, some companies require employees to bring a doctor’s note to prove that they were ill.

What if you don’t feel sick, but you simply need a day to relax and recharge? Your best option is to take a personal day. However, not all employers offer these. For example, many retail and other hourly jobs do not offer personal days.

In that case, one option is to call in sick. If you do so, you will still want to follow all the same steps. However, there are a few more things you will want to keep in mind.

It is easier to convince your boss you are really sick when you pick a random workday. However, if you pick a Monday or Friday (or a day right before or after a holiday), your boss might be suspicious that you are simply trying to extend your weekend. If you don’t care which day you take off, you might try a day between Tuesday and Thursday.

Unless you are confident you can lie to your boss over the phone, you might want to avoid a direct conversation with him or her. Instead, send an email or text (whatever is preferable to your employer). If your boss would prefer a phone call, try calling early in the morning—it will increase your chance of being able to leave a voicemail instead of speaking to your boss directly.

You always want to keep a call about your absence brief, but in this case, keep it very brief. The more you talk, the more you will be lying, and the better your chances are of getting caught.

Simply say you are calling in sick. If your boss asks more questions, answer them, but keep your answers short. There are some excuses that work better than others when you need a day off from work, or when you need to leave work early.

Don’t tell any of your coworkers that you were not really sick. Even if they are your friends, you run the risk that one of them might tell your boss (on purpose or even by accident).

A lot of employees have gotten caught faking an illness due to social media. They say they are sick, then they post a picture of their day at the beach, and their boss finds out. Avoid posting anything about your fun day off on social media. This will prevent any information from getting back to your boss.

After taking a day off work, you always want to work hard to catch up on any projects. This is especially the case if you took a secret personal day. Show your boss that you are still a committed team member who can work hard and get the job done.

Early identification can significantly affect outcomes. Diagnosis is made by pairing the clinical presentation with appropriate imaging. Imaging can include x-rays, radionuclide bone scanning, and magnetic resonance imaging (MRI). The use of imaging in the context of the patient’s symptoms can help guide appropriate treatment.

Plain-film radiography is typically obtained in two planes, utilizing both anterior-posterior and frog-leg lateral films. Radiographs may show subchondral radiolucency, which is the pathognomonic “crescent sign,” indicating subchondral collapse. Uptake of Technetium-99m can show a “donut sign,” which is a ring of increased uptake around a cold center. This sign represents accelerated bone turnover at the demarcation, where reactive bone meets the dead bone. MRI is the gold standard of diagnosis for osteonecrosis. Though both X-rays and radionuclide scans can aid in the diagnosis, neither is as sensitive as MRI; nor as reliable at showing radiographic evidence early in disease progression. MRI can visualize bone marrow changes, size/location of the necrotic area, the effect on acetabular cartilage, depth of collapse, etc.; which are incredibly helpful when ascertaining a patient’s prognosis and formulating a plan of care.

Once obtaining adequate imaging, the extent of necrosis can be classified. While multiple staging systems exist, the most commonly used is the Steinberg staging system. It identifies seven stages as follows:

Steinberg staging system

Stage   Features

0          Normal radiograph, bone scan, and MRI

I          Normal radiograph, abnormal bone scan and or magnetic resonance imaging

IA Mild (involves less than 15% of the femoral head).

IB Moderate (involves 15% to 30% of the femoral head)

IC Severe (involves over 30% of the femoral head)

II         Cystic and sclerotic change of the femoral head

IIA Mild (involves less than 15% of the femoral head)

IIB Moderate (involves 15% to 30% of the femoral head)

IIC Severe (involves more than than 30% of the femoral head)

III       Subchondral collapse (crescent sign) without flattening of the femoral head

IIIA Mild (involves under 15% of the femoral head)

IIIB Moderate (involves 15% to 30% of the femoral head)

IIIC Severe (involves over 30% of the femoral head)

IV        Flattening of the femoral head/femoral head collapse

IVA Mild (involves under 15% of the femoral head)

IVB Moderate (involves 15% to 30% of the femoral head)

IVC Severe (involves greater than 30% of the femoral head)

V         Joint space narrowing and/or acetabular changes

VA Mild

VB Moderate

VC Severe

VI        Advanced degenerative joint disease

A laboratory workup should be done to help rule out other causes of hip pain as well as to assess for comorbid factors in patients with suspected osteonecrosis. A workup may include a complete blood count (CBC), lipid panel, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-nuclear antibody (ANA), anti-cyclic citrullinated peptide (anti-CCP), and hemoglobin electrophoresis. Elevated ANA and/or RF would indicate an active autoimmune process but are non-specific. Both ESR and CRP are elevated by inflammatory processes but are also non-specific. Elevated anti-CCP antibodies are specific for rheumatoid arthritis, while hemoglobin electrophoresis showing HbS with a low concentration of HbF would indicate sickle cell disease. A CBC showing evidence of normocytic or microcytic anemia with an elevated reticulocyte count would also be consistent with a diagnosis of sickle cell disease. Rheumatoid arthritis and sickle cell disease are two conditions that can precipitate the development of osteonecrosis in the femoral head and can cause hip pain even without osteonecrosis.

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