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Maximizing Outcomes
     Employers who are willing to make a few policy concessions for CFS patients will often, in return, receive a superior work product. The CFS patient tends to be someone with high performance standards and a strong sense of commitment and responsibility. Thus, the typical CFS patient is not someone who will fail to come through when there is an important deadline or organizational event. Bending the rules a bit for the CFS patient can often mean the difference between good job performance and less desirable outcomes.
     During a crisis, when an important unforseen task needs to be accomplished within a short amount of time, the CFS patient will usually push very hard, knowing the extra pressure will exacerbate the symptoms. After the task is completed, the CFS patient can often use a few hours to get some rest. This is especially true when the CFS patient has worked overtime to meet the deadline. If the task is completed in the middle of the day, sending the CFS patient home to rest will enable the employee to rejuvenate and be productive the following day. Keeping the CFS patient in the office afterwards to comply with the rules is a sure way to bring the CFS patient into a relapse. Thus, the employee might be at the office physically, but a series of "off days" might follow.
     Most companies have a limited amount of break time and sick time. Policies governing lunch periods and absences are certainly necessary for the clarification of expectations and avoidance of abuses. CFS patients, however, are not the type of employees who will deliberately abuse corporate policies. Allowing them to exceed the limits for lunch breaks and sick days, when necessary, will enable CFS patients to be more productive and efficient employees. When given the opportunity to regain their energy, CFS patients will come through with a high quality work product.
     Occupational stress is an integral part of the job for any responsible employee. Reducing extrinsic sources of stress for the CFS patient will enable the CFS patient to expend more energy on tasks directly relevant to a good job performance. Thus, not requiring a CFS patient to serve on extracurricular committees or engage in company-sponsored social activities will facilitate that employee's regrouping of energy to expend on job-related tasks and maximize the quality of the work product. Requiring the CFS patient to attend the company picnic, participate on the company softball team, or take part in Toastmasters will only deplete that employee of energy needed for job performance.

Disability
     When the CFS patient is unable to perform at a satisfactory level, disability is a viable option. Disability benefits allow the CFS patient to financially survive, although at a much lower standard of living than that to which the employee has become accustomed. Disability programs often allow the employer to replace the CFS patient with an employee who is in better health than the CFS patient. If the healthier employee is more efficient and productive than the CFS patient, taking advantage of organizational disability benefits is advantageous to both the employee and employer. However, if the healthier employee performs below the level of the CFS patient, then utilizing organizational disability benefits might not be such a good decision especially in situations where the CFS patient wants to continue working.
     If the disability benefits are provided by an insurance carrier, every time an employee receives such benefits the probability increases that the insurance premiums of the company will be raised. If the disability benefits are provided by a self-insured plan, every disability payment becomes a loss to the company. Additionally, the standard of living for the CFS patient collecting disability benefits usually declines to an uncomfortable level. Therefore, the option of utilizing disability benefits should only be considered when the performance of the CFS patient has truly degenerated to an unsatisfactory level.

Termination
     Abrupt termination of a CFS patient might bring about what might initially seem to be a quick solution to the problem of what to do with that employee. However, many states require specific procedures, including verbal and written warnings, as well as a probationary period, before the termination is effectuated. In at-will states, such procedures might not be required under state statutes, but might be required by the policies of the organization, especially if the organization is a large company operating in several states, or on a national or international level. Thus, if pre-termination procedures are not properly followed, legal repercussions costly to the organization could result.
     A perceptive CFS patient will often apply for disability benefits when pre-termination procedures are commenced. Thus, it would make sense to confront the CFS patient with a performance problem and look for ways to accommodate that employee so that job performance can be maximized.

Recognizing the CFS Patient
     Chronic Fatigue Syndrome has been documented in individuals in all age groups, from early childhood to the golden years. However, the typical CFS patient is an intelligent, educated, ambitious, hard-working young adult.
     In the work place, the CFS patient is often a "star performer" with a good track record, who just seems to have a higher-than-usual number of what appear to be "off days," where productivity declines. In actuality, the "off days" are days when the patient is more symptomatic.
     Because of the stigma attached to CFS, the employee is often afraid to discuss the illness with the employer. On an "off day," while the CFS patient is desperately trying to hide the symptoms, as well as the reduced productivity, management might be wondering what it would take to get that employee to maintain a more steady pattern of peak performance. Ironically, just when effective communication is needed between management and the afflicted employee, the communication breaks down, and there is suspicion about motives on both sides.

Making the Final Decision
     When a decision needs to be made regarding whether a CFS patient should be allowed to continue working with a few minor accommodations provided by the employer, whether that employee shold be encouraged to apply for disability benefits, or whether that employee should be terminated, it is important to consider that employee's overall contribution to the company. If the employee with CFS is particularly talented, it might be difficult to find a replacement that will perform comparably, although the replacement might be healthier. Replacing an employee is a very expensive endeavor. Allowing the CFS patient to continue working, when possible, will provide maximum outcomes for both the organization and the employee. Additionally, allowing the CFS patient to continue working, when possible, is often congruent with the Americans with Disabilities Act of 1990.
     During tight economic times, there is usually an employer's market, where jobs might be scarce and companies might have more leverage in placing high demands on personnel and finding replacements if those demands are not met. However, when economies recover and full employment is approached, good personnel become more difficult to find. In this situation, talented potential employees in good health might refuse employment with companies that have acquired a reputation as being less than compassionate in their treatment of personnel who develop medical problems. Thus, focusing on the short-term, without any consideration of the long-term, generally does not maximize outcomes for companies.
     Today's CFS patient who is forced out of a company could recover and turn out to be tomorrow's "star performer" for the next company. The ultimate decision on the handling of the CFS patient, however, rests with the employer.

Economic Considerations
     Replacing an employee is generally a costly process. Recruitment fees are very expensive. Training a new employee entails numerous costs, some of which are more discernable, and some of which are less visible. More discernable costs of training a new employee would include expenses directly related to the teaching process, such as the price of attending an educational seminar. Less visible costs would include the price of errors made by an individual learning the job. Thus, when possible, it would make good business sense to accommodate a CFS patient who knows the job and has sound judgement that has been developed through on-the-job experience.

Brochure authored by Ruth Robin, M.S., president,
Chronic Fatigue Syndrome Society of Illinois
P.O. Box 10139, Chicago, IL 60610

Brochure prepared by the
National Chronic Fatigue Syndrome and Fibromyalgia Association

* Brochure information may be reproduced provided sources are credited *