my employee keeps groaning in pain — and won’t get medical treatment

A reader writes:

One of my employees, “X,” has been having pains that I won’t specify for the sake of anonymity. Many months ago, X went to their doctor, who then referred them to a specialist. It turns out that the condition is degenerative but can be managed quite successfully through physical therapy and occasional steroid injections. I happily made several doctor-recommended accommodations and alterations to X’s workspace, at the expense of the company, to make the eight hours a day they spend here more manageable.

X went to several weeks of physical therapy sessions — which I gladly gave “off the record” time off for — but then stopped going because it turns out physical therapy “isn’t really enjoyable for me” (is it for anyone?). X also stopped doing the steroid injections, which they said was because they hated waiting so long each time they had to go in. The employee had shown marked improvement and relief during the time they were being treated. All this is info that was very openly volunteered to me.

Now, for the past three months since they stopped treatment, everyone in our office — myself included — has been subjected to near-constant moans and groans of pain. The worst is in the morning when X shuffles in and groans with every step taken. I’ve had several coworkers come to me with complaints from others in the office saying that the constant groaning is taking a toll on people’s sanity. I would probably count myself among them, with X sitting just outside my office. I can just about guarantee that the decision to stop treatment is not financially related because I know a) how much they make and b) that they are on our 100% funded health insurance plan, which covers physical therapy at 100% after a very low deductible (like one visit’s worth) and these occasional steroid treatment office visits at 100% and a $20 copay.

Side note: Yes our insurance is awesome; our provider said we have assembled the best corporate plan in the entire state.

Anyway, I literally do not know how to handle such a sensitive issue with the employee. We are only a company of 80 people so we have no HR person to give us guidance on this. X is A+ across the board in performance; no other issues. But at the end of the day, X’s decision to not take care of their very treatable medical needs is subjecting the entire company to misery and lots of eye-rolling. I just can’t say that to them for obvious reasons.

If this were a friend or a relative, you’d probably tell the person, “Look, you’re in horrible pain! You were doing really well when you were in treatment. You’ve got to go back — for yourself, but also for the rest of us because it’s awful to see you this way.”

But when it’s an employee and there’s a medical condition involved, you’ve got to make sure you’re following the law. I took this question to Jon Hyman, who writes the incredibly useful Ohio Employer Law Blog and is the author of The Employer Bill of Rights: A Manager’s Guide to Workplace Law. Here’s what Jon said:

This is indeed a tricky one.

I’m not sure I’d tell the employee to stop moaning in pain. I’d be concerned that the employee might perceive it as harassment and it will create more problems than it fixes. (Note from Alison: Later in our conversation, Jon expanded on this: “I’d be worried if it wasn’t presented exactly right, the employer could end up offending her and creating an issue that need not be created. I don’t think it’s a winning claim, but it’s definitely a possibility.”)

I wonder if the right way to handle this is to place the employee on a leave of absence (paid or unpaid) and require a fitness for duty before she is permitted to return back to work. If she’s groaning in pain all day long, I’d argue that she has a medical issue that is limiting her ability to perform her job, and require her doctor to certify her as fit to work. Clearly something is wrong if she can’t even sit at a desk without groaning all day. If a medical provider declares her fit to return to work, however, the employer’s hands might be tied. Is there an office they can put her in away from the crowd to muffle the sound? That’s one possible solution, as long as she doesn’t object (and I’m not sure who would object to a private office). Indeed, if they don’t want to go the LOA/doctor’s note route, maybe a “Congratulations, a private office just became available and we’ve decided to offer it to you first.” Gloss it up as a reward, and not as a means to hide her away so no one has to hear her moan all day long.

I worry a bit that requiring a leave of absence could seem heavy-handed (although I see the legal wisdom in it), but I like Jon’s solution of moving her in a way that doesn’t seem like punishment.

Sometimes we get letters here from people who are frustrated that a colleague’s illness seems to be self-inflicted or, as in this case, that they’re not taking what seem like obvious steps to help themselves. People often feel those situations are different than what the law was set up to protect. But legally, they’re not — as an employer there are limits to what you can do, and you’re always safer treating the situation as a disability, period, not as “a disability you could fix if you did X/didn’t do Y/sought different treatment/tried harder/ate better/etc.” It’s also good to remember that as obvious as the facts might seem from the outside, it’s possible there’s more to it that they’ve chosen not to share with you. That doesn’t mean that’s the case here — maybe it is, maybe it isn’t — but proceeding as if it is will likely guide you in the right direction, and probably ease some of your aggravation too.

{ 441 comments… read them below }

  1. Stephanie*

    No one likes physical therapy.

    Someone who did four months of it earlier this year

    But yeah, seems like the potential LOA might be the easiest avenue?

    1. Mathilde*

      But if the condition is degenerative, it is only going to get worse, so isn’t it just a short term solution ?

      1. Lucette Kensack*

        The purpose of the leave isn’t to allow the employee to heal passively; it’s to require that she be declared fit for work by a doctor before she can return, so she isn’t sitting at work moaning in pain all day (which is terrible for her and annoying for her coworkers).

        1. Mathilde*

          I understand that.
          But I would worry that if the employee already stopped after some time, it will only get worse (and the physical therapy will be even more painful / taxing). So even with a leave of absence, I would worry that the employee would be cleared for work and after some time, will stop the treatment again.

          But of course, there doesn’t seem to be a ideal solution here.

          1. ChimericalOne*

            My hope would be that giving the employee a leave of absence would enable them to get into a good routine with their physical therapy, maybe find a better physical therapist or a closer one if that’s been one of the barriers for them, and then, once they had gotten into a groove (without having to worry about doing their work at the same time), that they’d be better able to keep it up.
            It also sounds like the LOA route would let the employee know that their employer has some expectations that they’re currently not meeting, which might get them to take their treatment more seriously. (The OP should expect the employee to push back on a LOA, however, and needs to be prepared to say, “We need a note from your doctor that you’re cleared to return to work” and hold firm to it.)
            If the LOA fails, finding a more isolated / private place for the employee to work is the next best thing.

        2. Quill*

          I’d personally be worried, were I the employee, that a LOA after disclosing a degenerative illness could turn into a sort of soft layoff – “We need you certified fit to work” could easily spiral into difficulties with insurance, etc.

          1. ChimericalOne*

            OP says their insurance is excellent. I don’t think a LOA would negatively impact that — other types of leave do not (e.g., maternity leave, short-term disability).

          2. Wintermute*

            It sort of can be, because if you can’t be certified fit to work, you will probably end up on permanent disability. But that’s why such things exist, because some people CAN’T work.

      2. Emily Spinach*

        Often with things like arthritis, PT can improve pain and function even though the fact of bone-on-bone rubbing isn’t fixable. So your condition might still deteriorate over time but your day to day life will be better longer with treatment. (That’s my understanding from a close family member who is a PT.)

        1. SheLooksFamiliar*

          That’s my take, too. I have an arthritic shoulder that will never be totally pain free. Cortisone injections can only do so much, and for only so long. My range of motion will never be what it used to be. I have to think about how I lift weights, reach for things, etc.

          I hated PT because it could be painful and tiring, but I can function so much better now. PT, daily exercises, and topicals like Blue Emu make a big difference. I hope OP’s employee finds a solution and relief for her own peace and health.

        2. Mia*

          This. My mom and grandmother both have a degenerative autoimmune condition and PT is basically a pain management tool for them. The disease is still there, but the types of PT exercises they do are designed to make living with it less painful.

      3. fposte*

        I think it’s still reasonable to have a short-term solution that will help both the employee and employer evolve their view of the future. And “degenerative” here may sound more alarming than it really is, in that if it’s something orthopedic, “degenerative” generally means the wear and tear that’s common with aging, not an accelerated process that’s going to change radically in the next year. (Obviously I don’t know what the employee has, but what’s being described could fit the pattern.)

      4. Anonymous For This*

        It depends on the condition, but physical therapy may affect the expected course of the condition or help reduce pain.

        I have a degenerative condition (it’s not, like, fatal, it’s just something that kind of sucks). I know I’m going to continue losing physical ability. However, things like doctor-approved exercise and physical therapy do help me. Avoiding these activities causes deconditioning.

        1. Anonymous For This*

          Note: I am only talking about myself here. I am not a doctor and I have no opinion on what other people with degenerative conditions should or should not do!! :)

      5. Princess Consuela Banana Hammock*

        Even if it’s degenerative, PT can be an essential long-term “quality of life” treatment solution. Sometimes it’s the difference between being able to walk, or being completely crippled by pain or degeneration.

        But I agree with Stephanie that no one really loves PT. It’s usually painful and frustrating and goes so much slower than any of us would wish. But you do it because the alternative (chronic pain, permanent injury, loss of limb or joint use) is so much worse.

        1. fposte*

          I think what you’re saying is likelier to be true with post-injury rehab PT, though; for chronic stuff it’s more variable. I’ve done a lot of PT that hasn’t been worth the effort, and I’ve done some PT that’s actively made things worse. (I have a friend with EDS who has had *really* bad PT experiences.) And in a situation where you’re talking not about a goal of recovery but a goal of minimizing loss, it’s hard to know whether you’re getting good PT or not, because there’s no “getting back to” result to measure by.

          1. Pommette!*

            My experience has been similar to yours. I’ve done unpleasant but useful therapy in the wake of an injury, so I know that the discomfort and effort can be worth it. But I’ve also done painful and time consuming therapy to deal with a chronic pain condition. After about a year of getting worse, I quit. I’m still getting worse, but more slowly. Quitting was worth it: I get an extra half hour to spend on activities I enjoy every day, and I’m not exacerbating the pain. It’s gotten easier to live with, and ignore,the pain, now that I’m not investing so much time thinking about and managing it.

            Physical therapy can help some people with degenerative diseases maintain function and reduce pain, but it definitely doesn’t work for everyone. Even when it does work, it involves tradeoffs (time, money, attention, energy). The OP’s employee is best situated to decide whether the tradeoffs are worth it for them.

      6. Not Rebee*

        Often, physical therapy is meant to help train and recruit muscles to assist where there is a problem. It’s possible that with additional strength from supporting muscles the situation will reduce on it’s own and even though it may increase over time it will at the very least be helped greatly for now. Additionally, with physical therapy it’s likely that, even at the worst point of pain, it will be significantly better than it would be without physical therapy. So just because it’s going to get worse no matter what doesn’t mean that the PT won’t be helpful or worth the time.

        Of course, PT is not for forever. Most of it is learning the exercises for a short time under supervision, working out any kinks, making some increased demands once there has been an improvement at the original exercises, and then sending the patient home to continue those exercise as daily tools for management of the condition. Admittedly, it’s not fun and it’s very time consuming to do the homework, it’s still always worth the time.

        Signed, someone who broke her shoulder and did 4 months of PT and 2 years later still does some of the homework when things are stiff and is considering going back because she still can’t zip up a dress unassisted.

        1. Elizabeth West*

          I have shoulder impingement syndrome and the PT only works when I do it. I’ve been doing it for frickin ever. It is a direct result of all the box slinging I did at OldExjob.

          I feel bad for the OP’s coworker, but they are not going to get better unless they actually do the treatment.

          1. Dahlia*

            They’re… probably not going to get better period. That’s kind of how it goes with chronic illness. You don’t “get better” from it.

                1. Devil Fish*

                  Point taken, but OP said in the letter that the situation seemed to improve when X was getting treatment and then got worse again after X quit treatment.

                  None of us are saying X will be doing backflips across the office, just maybe they’ll be less miserable at work and get enough pain management tools to not be compelled to be quite so distracting about it. (I realize I sound like a dick but I would be super embarrassed if I was literally moaning all day at work; X needs to sort their life out because that’s no way to live.)

                2. Pommette!*

                  (Replying to Devil Fish):
                  The decreased pain probably had more to do with corticosteroid injections (which act quickly, and often well) than with physical therapy (which usually takes a while to take effect, since it involves retraining/building muscles). Injections come with side effects that may not be sustainable long-term, and apparently were inconvenient to obtain.

                  It may be that the employee has sorted out his or her life, and that the best-case scenario is one that involves intense chronic pain.

            1. Pommette!*

              This is true, and an important point!

              People who haven’t had to deal with chronic, degenerative diseases often have an inflated sense of the effectiveness of physical therapy and other interventions. Physical therapy won’t actually help every person, or every condition. Or it might help a bit, but not enough to justify the hassle and expense. The person dealing with chronic pain is entitled to decide whether a given treatment is worth it for them.

      7. dealing with dragons*

        so with these, generally your PT is to strengthen the surrounding muscles to help support the joint. for me, I have a labrum tear in my shoulder so I did PT to strengthen my shoulder and back so that they could take over the load that my labrum would normally bear. It won’t ever heal on its own, but it can definitely get worse on its own.

    2. Emily Spinach*

      I liked mine! But it does vary a lot for everyone, depending on your injury, your PT, and other factors. I really liked feeling like there were concrete things I could do to improve my pain and get back to the activities I like (even though it took way longer than I wanted it to!).

      1. AvonLady Barksdale*

        I liked mine because I loved the people in the office. But some days? Hoo boy, that was a slog. But there was definitely a sense of, “Do this and you will feel much better much more quickly, and if you do this you’re much less likely to injure yourself again.”

      2. Stephanie*

        Fair enough! It definitely helped me, but yeah…it was definitely frustrating at times. And I agree it took waaaaay longer than I would have thought to get back to my activities.

      3. Salamander*

        I liked mine for the same reasons. If I followed the plan, I saw very concrete results faster than I expected. It was uncomfortable, challenging, and sometimes painful. But I did feel like it was something I could actively do to speed healing along.

      4. Risha*

        I liked mine, too! I’m not really an exercise person and everyone says PT is awful so I expected to hate it, but I was pleasantly surprised when the exercise portion was very effective and yet never once pushed me to the point of pain. And the stretching and massage parts were great, and they got me my own TENS unit through my insurance after I responded extremely well to it.

      5. Princess Consuela Banana Hammock*

        I loved my therapist, and in retrospect am very grateful to have had PT. But I didn’t really love the PT itself. :)

      6. Ms Jackie*

        I liked mine too. Now given, mine was when I was 14 and was prescribed going into a hot tub 3 times a week :) It was a hard life. (I broken my ankle really badly and required screws – once the cast came off and i could walk, the ligaments needed to be loosened hence the hot tub along with icy hot+ exercises at night)

    3. Falling Diphthong*

      That was my first thought: X, every physical therapist’s office I’ve been to had posters playing into the idea that it’s torture, and that when the therapist says “Okay now do 10 more” you experience a deep loathing for them. One PT had me use a device (kind of like a ski you hold at arm’s length and wiggle) that he told me a previous client nicknamed “the humiliator” and boy was that accurate.

      But… X didn’t write in. And I bow to Jon re what an employer is allowed to tell an employee about how deeply frustrating everyone around them finds their refusal to get treatment, no matter how much it would make sense to speak up to a friend or family member.

    4. I edit everything*

      I liked mine, too, but that’s because it was ultrasound therapy–it was like a warm, smooth massage that exactly targeted my pain. But I do get that for most people, it’s hard work.

      1. KimberlyInOhio*

        I had months of PT after a rotator cuff repair, and called them my PT brutes. :-) I cried every session as I built my shoulder muscles back up, until the first time I didn’t cry. I asked if they were going easy on me that day, and they said, “No, you’re getting better.” It wasn’t the last time I cried, but it got so much easier once I could see progress. I can understand being demoralized by pain but if they know it helps them but choose not to do it, it doesn’t make a lot of sense, especially if it’s not costing them money or time off. If you’re out of paid time off, I can see not going. If your insurance covers not much of anything, I can see not being able to go. But that doesn’t sound like the issue here.

        1. JJ Bittenbinder*

          Oh, wow, someone like me! I had a shoulder and neck issue about 10 years ago that was super painful. i cried every GD PT session and swore that it wasn’t working…until my second-to-last week, when something magical happened.

          I will admit, I didn’t go to PT the last time it was prescribed to me, but that’s because I have a $15/session copay and I just couldn’t afford it. OP’s coworker has no such excuse.

      2. Quill*

        Oh gosh, a hot towel baking my feet and the ankle massage was the best part of PT.

        Seriously considering trying to befriend a masseuse for the future. “I’ll cook for you if you will help me with the feet.”

    5. Sales Geek*

      You know the old saying, of course: If you don’t hate your physical therapist they’re not doing their job.

    6. Blue*

      Also…X is already in pain. It’s not like skipping PT allows them to avoid pain – but it does keep them from the possibility of longer-term relief. That’s probably what I’d find most frustrating about this, as an observer.

      1. Mayati*

        Respectfully, though, it’s not your pain, and not your decision to make. Sometimes the pain of PT is worse than the pain of just dealing with the condition without treatment, and even if it’s not, it’s not really for us to say whether X is being unwise.

        1. Kate2*

          Yeah but x wasn’t moaning aloud in pain for 8 hours every day when they were doing PT. So they probably stopped for exactly the reasons they said.

          1. Marmaduke*

            PT was very hard to me because of my PTSD related to a doctor’s misconduct. I’m not saying that is a likely explanation for X’s decision, but there can sometimes be deeply personal non-pain-related complications with PT that people might not be ready to disclose.

      2. PVR*

        But most PT programs are not meant to last forever—you are not seeing a personal trainer. After awhile, they will put together a plan to follow at home, and in fact that is the goal. They don’t need to watch you every time you do your exercises. Also sometimes physical therapy can make things worse. There can be a lot of trial and error in finding which exercises are effective and which exercises aggravate the condition. Without knowing more, I don’t think we can effectively judge whether PT is helpful to the coworker or not. And frankly, neither can the OP. And in regards to steroid injections, is there not a limit to how many/how often you can get them?

    7. sparty07*

      I enjoyed my last physical therapy for my ankle. It actually had more “fun” activities than a normal one. Balancing while throwing a 3 pound ball against a trampoline, using the slide board, etc. Much better than my rotator cuff when lifting 1 and 2 pound weights hurt.

    8. dealing with dragons*

      I actually enjoyed it, but it’s cause I ripped a muscle so I got like 20 minutes of “free” leg massage once a week lol

    9. Yellow Flags Are Real*

      I just wanted to point out that there is increasing understanding of the impact of mental health/psychosocial factors on pain. My familiarity about it comes via low back pain, but I’m sure it applies elsewhere. Cognitive behavioral therapy/mindfullness therapies are increasingly recommended for low back pain and doctors/physical therapists are increasingly recommended to screen for yellow flags (psychosocial factors) that are likely to impact improvement. Some people are fearful of activity or have avoidance issues or a tendency to catastrophize. Think of it this way: two people have the same pain and go through PT. At the end of it, they regain 90% of their pre-injury abilities but still have some pain. Person A, who has good mental health and has been given a realistic idea of what kind of improvement they should expect, is glad they did physical therapy because they went from 50% functional to 90. Person B has a tendency to catastrophize and all they know is that even though they did physical therapy, they are still in pain and so it didn’t work, it will never work, and they are likely to never be without pain so why bother trying. Now, there is nothing OP can do about this — the employee’s doctor should see about recommending them for mental health, not the OP — but maybe it would help to reframe how the OP thinks about the employee. That is, the employee is not lazy or cheap, but may have an underlying mental health issue that prevents them from doing those therapies. (Disclaimer: OP is (probably) not a doctor, so should not diagnose employee with mental health issues, but understanding that there can be a mental health component to the pain might help the OP change how they view employees with pain who seem unwilling to seek treatment.)

      1. fposte*

        There’s also some good work on how pain actually changes the brain. I’m pretty impressed that this employee is still functioning at a high level.

        1. Not So NewReader*

          I am impressed also. If I were having half that pain I probably would not be at work.

    10. shartheheretic*

      I’m currently in my second month of therapy after breaking my arm near the shoulder (and having surgery on it). at first, I really hated it but now I look forward to going twice a week because I can see the improvement on an almost daily basis. when I first started in physical therapy, I jokingly referred to my physical therapist as the sadist. But now I jokingly say I would marry him if he wasn’t already taken. LOL

    11. bluephone*

      And there are a lot of things that no one likes doing but we do them because it’s part of being a person/adult. (I mean, most people don’t like *having* to work even if they liked their actual job–but they like having a secure roof over their heads, food on the table, etc. so it’s off to work we go. I doubt anyone *likes* getting a flu shot but we do it because the benefits outweigh the discomfort or pain).

      1. ComfortablyNumb*

        But no one other than the employee in pain, including the letter writer, actually knows whether the benefits outweigh the discomfort/pain. The letter writer is assuming quite a lot, and the commenters here know even less about this person’s condition.

        I have a spinal cord injury and do physical therapy to help me not lose what mobility I still have – without physio, my paralysed muscles will degenerate more quickly than without it. I also have nerve pain, which can be debilitating (luckily in my case it’s fairly brief periods of shocks). My physio work does nothing for that nerve pain and never will. I could take one of several different drugs, but the mind fog they cause means it’s not worth it because I wouldn’t be able to work full-time like I do now.

        The choices that people with disabilities, chronic illnesses and chronic pain are hard and NO ONE is better equipped to make those judgements than the person and their doctors. Period.

    12. Eukomos*

      When I had a really painful back injury I LOVED physical therapy, which gave me an inital positive feeling towards it, but I must admit that once I was no longer in excruciating pain and just had to include long boring planks into my workout routine for the rest of forever, I got less fond of it. Still, a damn sight better than being in pain.

    13. Boobookitty*

      I had physiotherapy after a dentist dislocated my jaw by forcing it open with his hands when he decided I hadn’t opened wide enough. Once the freezing wore off and I realized I could not put my upper and lower jaw together to do things like, oh, eat solid food… I actually loved my short-term physical therapy because I got better after each treatment and could finally put my lips together again.

      1. Robbenmel*

        Oh, Boobookitty…I gasped aloud at this description. I am so sorry you went through that! *shudder*

    14. Alison*

      Oh man I did about 6 months of PT following a bad ankle fracture and ORIF surgery and I freaking LOVED it. I would have kept going for several months more but my physical therapist basically told me I was good and done. It was painful yes but I enjoyed every bit of it. I had to do a 2nd very short stint the following year after I had my hardware removed and still loved it. I don’t know if it was my competitiveness (had to show I was improving every session) or what but it was definitely my jam.

  2. Mathilde*

    I hope you have the possiblity to confine this person and the noise they make to a private office, because is you can’t, this really is an awful situation for the other employees. At best, the constant moaning is really disruptive, and at worst, it can take a toll to their mental health.

    I am sympathetic to this person’s plight, but you have done all you can for her.

    And as a side note, I am always surprised by people who make public the fact that they are not getting treatment beacause it is inconvenient, and then are very vocal with their pain. What do they except to achieve by telling this ?

    1. Sick of Workplace Bullshit*

      Maybe money really is an issue, or X really doesn’t want to face they have a degenerative disease and they are in denial about how bad the issue really is. Either way, it sucks for their co-workers.

        1. lemon*

          Yep. Or maybe the steroids are causing uncomfortable side effects they don’t feel comfortable sharing with other.

          1. Not a Blossom*

            I mean, that could all be the truth, but X framed it as PT isn’t enjoyable and I don’t want the steroids because I don’t like waiting in the office. The OP is taking her at her word, and I imagine those reasons make it much more frustrating.

            To Mathilde’s point, I wonder the same thing. Were I X, I wouldn’t have shared my reasons. I would have just said that PT and steroids weren’t working out or I’d decided to discontinue them or something neutral.

            1. Devil Fish*

              I’ve known enough people who didn’t like to wait for things or do things that weren’t immediately enjoyable to think there’s a better than even chance X was telling the truth and there’s not more to it. People in general tend to assume that they’re making rational, reasonable decisions that others will agree with. Obviously they stopped getting the steroid shots: it takes too long. Obviously they quit going to PT: it wasn’t sparking joy. Obviously they quit treatment: what choice did they have?

              I kind of wish a coworker had written in instead of the manager, since a peer could lean on the work friendship and really try to Socratic method X into getting back in to treatment more than would be appropriate for a manager to do.

          2. RUKiddingMe*

            Yup. They could not pay me enough to get any kind of steroid no matter how much it’s supposed to help. BTDT…. it didn’t.

        2. Feather*

          Yeeeeah even when it is literally the only thing to do it can in fact be really tough to face how *much* discomfort physio can involve in certain cases. and it’s nigh impossible to know even if you technically have the same condition.

          It can take a long time to come to terms with the fact that regular specific sessions of deep discomfort and pain are actually a trade-off for decreasing and limiting loss of function and pervasive all-the-time pain in the rest of your life.

      1. Lucy Preston*

        Yeah. I wouldn’t be so quick to write-off a money issue either. We have several employees who make roughly the same amount. However, while most seem good with the amount, others seem to need much more to make ends meet. It’s not good to assume everyone’s finances are the same.
        Plus, we had one employee who was recommended for PT, went for a few weeks, but then stopped going because the $30 copay was too much of a strain on the budget.

        1. Librarianne*

          This. Your take-home pay is such an incomplete picture of your finances! My work friend and I make roughly the same amount, but I have student loan debt and she doesn’t. She owns a condo and buys 1st class plane tickets; I’m considering cutting down my own PT to every other week because the $30 copay + recent rent increase is pushing me too close to my financial edge for comfort.

        2. MistOrMister*

          That money comment bothered me. You never know what bills someone has. So maybe they make what looks like a salary anyone could live off of and easily afford PT copays and whatnot, but you don’t see the 100k medical bill they have from when they were unemployed. Or the 10k a month they owe to the nursing home to care for their parent. Or any other number of things! Unless someone is making an obscene amount of money you really never can assume. I had a number of appointments for specialists years ago and that $20 copay got old really fast.

      2. BethDH*

        I was initially pretty unsympathetic towards X and I still really feel for the coworkers, but I also started thinking about the times I’ve been in physical and/or mental pain (they so often go together). Really small things or tiny sources of additional stress can be insurmountable— think about people who are depressed and can’t bring themselves to shower even if they know it will make them feel better. In that context, I could see how X really might find the small-to-us additional annoyance of PT or waiting for shots insurmountable.

    2. Falling Diphthong*

      Your last paragraph is an interesting question about the human condition.

      Though illnesses aside, we see people who will assert things like “I’m miserable in my job” and when other people suggest finding another one launch into the 30 incredibly flimsy reasons that they could not possibly consider a different job.

      1. NW Mossy*

        It is so, so, so common for people to fall into this line of thinking in most major aspects of life – relationships, career, and health are just a few examples.

        In my experience, I tend to see it most in people who, for reasons of their own, have a low capacity to absorb change. Even when change is positive, it takes work to engage in creating a new reality and adapting to it once it arrives. That can be a lot for some people, and it’s harder still if you’re feeling powerless generally or have a propensity to worry and/or loss aversion (where the fear of losing something feels much worse that the buzz of gaining something).

        I know when I’ve found myself in that line of thinking, I understand objectively that I’m being defeatist in a way that’s not supported by evidence. Sometimes that helps with snapping out of it, but sometimes it just takes me some time to process through a complicated web of feelings about a bunch of seemingly unrelated things to get to a place where I feel like I can make the leap of faith required to make a big change.

        1. Falling Diphthong*

          That’s a good point–it’s in the major aspects of one’s life, where the payoff for change is so obvious to outside observers, that people most display this attitude.

    3. Slow Gin Lizz*

      I keep thinking that maybe the person has a fear of needles or hates them. That would explain the cessation of the steroid injections. And PT can be quite difficult, and I imagine moreso for a degenerative condition that causes a lot of pain. And maybe the person really hates being active.

      But I agree it is really hard to be sympathetic to a person who has all the means to help themselves minimize their pain even slightly but refuses to do so. It’s a mystery to me why anyone wouldn’t try to help themselves.

      Of course, then I get around to thinking that the person did actually try, and maybe they didn’t actually feel much better. Evidence would suggest that they did but maybe they didn’t realize it at the time.

      OP, could you maybe ask nicely, in a friendly non-managerial way, how the person is feeling and maybe get a read on the situation? You don’t have to offer any advice (it seems like there are legal issues why you shouldn’t), but maybe even just asking would nudge the person into some kind of realization. It’s a long shot, but maybe worth a try.

      1. TechWorker*

        I don’t think the OP should go anywhere near guessing at their colleagues mental state, fwiw, but I can think of a whole bunch of reasons why sick or injured people don’t always ‘help themselves’.

        Sometimes you don’t see improvement and it gets you down… (I do wonder if the colleagues view of how successful the treatment was is different to LW – maybe they started getting worse before they stopped the treatment? Or maybe it had side effects not discussed?) – sometimes, if your mental health is not good, you don’t have the energy to look after yourself. Sometimes, the cost to your mental health of obeying ‘doctors orders’ is, in that moment at least, higher than the cost to your physical health of ignoring them.

        I don’t mean those as excuses – but maybe some explanation?

        1. Slow Gin Lizz*

          Right, that was the point of my post as well, explanations, not excuses. Just something to get the OP thinking that there might be some reasons why X stopped the treatments.

      2. Jennifer Thneed*

        > I get around to thinking that the person did actually try, and maybe they didn’t actually feel much better. Evidence would suggest that they did but maybe they didn’t realize it at the time.

        I’ve seen this in action, where a person’s outer behavior showed positive changes but their inner experience was still so unpleasant that they didn’t really feel any improvement. They could acknowledge the objective signs of improvement but still felt so crappy it was like they were dealing in negative numbers, and -1 is still less than zero, even if it’s not -15.

        But if someone is in so much pain that they are literally moaning all the time, I really have to wonder how good their work is. Because when I’m in that kind of pain, I do not have any ability to concentrate on anything sustained. OP says that their employee is still doing good work, so clearly I am not their employee :)

    4. AvonLady Barksdale*

      I know a person who does not pursue treatments she should, does not make lifestyle changes that would help her, does not do what the doctors tell her, and tells everyone how much pain she is in all. the. time. I’m convinced it’s purely for attention and I simply stopped responding.

      Actually, I know two people. One of whom is an elderly relative, and I just tell her on a regular basis that if she went back to PT she wouldn’t be so uncomfortable, then she tells me I’m ridiculous, then I tell her that if she would at least try it might help, then she tells me I’m wrong, then I remind her this was the recommendation of all of her doctors, etc.. Around and around. But she’s a relative and I can roll my eyes at her– can’t do that with a work colleague, at least not to her face.

      1. anon and OT*

        Yup, this is my mom, who I see for a couple of days once or twice a year (plus weekly phone calls). Arthritis in knees, didn’t do recommended exercise after knee replacements because it didn’t feel good. Sighs and moans loudly every time she has to get up out of her chair, but won’t ask for help like an adult – just snaps at my dad for “watching her struggle,” but snaps equally if he does proactively try to help because it’s never right/good enough.

        She’s done this kind of thing since I was child. When I took a health psychology class in college, a textbook section on people “performing” pain behaviors as a form of manipulation, and how you needed to not reward it, came as a revelation.

        My dad tolerates it. I won’t – if he goes first, she won’t be living with me, which will probably come as a great shock and betrayal to her.

        1. Never Been There, Never Done That*

          Same situation for me growing up too. I think it was the only way my mom thought she could ask for something, you know, if she was ill. I learned to tune it out when I could and respond when necessary. I rarely talk to my mom on the phone and see her maybe once a year for the same reason. I had to put up with it then but I don’t now.

        2. Devil Fish*

          You’re not obligated to take her in and don’t let anyone else tell you otherwise: you need to do what’s best for you. Just because she’s successfully relied on the sunk cost fallacy to keep her marriage together this whole time doesn’t give her any right to expect it to work on you. Fuck that noise.

    5. smoke tree*

      It seems likely to me that they’re trying to downplay the whole situation, either because they’re not comfortable sharing the details or because they’re trying to minimize it for themselves. They may not even really be aware of the groaning if they do it all the time. Agreed that it’s not a great situation for anyone, and hopefully they’re able to find a way to effective treatment.

    6. PVR*

      But to be fair—steroid injections are typically limited—you can’t just get them all the time. Because while they can help certain conditions, too much/too often can increase the likelihood of tendon tears or degradation. Additionally I would not be surprised if some people have negative reactions and not able to get the shots. It’s entirely possible this person has exhausted the number of injections they can have for a certain length of time. Also when you go to PT, typically over time, they will create an at home program for you and then “graduate” you out of the program or see you much less frequently. And while you may improve quite rapidly in the beginning it levels off over time. It’s entirely possible that PT has ended and that the coworker can no longer receive steroid injections for a specified period of time and is therefore stuck in no mans land without relief. The coworker may not feel like going into all the details as to why they are no longer getting the injections (side effects/have to wait a period of time) Or going to PT any longer nor should they have to. Sometimes it’s a lot easier to make up an excuse than have to share additional details that aren’t actually anyone’s business.

  3. staceyizme*

    I think the leave of absence/ fitness for duty makes the most sense. It’s a means of protecting privacy and choices in treatment while also acknowledging the impact.

    1. Mama Bear*

      And a leave of absence might morph into an early retirement, work from home, or going out on disability, depending on the situation. I know folks who quit PT and now they can’t do some things for themselves. It’s frustrating on a friend/relative level, too, when someone quits PT early. I hope a solution can be found for all involved.

  4. Amber Rose*

    I sympathize, really. I enjoy physio more or less, but the necessity of giving up hours of my time to sit in a room alternating stretching with torture is not ideal, and sitting around for ages in a doctor’s office for a three second shot really sucks also. The combination of the two has sent me into full blown panic attacks. It really. Sucks.

    But also? Being in pain 24/7 really sucks. Like, way worse. And I have to wonder if it isn’t impacting this employee’s work, since constant pain is not the greatest thing for attention to detail or just like, communicating with people.

    If that is the case (and I’m making a guess, obvs) then a LOA is in the best interests of literally everyone. And if it’s not the case, I’m still leaning towards it being the best option you have. It seems pretty unfortunate to offer rewards to people based on your desire to isolate them, so the private office things kinda rubs me the wrong way.

    1. Vermonter*

      Without knowing X’s condition, we can’t be sure that physio does enough. I do PT, but I’m still in pain 24/7 – always will be. I also have a degenerative condition; eventually, PT won’t help enough to make it worth the hassle. “PT isn’t fun” might be a way of saying “PT stopped helping.”

      1. That Girl From Quinn's House*

        Her therapist might not be a good match for her, either. I’ve done physical therapy a few times and I’ve had really different results from the individual therapists. The first one I went to helped well enough, the second was no help, and the third gave me a full detailed diagnosis that explained what the first and second therapists missed in their assessment and why those earlier exercises didn’t work.

        If your therapist assesses your issue incorrectly, or fails to explain the purpose of the exercises and what result you should be seeing and when, in terms that you can understand, PT won’t be successful.

      2. JSPA*

        This! Having someone without a medical background decide whether “two days/weeks of more extreme pain from X treatment balanced by one better day/week” is an acceptable trade-off.

        If the treatment, say, makes it hard for the employee to get out of bed and go to the bathroom without falling over at night, then it may not be a reasonable tradeoff for “that same daily pain.”

        I’m in PT now (it’s easy, they won’t bounce up the level, and I can do essentially all the same exercises at home with a band and a ball, so I may not go back as often as they want to schedule me.)

        While there, I hear the other people talking to their therapists. Some of whom don’t seem to process “this isn’t doing what I need it to do” as well as others do. When someone born in 1935 tells you, “I hurt badly enough after the last session that I cramped and fell on the way to the bathroom that night,” maybe that’s important information.

      3. PVR*

        Exactly. I doubt the coworker is giving the full story, nor should they have to. There is probably a lot going on. I’ve been in PT several times and “kicked out” twice—once because my therapist thought my issues were beyond what she could do to help and the other time they were like, well this is as much as we can help you. PT is not a cure all and effectiveness can really vary based on the therapist themselves.

    2. Bostonian*

      Yeah, the private office thing rubs me the wrong way, too. But that’s because I know it would go over like a lead balloon in my office. Someone outside a certain rank getting an office would cause a lot of resentment and questions. Even if they knew it was related to a medical issue (which they probably shouldn’t know anyway), there would still be resentment.

      1. Devil Fish*

        I got the impression from the letter that at least the nearby coworkers are at least somewhat aware that it’s a medical issue, since OP said a lot of information had been volunteered to them and the nearby coworkers are complaining about the noise so it makes sense some information might have been shared with them as well.

        Besides the resentment and questions, I don’t like the idea of a private office because it’s not guaranteed to work out the way OP wants: what if X leaves the door open all the time, or gets lonely and comes out to chat with their peers, or refuses the office because it’s too isolated or otherwise unsuitable to their workflow? Lawyers are going to give advice based on limiting potential legal liability but this seemed like horrible advice.

  5. Nonprofit Lady*

    Can we talk about this: “We are only a company of 80 people so we have no HR person to give us guidance on this.”

    This is mind blowing to me that as a company of 80 people, there is no HR person and OP seems to find this totally normal? Is it normal? I’ve always worked in small companies and nonprofits, and they always had HR people (even if they also served other functions).

    1. Ann O'Nemity*

      I’m curious about this too. At what point does a company typically hire an HR person? I would guess 50+ people.

    2. Ask a Manager* Post author

      Often with small companies the “HR person” isn’t really an HR person. They handle onboarding paperwork and benefits questions in addition to some other job, but they don’t have the skills/training to handle this kind of thing. That said, once you hit 50 people and FMLA starts being in effect (it’s not with fewer than 50 employees), most companies find they need someone with at least some HR training.

      1. Edianter*

        I used to work for a multi-national company with about 400 employees, and my boss (the CEO) refused to even consider having an HR team. That meant I, as a manager, had to do all of my own recruiting, hiring, onboarding, and all of my team’s HR “stuff” IN ADDITION to my regular job as a manager.

        At one point, I was responsible for a team of 75 people who were based in 4 different countries. The HR side of my job took about 65% of my time and left me very little energy to actually manage the people/projects I had.

        Now, when I job search, and people ask me what kind of company I want to work for, one of my only stipulations is that it has to be big enough to have HR.

        1. De Minimis*

          Amen to that. At my previous job HR duties were split up between the finance employees, which included me. We only had about 30-35 employees during my time there, but we were based in California [which always means more compliance duties than a lot of other states] and we also had employees elsewhere. We had a company that helped us with some of the bigger stuff, but for me the HR duties were the death of a thousand cuts. I’m glad I had the experience, but I don’t think I want to do it again.

    3. sunny-dee*

      They could be outsourcing a lot of the daily HR tasks, so they have HR services, just not an HR person. Or (depending on the company) they may be a local office for a larger organization — my company has a local office with about 150 people assigned to it (about 60 who actually work in the office), but all the HR functions are in the main office in another state.

      1. Anon for this*

        Same here. Our company employs several hundred people. Our HR is in our main office and they are awful.

        At a previous employer we were 25-30 employees and our HR person was as Alison described above. They wore many, many hats. And they were exceptional.

        Quantity does not equal quality.

    4. Clever Name*

      I was surprised at this as well. My company has approximately 75 FTE and we have a dedicated HR person. (She wears a few different hats, of course, but HR is one of her primary functions)

    5. Emily K*

      I actually had the same reaction – I would think by around the hire of the 50th employee or reaching $500K in annual revenue you’d have created a dedicated HR role, since those are the thresholds at which various federal labor laws generally kick in which are complex enough you wouldn’t want to be winging it or relying on outsourced/contract HR (because in my experience when a company contracts/outsources HR and IT services, because you pay a pretty penny per hour of the contractor’s time, there’s a strong impetus from on high to contain costs by using the contractors as little as possible).

      1. OP*


        You would think so, but unfortunately that is one point that our principals refuse to budge on. They don’t want it being an “HR controlled” workplace because they like the “big family” atmosphere and want people to feel like they can speak openly and freely. Yes, it still felt somewhat like a big family when we were at 50 people when I got hired 5 years ago, and self-policing of issues worked for the most part.

        But the “family” feeling naturally wore off as we grew and we brought in younger generations with different personalities and worldviews. Some comments that some of the “old guard” make that got dismissed with a chuckle five years ago now raise eyebrows from some of the younger employees, even in a couple of cases prompting an employee to come to me in confidence about how they thought a comment was inappropriate. In which case I had to address it with the offending employee or the offending employee’s boss and remind them that times are (or have…a long time ago) changing. One of my employees who left for another job told me in her exit interview that she frequently overheard calls between some of our older sales staff and their customers/suppliers and found the conversations to be disgusting. Speaking of exit interviews, just about everyone in our company thinks I invented the concept.

        We have 80 employees and bring in around $200M in revenue annually. There’s no reason we shouldn’t have a couple of HR generalists on payroll.

        1. Zombeyonce*

          Sounds like the lack of an HR person/team is going to severely limit the number of younger people willing to stay on after being hired. Eventually you’ll just have a company full of people stuck in their ways (read: fine with saying offensive and gross things) and your company will get a reputation for it being pretty unpleasant to work for. I hope you can continue to bring this up to the principals as it’s going to affect the bottom line and reputation.

          If younger people are part of your customer demographic, your company’s outlook is going to be even worse as its reputation declines, which it will since Glassdoor exists and this kind of stuff is brought up all the time on sites like Reddit. I’ve read a lot of articles about people under 40 making purchasing decisions not just on quality of a product, but on the reputation of a company and how it treats its workers. I’ve seen this firsthand with my peers, too.

        2. Jadelyn*

          “HR controlled”…are they aware that to an outside observer, referring to the mere fact of having HR on staff as “being HR controlled” basically translates to “We want to be able to keep treating our employees like crap, violating labor laws whenever we feel like it, making racist/sexist/etc comments, basing our hiring decisions on prejudice, and not have anyone call us out on it”? They’re going to develop a seriously ugly reputation, if they haven’t already, as being a “good old boys club” environment to work.

          On the other hand, as badly as you need real HR, I’d deeply pity the poor HR person who gets brought into such a resistant, even hostile environment as far as their view of HR.

          1. Polaris*

            Yup, this is just a different framing of “complaining about the PC police because I can’t be as openly racist/sexist/etc as I used to be”.

        3. Batgirl*

          HR Controlled? I’m sure some people think a HR professional is some kind of wand bearing sheriff, part of a greater force who can force people in the wilderness to follow the law. Fact of the matter is, the HR rep is still just an employee and control remains with the boss. All the HR person can do to effect change is give advice on law and best practices. If the boss decides it isn’t the culture they want there’s didley squat the HR person can do. Some people are so scared of change they don’t even want the information.

    6. E*

      If nothing else, you can often outsource the HR role to a company with several HR generalists so that you get good advice on these sort of situations without the full time salary cost possibly.

      1. Dr. Jayus*

        Yeah, this seemed wild to me too! I work for a nonprofit with about 30 full-time staff and we have a dedicated HR Director.

        1. Edith*

          Yes! I specifically came to the comments to see if that stuck out to anyone else. I work at a nonprofit that has half the staff OP’s office does, and we have an HR person. And not just a person who handles onboarding like Alison mentioned, but an actual trained professional HR person. And we regularly seek the input from an outside HR consultant. 80 people is a huge office to not have such an essential department.

        2. De Minimis*

          I know with my former employer they used to have more employees and an actual HR department, then there were big layoffs and it was decided to forego full-time HR, and that’s the way they carried on from then on.

          Current employer is a non-profit healthcare org with about 180 employees, and a dedicated HR team, but I think they’re still relatively new and trying to get established.

    7. OP*

      Having worked for a Fortune 500 company, as well as a company smaller (about 50 people and had an actual accredited HR person) than my current employer, which is the employer in question, I assure you I find nothing normal about the fact that our company of 80 people does not have a legitimate HR person. In our case, we have a single person whose 4th or 5th responsibility is the administrative side of HR: on-boarding paperwork, printing and issuing badges, benefits enrollment, etc. That individual has no formal training or education in human resources and would not be qualified to provide counseling or guidance on a topic such as this.

      As someone in senior management, I have raised the concern with our corporate leadership before; a few people at my level have echoed the concern, but most of my fellow managers don’t see an issue with it, nor do the actual principals of the company. Most of the officers of the company have been here since the company employed only 8 people 50 years ago. Most of the other senior managers have been here for 20+ years and started here right out of college. I’m one of very few with experience outside of the company. Essentially, no one has known any different, and “if it isn’t broken, don’t fix it.” However, I’d argue that at 80 employees, naturally things are definitely starting to break and we need to fix it.

      1. OhNo*

        As mercenary as it feels to say this when that’s not the first consideration – is there any chance you can use this situation as an example or excuse to push for more HR support? It may not work, but this seems like it qualifies as a pretty good example of “broken” and in need of fixing.

        1. Jadelyn*

          This. And if they’re not going to be receptive to adding FTE to give you a dedicated HR professional on staff, maybe you could get them to contract with an HR services company at least?

      2. NW Mossy*

        And your situation with your employee is a prime example of the things that start to break – not knowing how to navigate effectively through a thorny employee/employer relations issue.

        When the company is very small (i.e., just the principals and a few early hires), you avoid a lot of these issues simply through being on the right side of statistical luck. But as the organization grows and matures, that luck starts to run out and the rare situations start to affect you. Ideally, an organization would recognize when it reaches the tipping point where seat-of-the-pants, sidebar-to-the-main-mission management needs to become professionalized management, but that often doesn’t happen proactively.

        Sadly, what tends to happen is that some moment of crisis occurs that makes it impossible to do anything other than professionalize the management. It might be a health crisis for a principal, a lawsuit, the merger/acquisition of the company, or a thousand other things, but something WILL happen that forces their hand. There’s simply no way to keep an organization of many people running smoothly without the infrastructure of strong, capable management.

    8. Oaktree*

      I worked in a nonprofit that had about 60 people, and we didn’t have an HR department either. My onboarding was handled by my manager/head of department. It’s not really that crazy an idea.

    9. MsMaryMary*

      I work with small to mid-sized employers and I’d say it’s pretty common for organizations with under 100 employees not to have a dedicated HR person. Someone is doing recruiting, hiring, firing, payroll, benefits, etc, but either many people are splitting the work or the office manager/someone in accounting is the de facto HR person. I’ve seen organizations of 200-300 people who don’t have an actual HR person or team.

      Some organizations don’t want to add a position that doesn’t directly contribute to revenue. This happens a lot at places that are very sales or tech focused. Sometimes leadership knows they’re not really operating on the up-and-up and don’t want someone to tell them no. Some people have never worked a good HR person and don’t understand what the organization is missing.

      And to Alison’s point, the organizations without HR often have regulatory issues. FMLA is a big one, so is COBRA administration. Wage and hours issues, sometimes even tax issues. It’s a gamble, but until a regulator actually catches them a lot of organizations don’t know they’re running a risk or don’t care.

    10. mlem*

      My company has 3500 people and no HR, by active choice of the company founders/higher-ups. All those functions are handled by individual management chains and function-specific departments (Payroll, Personnel, Recruiting, Training & Ed, etc.).

        1. mlem*

          There’s a “staff ombudsman” who mostly just quotes the handbook; all harassment reports are specifically supposed to go either to that person or to any Manager or Director or Vice President. Other conflicts are supposed to go up one’s management chain (presumably skipping anyone who *is* the conflict) or could theoretically go to the ombudsman (who, I’m guessing, would find a higher-up to handle the issue).

      1. MsMaryMary*

        How is Personnel different from HR? I think of it as an old-fashioned term for what is now HR.

        1. mlem*

          I tried to use generic terms and got that one wrong. We do actually “Benefits”, which is kind of a part of “Accounting”, I think? Like, a subset of traditional HR stuff. But there’s no one central group for “HR issues” the way other companies take for granted.

          1. Jadelyn*

            So…it sounds like they’ve basically parted HR out into being a bunch of separate sub-departments, and they just don’t want to call it HR. Most places of that size would have dedicated payroll people, dedicated benefits, dedicated recruiting – often with independent reporting lines that roll up to a single head over the wider HR function. It just sounds like they’ve skipped that last step. AKA they have HR, they just don’t want to call it HR.

    11. bonkerballs*

      Speaking as one of those “HR people who serve other functions in a small non-profit” we often have no idea of anything past the basics of HR and on-boarding and really no desire to learn more seeing as I’m an accountant not HR. It blows.

      But, yeah I would think 80 people would need an actual HR person. And honestly, before that I was surprised at referring to an 80 person company as small. But then I usually work for places with 25 or less employees.

    12. JJ Bittenbinder*

      I was coming to comment on the same thing! 80 people seems more than enough to justify an HR person.

  6. EPLawyer*

    This is one of those no-win situations. You can’t force the employee to take treatment. Physical therapy is a PITA. It is mentally and physically draining. The steroid injections have side effects that the employee might not want. Or they realize it’s degenerative and only going to get worse. So why bother fighting it?

    On the other hand, it’s not fair to everyone else to listen to the moaning and groaning all day. It is definitely a distraction if you are trying to focus and get work done. Yet another strike against open office plans.

    I’m not sure there is a way to move the person without it seeming a punishment. Framing it as “it’s easier for you to relax in a private office” might be about it. But then, do you give a private office to everyone who needs accomodation?

    Just a tough one all around.

    1. Sarah N.*

      Is there any way you could offer the employee work-from-home at least some of the time? Obviously this depends a LOT on their job functions, but it seems like it would definitely solve the “listening to groaning” all day issue, and possibly would also help them out by eliminating their commute, letting them take a break easily when symptoms are particularly bad, and potentially even make getting to doctor’s appointments easier if they do decide to get back into treatment.

      1. OhNo*

        That was my first thought, too. Working from home would probably be more helpful, since it would eliminate the moaning-and-groaning from the office entirely, rather than just muffling it. Besides, there is every chance that even if you give X a private office, they might decide to just keep the door open all the time, and then you haven’t really changed anything.

        I would not suggest a leave of absence, just because I don’t think that the employer gets to decide what constitutes “fit for work”. I could be completely off base, but it seems very weird that an employer would have the ability to say “you’re on leave until you can make it through the day without moaning every five seconds”. If the leave would be dependent on just generally being fit for work, well… if X’s productivity hasn’t dropped off, it sounds like they already are fit, just unpleasant to be around.

        1. JB*

          Work from home would also improve whatever pain they were in, which is certainly exacerbated by getting into/out of a car or navigating public transit. Regardless of other factors, that would help them at least somewhat.

        2. Friendly Comp Manager*

          But the suggestion was that a doctor determine fit for work, the company is just mandating that this type of review take place.

      2. A*

        This was my first thought as well. Seems like it would benefit all parties, and be the next natural step for ADA accommodation.

    2. OP*

      No one in our company below the senior management level gets a private office. Employee X is a specialist with no managerial duty. It would likely be immediately obvious what the motives were if we were to give X a private office.

      Regarding work-from-home, first a sidenote: the company is starting to warm to the idea in general. When I started here five years ago, it was completely out of the question for any reason, no excuses what so ever. Most employees weren’t even allowed to have laptops because our corporate leadership didn’t even want it to come up as a suggestion.

      Over the years, myself and some others have gradually changed the culture to be more accepting of the idea. When I had a bad case of bacterial pneumonia a couple of years ago, I convinced our leadership to allow me to work from home rather than take time off because “would you rather pay me to not do anything or pay me to do my job, just from somewhere else?” When I returned the following week, they were absolutely amazed that I had successfully managed a team of 6 people juggling several projects, without a single ball being dropped (and in fact with greater efficiency), all from my basement 19 miles away. In our company’s previous culture, “work from home” was synonymous with “tell everyone you’re working but go fishing instead.” That has definitely changed. Last fall, our company took the very big step of granting an employee that had a 3-week recovery from major surgery the opportunity to work from home rather than take disability. They were once again astonished by the results; the employee didn’t have to take short-term disability and the accounting department wasn’t burdened by the temporary loss of one of their clerks. Win-win. That said, there’s still a lot of grumbling when the idea comes up, and the company really prefers people to be at the office if they’re physically able.

      So, it’s probably do-able in the short term, I just don’t know if the head shed will be OK with it for the long term, especially after they approved about $1500 worth of new furniture and other ergonomics improvements to better accommodate employee X here at the office.

      1. MoopySwarpet*

        Even a couple days a week might significantly improve the situation, though. Then the physical accommodations would still get used, and (maybe) the noise level will decrease.

      2. Bibliovore*

        Work from home is a terrific solution if can happen. I have a chronic pain, degenerative condition and I am sure that the noises that come out of me are not that pleasant but fortunately I have a private office and can work from home.
        I know it is painful to hear the sudden gasps. (pain is shockingly surprising at times) and the oy, oy , oys.
        This is an A+ worker.
        On the other front- I am assuming you know about PT and steroid shots because the employee has told you. Here to say if I did all the PT prescribed it would be a full time job. Steroid shots don’t always work, are painful, and have side effects. Just because you and others have found these things helpful doesn’t mean that X does.

        So, stop discussing Xs health period. Any disturbing noises can be discussed as just that. The involuntary noises that you make in response to pain are disturbing and distracting to your coworkers. How can we help?

        Perhaps there is a more comfortable way for the employee to work that is outside the box. I CANNOT sit in a chair or at a desk. It is simply not an option. I have a couch in my office. I do all my work on a laptop, sitting tucked into the corner of a couch that is padded with memory foam. My arms are supported by buckwheat pillows. I have a freezer full of cold packs at work and at home. I have a rice filled neck thing that heats in the microwave.

        Chronic pain needs coordinated care. Perhaps a recommendation to a clinic from EAP.
        It is hard for people to understand that work is the thing that keeps me sane and distracted from my crappy body.

      3. Devil Fish*

        Could you potentially clear the work from home idea with the powers that be and then discuss it with X as a thing they could take advantage of for a limited number of days per week as part of their accommodations?

        You might even consider a brief tangent into the idea that X could talk with their doctors to explore further treatment options and try to find something that might work better for them, because the company is supportive of them doing whatever they need to do to effectively manage their condition. I know it was shot down by the lawyer because of potential legal liability if it’s mishandled but as someone with a chronic illness, it can mean so much to hear that your manager is on your side and doesn’t resent your accommodations.

  7. Amethystmoon*

    Is it possible that the real reason is copay cost, and not the other things the employee mentioned? Not everyone likes to advertise when they’re struggling financially. Insurance companies need to step up and stop pushing cost onto patients.

    1. Lucette Kensack*

      Well, there doesn’t seem to be a co-pay for the physical therapy (it’s covered at 100% after a deductible that’s approximately the cost of one session; presumably the employee is past that deductible since she’s been to more than one session).

      But yes — cost can always be a factor, even just a psychological one. I admit to not tending to my health as much as I should because, even though I can afford it, there is so much more I’d rathr spend $200 on than a visit to the doctor. (As you can see, my insurance isn’t nearly as good as the employee in this question!)

    2. Spargle*

      Agreed about insurance but a $20 copay once in a while really isn’t that much. Even at my brokest (which was pretty fucking broke), I could have saved up $20 for an occasional steroid treatment. And the doctor’s office may have a way to work with this employee to pay $2-3 at a time.

      The employee stated that they hate the wait, which seems to fit with the other statement of not enjoying PT. They’ve made a cost-benefit analysis and come out on the side of daily pain is worth it to avoid PT and a doctor’s visit. I personally think it’s a foolish decision that will harm more than it hurts, but it’s not my body.

      Put my vote on the Leave of Absence With Doctor’s Note ballot.

      1. FillerSN*

        $20 copay? Real cute. Our insurance puts specialist visits (which PT falls under) at an $80 copay per instance. At 1-2x a week, that adds up pretty quickly.

        1. J*

          The OP mentioned the $20 copay. That’s not a number Spargle made up. It’s also for the “occasional” steroid injection, not the regular PT visits, which are covered 100%.

  8. Holly*

    What’s unclear is has the employee’s work been an issue? If the employee has been able to do the job 100% fine but is just like, making audible groans, it’s really tricky. If the condition is causing the employee to literally be in so much pain they are just sitting and not working, or anything else, that is the reason to step in and say you aren’t fulfilling your job duties, you need to go on a leave of absence to rehabilitate.

    1. Bulldog*

      LW says the employee is “A+ across the board in performance,” so I presume their work product is not an issue.

      1. Samwise*

        Employee is working at A+, but the moaning all day may mean that co-workers cannot do their best. That’s the issue — that it’s negatively affecting the ability of everyone else in the office to do their own work.

    2. ACDC*

      True, but it does sound like this employee’s condition is effecting how other around her are working.

      1. Holly*

        But if someone with a disability is performing A+, just audibly groaning due to pain, you’re walking pretty close to the line of disability discrimination if you terminate or discipline that person.

        1. bonkerballs*

          Which is clearly why OP wrote in to figure out a solution that doesn’t involve termination or discipline, but still solves the problem

          1. Holly*

            I’m not sure what the purpose of your response is – if you don’t think my comment is helpful that’s fine, but you can scroll down and just say nothing. It’s a bit needlessly pointed.

        2. WS*

          I don’t think that’s necessarily the case? If someone was performing A+ but only while they had all their speakers turned up full in an open office to block out distractions, you wouldn’t say that was an acceptable situation since it would strongly affect other people’s work. The disability (chronic pain) isn’t the problem but the way it affects other workers is.

  9. Petunia*

    I hate to say it, but I’d wonder if the employee is maybe faking/exaggerating a tad for attention. I’ve worked with folks like this and while yes, I don’t know their full story, it was fairly obvious they were playing up their conditions for attention. I’m also surprised that someone would be in such pain as to drag themselves to work and groan all day, but taking steps to help reduce the pain is too much. I’m not saying it never happens, but as someone who’s also suffered chronic pain (from an injury though, not a degenerative condition) I can’t understand the mindset of someone who has the opportunity to feel less pain at no cost to them, and just… doesn’t take it. That’s what makes me feel the groaning is being played up a bit. Maybe the offer of a leave of absence or being secluded in an office will put a stop to this, since it’ll cut down on the attention the person might receive.

    (For the record, I would never, EVER confront someone I suspect was exaggerating or playing up their pain. Even if I’m convinced they’re faking, I would never risk distressing someone whose pain turned out to be real. I just keep my thoughts to myself.)

    1. fposte*

      I think “for attention” is a really tricky concept, though. For one thing, it seems to consider wanting attention to be a bad thing, but attention is pretty vital to our existence. I also think that we can skew too far to valorizing the strong, silent response to pain; some people find pain really distressing and really value the acknowledgment of others.

      (I was in physical therapy a few weeks ago and was kind of impressed with a woman there who did not buy into the stoicism thing at all. She whimpered away through painful procedures, and I thought “Good for you.”)

      1. Petunia*

        Right, but there’s a time and place for these things, isn’t there? I’m not talking about sucking up pain without a peep. I’m talking about the people who want the “Aw man, poor you, that looks painful, poor baby” reactions. To me, it’s the difference between “Ugh, my back’s killing me today, don’t mind me if I get up and stretch” vs. “OW OW OW MY BACK. IS EVERYONE LOOKING AT ME? ASK ME ABOUT MY BACK PLEASE. PITY ME. BABY ME” etc. etc. I once worked with someone who would groan, wait for someone to acknowledge him, and then repeat louder and louder until someone gave him attention. It was irritating and we all made a pact to ignore him.

        Physical therapy is the place to moan all day. At home, with friends, with family, sure! At work? Maybe not so much.

        I’d like to restate that I have zero evidence that OP’s coworker is playing it up. It was just a thought that occurred to me and I wanted to share my experience.

        1. fposte*

          I don’t think there’s any universal determination of the appropriateness of the time and place, though. It’s fine for you to find it irritating and decide not to respond to it, but that doesn’t make it inherently inappropriate to do. And I’m not saying I wouldn’t have found it irritating either–I don’t know how I’d have felt–just noting that we’re not culturally very reasonable at handling responses to pain, and seeking acknowledgment of pain isn’t an inherently awful thing to do.

          1. Petunia*

            You’re right. I guess I’m a little bit jaded because of past workplaces with this! I guess it isn’t wrong on its own to want attention, I’ve just dealt with some folks who did the moaning and playing up for attention to the point of disruption so that’s what I’m focusing on.

            Either way– we can all agree it’s never appropriate to call someone out on “playing it up”, so solutions should focus on things like LOAs and private offices and telework. Which is what we did in my past offices, which DID work for rooting out the exaggerators. “Oh, actually I’m feeling better, I’m okay to stay in the office…” sort of thing. :)

            1. WellRed*

              Eh, if you want attention at work, it needs to be for your job performance. Moaning and groaning is asking for attention of the emotional labor sort.

              1. fposte*

                I don’t think it’s that simple, though. Morning greetings aren’t based on your job performance, but most of us still want to say hello and to be answered. We’re still humans in the workplace, and if somebody’s suffering, it’s understandable if they don’t turn off the desire to get that acknowledged by humans they spend 8 hours a day with.

                That doesn’t mean I’m advising people to moan in the workplace more–just suggesting that some of our thinking about pain and responses are a little reflexive.

            2. fposte*

              I think it taps into some really core impulses in us so we can respond strongly–this is stuff that looms very large when you’re a kid, for instance, so there’s a lot of early policing in life that shapes us. But that’s the kind of thing it can be worth getting away from in adulthood, so I’m with you on the conclusion–focus on what solutions can be offered, don’t worry about diving into her emotional portrait.

    2. JimmyJab*

      My spouse sometimes lets physical issues go until they get pretty intense, daily pain included. Spouse just is terrible at prioritizing their health over anything else (work, me, family, etc.). So it stinks, and I encourage them to take reasonable steps, but I sadly understand the mindset of letting things go, even once they get out of control/disruptive to life.

      1. smoke tree*

        I think when you’re hearing this stuff from a coworker, it can seem very obvious that they should just suck it up and go to physical therapy. But in reality, most people aren’t great at consistently making health-optimizing decisions for themselves, and sometimes there are good reasons for that–we can’t afford it, we have to prioritize other responsibilities, or we have to make tradeoffs in one area of health to compensate for a different one. But when you’re just hearing a general overview from someone you don’t know well, it’s easy to forget all of the context.

    3. Dust Bunny*

      I don’t really think so. The time/mental effort of seeking treatment seems like a completely plausible explanation to me.

      1. Cat Fan*

        Plus, the employee must come to work to get paid. they probably think of everything else as optional, but coming to work is not.

      1. Petunia*

        That’s kind of mean. I just said “I wonder if…” something, based on my past experience, not that the coworker was 100% doing this for sure.

          1. Petunia*

            That’s not what I said at all! I’ve worked with office exaggerators before. It is very disruptive and difficult to deal with, and I just wanted to share that experience. I would never outright accuse anyone of faking it. I literally said I would never risk distressing someone whose pain turned out to be real, no matter what my opinion on the realness of their condition was.

            I can see now how it wasn’t a very helpful thing to bring up, since it doesn’t change the nature of the advice. I just wanted to add something to the conversation. I’m sorry if it came off as unkind.

          2. Petunia*

            I’m so sorry Allison! I didn’t see your note until after I finished writing my comment. I’ll let it be now.

    4. valentine*

      someone who has the opportunity to feel less pain at no cost to them, and just… doesn’t take it. That’s what makes me feel the groaning is being played up a bit.
      I read the steroid shots as being $20 each, which is a lot to start, adds up, and may seem overwhelming if they’re meant to continue indefinitely, especially if the person can’t afford an HSA. There’s also the cost of making appointments, including any rearranging of one’s life they necessitate, and the extra time, travel, and effort of going to and enduring them. I doubt she’s getting attention after three months and see no reason to disbelieve her expressions of pain. I doubt she decided, “It’s a literal pain to go to PT and get shots, and it clears up my pain, so no one fusses over me. I’d much rather constant pain.”

      1. Petunia*

        Oh, my bad then. I thought the OP said the coworker decided to stop getting the injections because they didn’t like waiting, not because of the cost. I must have misunderstood.

        1. Michelle*

          X also stopped doing the steroid injections, which they said was because they hated waiting so long each time they had to go in
          You are correct, they said it was because of the waiting, not the cost.

        2. fposte*

          No, you’re right; they did.

          I think people’s reporting on their health stuff is pretty complicated at the best of times, and I feel like the OP is considering things to be more black and white than they are. Steroid shots aren’t magic (or fun), and you’re generally limited on their frequency. It’s likely also going to the doctor and waiting is pretty painful in its own right, and that’s a huge energy drain as well. So it’s possible, for instance, the employee had some improvement with the steroid but not enough to be worth the pain and effort.

          What from the outside may look like simple math just isn’t that from the POV of the person suffering. She’s doing what she’s doing for a reason, even if that reason isn’t something we know or feel.

          1. Petunia*

            That’s a good point. It could be that “I didn’t like waiting for the shots” was the coworker’s quick explanation for “they hurt and didn’t work well enough to be worth it” (if it’s cortisone shots, can confirm– they DO hurt! They worked wonders for me so it was worth it, but that might not be the case for everyone) The coworker does seem pretty open with their condition but maybe they didn’t feel like giving details in this case.

            1. fposte*

              Yeah, I vacillate between wild overexplanation and terse cover story for my chronic stuff. Depends on the day, the situation, and whether I feel like being breezy or more confiding.

          2. ThursdaysGeek*

            My first cortisone shot was magic (nor did it hurt!). The second was useless. There won’t be a third. Before prescribing PT, the doctor said it would do no good. I enjoyed it, but it didn’t change anything.

            So what helped before might no longer be helping anyway.

            1. fposte*

              Shoot, I guess my insurance only covered the un-magic kind :-).

              I have found PT to be highly variable. I’ve spent a lot of time doing exercises that did little to nothing or exacerbated other problems and shrugged and said “I guess maybe that helps?” But I’ve also found people who really could target stuff creatively in a helpful way. I don’t know how you tell in advance who’s good.

              (I was just thinking about you last week, TG, when I was reading some old columns. Good to see you!)

              1. ThursdaysGeek*

                You think about me?! I am honored.

                I usually agree with you, and get here late enough that everything that should be said has already been said, many times over. I rarely have anything more to contribute.

      2. The Man, Becky Lynch*

        They have a low deductible insurance, they aren’t eligible for HSA, it’s not about affording an HSA. HSA’s are supplemental for cruddy health insurance programs with high deducible.

    5. LawBee*

      “I can’t understand the mindset of someone who has the opportunity to feel less pain at no cost to them, and just… doesn’t take it.”

      There are other reasons than just cost, though, right? Maybe the wait for the shots is unbearable because the seating arrangements at the steroid doctor’s office cause more pain than the employee can manage. Maybe the PT was not nice, or there wasn’t a click. (I stopped going to my PT because I just could not with her even one more day – she was the conversational equivalent of the person who doesn’t understand personal space, which combined with the requirement that she actually BE in my personal space. was intolerable.)

      Maybe these treatments are just One More Thing that she has to deal with in a day already rife with constant pain, and a million decisions that the able-bodied don’t have to make, and a body that isn’t entirely under her control anymore, so this is an area where she’s going to exert what little control she has, darnit.

      It’s always more than what we know. Yes, this is disruptive for the other employees and that sucks, but being in constant pain sucks worse.

      1. hipaaanon*

        As someone who is dealing with osteoarthritis and fibromyalgia (and please don’t even; my doctor said I had it, so I have it), here are my two cents:

        When I plan outings with other people, I have to actively calculate the number of times I will be getting in and out of the car. Because that is the thing that causes me the most wear and tear, and diminishes my spoons the fastest. It’s weird that I can go for a half-hour walk and feel pretty good, but get in and out of the car twice in ten minutes and be exhausted and near tears.

        It took me a long time to figure out that this was the crux. I tested out a TON of other theories before I landed on this one. And who knows, it may change two years down the road and something else may be a worse issue.

        My point in saying this is: Maybe getting in the car, getting out of the car, going into the doctors’ office, sitting down, waiting, getting up, sitting down to get the shot, getting up, getting back in the car, getting out of the car and going back to work/home and sitting down… is so painful and exhausting that it just isn’t worth it. That’s nine major impacts on the hips and knees in quick succession. I’d be bawling.

        But we don’t know, and we can’t know, and maybe her reasons are her reasons and they’re good enough for her.

        1. Elspeth Mcgillicuddy*

          So I don’t know if this would be any help with cars, but I found it really interesting and wish I had known some of these tricks when my grandma was alive. It’s meant for caregivers, not the person getting in and out of the car, but maybe some tips would translate? Sorry if this is something you already know about.

        2. Mel*

          Virtual hugs from a fellow fibromyalgia person! (I too have to reply to folks regularly that I definitely have fibromyalgia, no questions.)

          I regularly have to explain the “fibromyalgia calculus” of determining which option(s) will hurt the least. My big example is whether or not I go up a flight of stairs (painful), or have to trek all the way around the side of a build to find the accessible entry and elevator (exhausting).

        3. Robbenmel*

          My husband is disabled, and getting in and out of the car is the hardest thing for him. Just yesterday, one visit to the doctor = getting in and out of the car six times, and his spoons were gone (and mine, too!)

    6. Budgie Buddy*

      I could see this as a possibility. There’s not much you can do from the outside, though, definitely. There are people who crave the sympathy that comes with having the biggest problems in the group, usually the result of lacking more positive ways of getting attention/affirmation. Might not be the case here, but the loud groaning does seem like a way of excising the stress that comes with having a degenerative illness. (“Ughhh this sucks…but does everyone KNOW how much it sucks?”)

      Moving the employee in the office might cause them to turn to other disruptive behaviors, if their easiest avenue of performing to the office is taken away, they might give up or they might find another one.

    7. Mia*

      I’m sure there’s some small possibility of something like this being the case, but I think it’s much more likely that LW’s employee found the treatment methods they need to undergo unpleasant or uncomfortable enough to avoid them altogether. Like, I have a few different chronic conditions and one of them requires a specific mind of surgery, which I’ve been putting off for nearly a decade. That sounds absolutely bananas to a lot of people, but sometimes the things you need to do to treat chronic illnesses mean dealing with a lot of discomfort that essentially amounts to getting worse before you get better, which can definitely create this kind of avoidant behavior.

    8. Cattiebee*

      “I can’t understand the mindset of someone who has the opportunity to feel less pain at no cost to them, and just… doesn’t take it.”

      A few years ago, I was diagnosed with a chronic disease that I’ll have to manage for the rest of my life. It can be excruciatingly painful sometimes, and I can expect to have several surgeries over my lifetime.

      In addition to all of the other issues posters here mentioned, there’s a mental and emotional cycle that a lot of people go through when they get this type of diagnosis. For many, there’s first a feeling of validation that someone is finally taking your symptoms seriously and that what you’re experiencing is a real thing and not just in your head. There’s relief that there are things they want to try that could help you. And even though they explain upfront that those things might really suck, it’s hard to really appreciate that when it’s still a hypothetical.

      Then reality sinks in. You realize you are going to have to manage this for the rest. of. your. life. The new normal, they call it. It’s a process to adjust to the new normal and grieve the normal you’re leaving behind. Some people sail through this period smoothly. But a lot of people, I might venture to say most people, take a minute to adjust. I spent a full year being angry, and that’s even with the help of a good therapist. A common stage to get stuck in is denial and fear: If you continue on as you always have, which includes ignoring big red flags, maybe things will get back to “normal.” Maybe you’ll have control of your life again. Except you’re not even rationalizing it out like that in your head; you’re just reacting. For a lot of people it takes time, sometimes quite a bit of it, to work through all of this and they might do some things that don’t make sense to others.

    9. nêhiyaw ayahkwêw*

      So here’s a reason they may not.

      I have two steroids currently available to me. I live in Canada, so I have prescription coverage for a lot of things, but not everything.

      Steroid #1 gets injected into my butt. It then causes intense bruising, which becomes incredibly sore, and makes it hard for me to sit for about 2 weeks afterwards. This steroid I would need to be given every 3 months or so. It also nearly always causes a flare, which can be so severe that I end up hospitalized, which means I miss out on living my life. It also affects the way my blood clots, so it’s much easier for me to bleed when cut, so sometimes when I brush my teeth my gums bleed non stop.

      Steroid #2 is extremely powerful, taken by mouth. When I’ve used it in the past it makes a massive difference in my pain, inflammation, and energy levels. Unfortunately, it also causes blood clots in the legs, known as deep vein thrombosis. The last time I used this medication, I had to be rushed to the hospital when one of those clots made it to my lungs. It also has a massive cancer risk. I got sick when I was 13, and for a long time couldn’t use any of these medications because I was too young. Now my doctor gave me a choice. I can use the medication, and likely have a much shorter life, albeit with less pain. I would likely pass from cancer and organ failure in the next couple decades. Or, I can stay off the meds, live in pain, and hopefully have a shot at a normal life span.

      I chose pain. Because I don’t want to die.

      Some of these comments have been so incredibly callous.

      1. Cherries on top*

        @ whom it may concern. I could benifit a great deal from physical therapy, but I have conflicting health problems. And solving those problems is something that is very complicated and health care here (anywhere) isn’t really set up to handle complex situations (e.g. you either have ADHD or a broken leg, pain or anxiety, but not possibly both). Something, like physical therapy, can be a “suck it up”-situation for one person and impossible for another. And the lack of empathy and level of judgement can be absolutely detrimental to a person. All this to say: try to be a bit flexible in your thinking.

  10. Ann O'Nemity*

    I know the legal advise is to not address it, but honestly it would be hard for me to ignore it! I’d be tempted to say something like, “X, you’re moaning in pain throughout the day. It’s become disruptive and disconcerting to the rest of the team. How can I help? I want to offer flexibility or whatever you need to help you to be more comfortable here.”

    1. valentine*

      Yes, why is “Let’s all listen to constant pain we can’t help with for three months” a reasonable accommodation? OP isn’t suggesting the employee suffer in silence.

    2. Massive Dynamic*

      I’d also be inclined to address it directly with the employee. Our pain as a species is sometimes performative, with the moans and grunts and tears, and for good reason! We’re hardwired to respond to these sounds and to help the person making them as best we can. If the employee can’t stop making the sounds then the first step after this chat would be to get a doctor’s certification that they CAN work…. that they’re not doing themselves any further harm by being in the office every day.

      But as a manager, I’d also definitely be seeking some legal counsel on this.

      1. Cherries on top*

        Or maybe they feel like no one cares or that they’ve become the “person in pain and a “how are you doing?” (healthwise or absolutely not healthwise) is what they really need. The moaning sounds disruptive, but some people also take offence at other people feeling visably bad in close proximity (like an old classmate I ended up comforting when she cried about feeling like I wasn’t worth as much as the others due to my major health complications).

    3. Dr. Pepper*

      I was wondering why this wasn’t mentioned as an option. Not framing it as a “you should be in treatment” thing but in a literal “the noises you make are disruptive” thing. Maybe it’s simply not possible to separate the medical issue from the noises, but it doesn’t make sense to me that the noises themselves, regardless of their cause, can’t be addressed.

    4. Jaydee*

      Also, I think saying it in a way like this, which is professional but also shows genuine concern for the employee, does two things that are really crucial:
      1. It makes the employee aware of what the actual problem is and
      2. It allows the employee to have a conversation with the employee and suggest solutions to the problem rather than the employee just deciding on and implementing a solution (leave of absence, work from home, private office).

      The concern I have with placing the employee on a LOA and requiring a doctor’s verification of “fitness for duty” is that, to the employee, that seems like the employer trying to force the employee out. Especially where there don’t seem to be any actual issues with the quantity or quality of their work. An emplo

      1. Jaydee*

        Accidentally hit “submit”…

        An employee will rightfully start feeling defensive if they’ve recently disclosed a disability or medical condition and then the employer starts making unilateral decisions about their working conditions without talking to them first.

        An employer who talks to the employee isn’t immune from a discrimination claim. Nice, decent, well-meaning people discriminate unlawfully all the time. But at least having the conversation can potentially help minimize unnecessary additional worries for the employee during what is undoubtedly already a pretty stressful time.

    5. Shamy*

      I feel like this could be a great way to address it. I wonder if the employee even realizes how much they are moaning and groaning. It seems perfectly reasonable to address this the way you would other disruptive noises in the environment with an extra dose of sensitivity given the circumstances.

    6. Zombeyonce*

      I also worry that moving them to an office under a pretense wouldn’t necessarily help the situation. If they kept the door open, they’re still going to be heard moaning by others and then you have OP writing in asking how to ask them to close their door. It’s a solution that doesn’t really fix the problem.

      I like your script since it calls out the issue and ask how to help in a compassionate way.

    7. Daphne Tyson*

      Yes! This 1000 times. There is no reason it can not be addressed in the context of a work related matter. Its not a lot different when we ask people to close their doors if they are on speakerphone.

    8. Baru Cormorant*

      Agreed, I was wondering why Alison didn’t suggest this solution, as the real issue here is the noises, not how much the employer can get involved in the person’s medical issues.

  11. S-Mart*

    I don’t love the private office solution. It could leave you with a different problem – the perception that X got a private office for whining/moaning, and that’s the (only/expedient) route for others to get one.

    1. Bulldog*

      This. Assuming a private office is considered a perk, and X has not done anything “above and beyond “ to deserve it, other employees would rightfully see it as a reward for the moaning. I could easily see resentment building up over it.

      1. Indigo a la mode*

        I think if I were in that office, I’d be able to discern exactly why she got the office and would be quite happy with the revised (i.e., no-more-moaning) situation. Surely most people are reasonable in that regard and wouldn’t immediately hatch plans to become a squeaky wheel in hopes of rewards.

      2. Massmatt*

        Others in the office might like the solution if it cuts down on the moaning and groaning, but still—someone getting a private office due to their groans of pain seems very odd. In most work places a private office is a big perk and there is much competition to get them. A workplace of 80 employees with no HR might not have any, at least to spare, anyway.

      3. hbc*

        Sure, if you want to get a documented painful condition and moan, then yes, that gives you a private office. We’ll see how many jump at the chance.

        Not that there won’t be complainers, but they’re probably the same people who whine that they don’t get to take 20 minutes in the lactation room too.

        1. Zombeyonce*

          I think you’re looking at the situation pretty myopically. What people may see could be that someone in pain is getting an office because it’ll help everyone else not be disrupted. But since she has told OP all the reasons she’s in pain and not doing anything to stop the pain, she’s likely told others, too. To others, this could come across as someone getting a private office because they are ignoring solutions to health issues when perfectly capable (as far as we know) of fixing them.

          I’m sure there are other people there with health issues and they’d love to have a private office to deal with them. It’s just that they didn’t complain loudly enough to get the perk.

          This may all be unfair to the woman in pain, but the way she’s coming across can definitely cause a lot of resentment if she’s given her own office.

    2. valentine*

      That would be a highly judgmental reaction to a solution that restores office, not hospice, sounds, and not one to be rewarded.

      1. Bostonian*

        And people can be very judgmental.

        Maybe offices aren’t a perk at OP’s office, and nobody would bat an eye; otherwise, this could be a real consequence to this solution.

    3. Ann Furthermore*

      Yes. This exactly. I’ve endured cubicles and open offices for almost all the years I’ve been working, because I’ve accepted that the days of everyone having a private office are long gone. I would love to have a private office. I would be inordinately p***ed off if someone who normally wouldn’t get one was rewarded with one because they moaned, groaned, whined, and complained so much. I’m sure others would feel the same way. A solution that ticks off everyone else will create more problems than it solves.

      1. Emily K*

        Would you want to trade positions with this person, and be in significant, constant pain every day, if it meant you got a private office out of it?

        This reminds me a bit of the, “A company should buy two coach tickets for obese employees even if they cost more than a single business class ticket because it would be be fair for the obese employee to get rewarded for their size with a higher class of travel,” that came up a while ago. Are people really so petty they would rather the company withhold an accommodation that could make a miserable situation slightly less miserable, just because the same accommodation would be a perk for someone not in a miserable situation?

        1. CheeryO*

          Have you met people? Yes, people are that petty. Putting this person in a private office may be the best option out of a bunch of not-great solutions, but it’s not a bad thing to be mindful of the fact that there will most likely be some eye-rolling and griping from other employees. I have a coworker who has gotten some accommodations for post-concussion symptoms, and I’ve heard all sorts of bitching about her special computer monitor and special notepads and the fact that she gets to use the conference room to have quiet time in the dark. It’s nasty, but I think it’s understandable to an extent.

          1. CheeryO*

            I will add that desk space is already a hot-button issue in many workplaces. If private offices are a rarity, it’s even more understandable that people would be annoyed to see someone get “rewarded” with one for their health issues.

          2. Bostonian*

            Yup. When I came back to work from FMLA due to a work-related injury, there were definitely people complaining about my reduced output (all the while knowing what happened).

            Management can try their best to convince these people that it’s none of their business and the accommodations are legitimate, but you can’t always make the resentment go away. Some people have really personal, deep-seated feelings about fairness.

        2. Ann Furthermore*

          No, this is not the same thing. This person is choosing not to avail themselves of the help available under the insurance plan (physical therapy and steroid injections) for petty reasons such as not liking to wait at the doctor’s office. And on top of that, this person has a very supportive manager who has gone out of his/her way to do everything possible to make things easier on them, like being flexible about appointments and modifying their workspace. If being frustrated that someone won’t try to help themselves when others have gone out of their way to do whatever they can to to be accommodating and supportive makes me an awful person, well, then, so be it.

        3. Jane*

          I’m with Ann. I’d be extremely pissed. And yes, I am in significant constant pain every day. And because I take care the best I can of my own health and know it’s inappropriate to let it impact coworkers any more than it has to (via groaning audibly in pain, more time off sick than necessary, avoiding treatment now requiring even more treatment later and so forth) I do everything I can to manage it. For example taking a high dose of opiates every single day, which makes me feel drowsy and beyond exhausted. I’d love a private office so I could have five minute naps on the desk every couple hours to make it easier to see the day out.

          OP’s worker is behaving atrociously and however they deal with her directly, giving a huge perk like a private office unearned isn’t remotely fair not only on healthy coworkers but also on the coworkers also dealing with chronic health issues who are being responsible about addressing them (and who can’t all be given a private office).

      2. Amethystmoon*

        I’ve never had a private office. I consider myself lucky to now have a cubicle with actual drawers to put things in and a decent amount of space. In my last job, it was totally open plan and we had no drawers, even.

  12. Goliath Corp.*

    As someone who has been in this situation, please don’t force the employee into a LOA — especially if your insurance plan doesn’t cover short-term disability, or if it only pays out at a fraction of their normally salary. It’s a good idea to make sure she’s informed of her options (including WFH flexibility, if possible), but don’t force her out if she’s still able to complete her work.

    (I was pitched on our “great” benefits plan, but then pushed out with no short-term disability coverage.)

    1. Goliath Corp.*

      Also, depending on the location, steroid injections can be incredibly painful. When you’re living at a 10/10 on the pain scale it may feel impossible to take on more, even with the possibility of some relief.

      1. Jamie*

        Idk if they are the same type of steroid injection, but when I was given steroids for pneumonia when in the hospital the side effects were so severe it was really scary.

        I don’t understand it being the wait, seeing as she’s getting time off to go, but I can see having severe side effects and the relief not being worth it. But going off the info from the letter it doesn’t make much sense.

        1. OhNo*

          The employee could be using the wait as shorthand for a lot of things that they may not want to – or even be able to – explain. Things like “the chairs in the waiting room are so miserable for my back that they cause more pain than the shots fix”, or “the staff at the shot clinic are awful to me and make me feel like crap every time I go”, or even “sitting in a waiting room with other disabled people for an hour makes me confront the reality of my condition in a way I’m not prepared to do right now”.

          All of which is to say, I think it’s perfectly reasonable for that to be the reason, even if it doesn’t make sense from an outside perspective. That doesn’t mean it’s a good reason, and I certainly understand why using the wait as an excuse would frustrate the bejeezus out of coworkers who have to hear you moan and groan all day long.

        2. Librarian of SHIELD*

          Doctor’s office waiting room chairs are uncomfortable even for people who aren’t dealing with chronic pain. I can see how having to spend an unpredictable amount of time sitting in an uncomfortable position when you’re already hurting can feel like too much, and I can also see how explaining that to people can be difficult or embarrassing, so you just shorten it to “the wait times were too long.”

        3. Samwise*

          The employee may be *saying* it’s these reasons, but they may be other reasons they don’t want to share. OP has no way of knowing. Now, it’s not wise of the employee in pain to give these apparently minor reasons, because the OP now has an unflattering picture of the employee. But that’s not the same.

          I am sure plenty of people give a throwaway reason to protect their own privacy. Or to keep themselves from falling to pieces so that they don’t have to retail the whole crappy story and crummy reasons to someone else. BTDT.

    2. Washi*

      I mean, she won’t be on a LOA if a doctor certifies her to work. And if the doctor says she she shouldn’t be at work, then she should be on leave.

      1. Art3mis*

        I think the point is that if there is no short (or long) term disability plan or the short term disability insurance company doesn’t agree, it leaves the employee with no income and in constant pain. The second scenario is exactly what happened to a friend of mine. Company wouldn’t let her work, doctors said she shouldn’t, insurance company disagreed. So she was left with no income and had to cash in a pension and 401k to survive for the two years it took SSDI to get approved.

      2. Doe-Eyed*

        Also, as someone who works in a medical office, please don’t outsource this uncomfortable conversation to a doctor because you don’t want to deal with it. It’s completely ridiculous to insist on a doctor’s note to verify she should be at work. She’s an adult human being at an office job – she can figure out if she should be there or not. Becuase you know what the doctor is going to do? Say to her “Hey, should you be in the office? Do you do anything dangerous or handle any particularly noxious chemicals? Are you driving a forklift?” The employee knows all of this already. Instead you’re making the doctor’s office fill out a bunch of ancillary paperwork and costing your company’s insurance more money.

  13. Anna*

    I had a co-worker like this once, she sat right across from me and suffered from horrible migraines. She would wear sunglasses and put a ice pack on her head. She would moan all day and refused to speak to anyone during her flair ups. She did this literally 4 out of 5 days per week. It was super distracting and of course nobody wants to see someone in total agony.

  14. KWu*

    Sincere question–is setting a work requirement that you can’t constantly be making noise all day, in an otherwise quiet office setting, something an employer would have to give a medical accommodation exception to? (This is in the event that a private office space is not available at all)

    1. Ask a Manager* Post author

      It likely would depend on how disruptive it was, if clients were exposed to it, etc. Jon Hyman said there was a risk that saying that could lead to a disability harassment complaint (one he thought ultimately wouldn’t win, but employers generally don’t want to open themselves up to that and the resources it will require to fight).

      1. Elitist Semicolon*

        This is similar to what I’ve been wondering in reading these responses: what if there is someone else in the office with auditory issues – misophonia, for example, or issues where prolongued, repeated noises are triggers? There’s “this sound distracts me” or a colloquial “that’s driving me crazy,” and then there’s “my brain cannot handle this sound and I am going to cry/hyperventilate/other panicky thing here.”

        1. AntOnMyTable*

          I think this is a very valid point. I have misophonia and if this moaning and groaning was that frequent it would have an outsize effect on my mood and productivity. I’d probably be using that amazing insurance to try and find a doctor to write a note for me saying this is an issue. I get headaches when I have something exerting constant pressure on my head so I don’t think I would be able to manage wearing headphones to block out the noise.

          I get that sometimes it is impossible to avoid involuntary noises when there is a sudden increase in pain but I think constant groaning and moaning is performative in nature. It is not impossible to keep the pain noises to a minimum for most people.

  15. BethRA*

    Can X work remotely? If they’re a high-performer, I can see not wanting to push the LOA (especially since the condition isn’t going away), but if walking across the office causes pain, I’d bet that commuting is really physically not fun. Framing the conversation around what you’ve observed as opposed to what you think is going on may also be a better way to broach the subject than approaching them as being disruptive – “from seeing you in the office, you still seem to be in a great deal of pain, if so, what can we do”

    1. Thoughts*

      Another question would be if flexible hours are an option and would help. I know when I was dealing with arthritis (autoimmune) some mornings were very hard but after walking around a bit I was much better. I had flexible hours so on those days I would let everyone know I would be in late.

  16. CommanderBanana*

    Oof. I was this person for a little while after a back injury. I had to stand or weirdly half-lean on a table during meetings to keep my sciatica from going bananas, and at one conference spent a not insignificant time in child’s pose on the floor of our break room to try to keep the pressure off my disc enough to continue functioning. And yes, would sometimes yelp if my back seized up while I was walking.

    1. Filosofickle*

      Oh, the yelping. When my sciatic stuff was just starting, I had painful nerve zaps that would just stab me out of the blue and cause swears or exclamations to just pop out of me! It was not controllable, tho I did my best to keep the volume down. At the time I was working in a super conservative, super quiet corporate cube farm. It was so hard to try to contain that on top of the general pain.

  17. banzo_bean*

    Telecommuting is not mentioned as an option, but perhaps giving the employee the ability to work from home on some days could cut down on this.
    Also, even if the “off the record” time off was granted to the employee maybe they were worried over using the PTO or that they were running out of goodwill with regards to time off for treatment. Maybe they just need to be told they’re allowed to take whatever time they need to go to physical therapy and treatment.

    1. JustMyImagination*

      I think it’s also important to look at the off the record time and the employee’s workload. Husband was in PT for a while where he went 3 days a week for an hour each. If employee needs to take 3 hours + travel time a week for PT, was the workload decreased by 10% or was X expected to stay later to make up that time out of the office? If they have kids, partner, after work commitments, or need to rest at night from the pain then that off the record time may not have been the accommodation LW is assuming it was.

      1. banzo_bean*

        Yeah, I’m kind of surprised the first advice, before an LOA, was to say “Hey employee, just wanted to check in to see if there was anything I could do to help accomodate you with ‘insert ailment here’. Whether thats extra flex time, ability to work remote, decrease in workload.”

    2. nnn*

      That’s what I came to comment. My current combination of medical situations is conspicuous to manage comfortably (i.e. I need to keep doing things that look strange in an office environment), and working from home allows me to do what I need to do without disturbing my co-workers *and* without me having to deal with my co-workers remarking upon how I’m managing my medical situations.

    3. OP*


      To clarify regarding “off the record” time off, I phrased it to the employee roughly as: “take whatever time you need to get your treatments done and to manage this condition. I want to make sure you don’t feel restrained in any way to do whatever it is you need to do to take care of yourself. Just give me a heads up when you’ve got a PT appointment or doctor’s appointment and don’t worry about a PTO request or anything. You’re a salaried employee; any time you take to manage and treat this is just as important as the time you’re here at the office.”

  18. Jess*

    Sounds like the psychological pain of treatment (which is a regular reminder of the degenerative nature of the disease–especially when sitting around in a waiting room for a long time) is more painful to X than the physical pain.

    I agree it’s a tricky situation. I like the private office approach, if X is on board. On some level this seems to fall into the bucket of any annoying/distracting sound in a work environment that can’t be eliminated — what can one do to mitigate the impact on the surrounding employees?

  19. Lilysparrow*

    It’s extremely common for people with chronic health conditions, especially chronic pain, to gloss over their real reasons for doing/not doing things, to preserve some level of privacy, and to make the explanation shorter and easier to repeat ten thousand times.

    Because when you have a chronic condition that significantly limits you, you get asked over and over, and over, why you don’t just do X, which is obviously easy and will certainly fix everything. /S.

    No. When you’re dealing with chronic pain, everything has a cost that nobody else can see, and that they don’t care about because it doesn’t affect them.

    Your employee stopped treatment because the downsides were not worth the upsides. And you can bet the downsides must have been pretty damn bad, if they weren’t worth pain relief. What you are seeing is *better* than the downside. Think about that for a second. How bad would the downside of a treatment have to be, for *you* to choose constant pain as the better option?

    The downside could be something like, the side effects ruined their sleep and made them unable to concentrate to the point that they were afraid of being fired and losing that awesome health insurance.

    It could be that the wait time + slow mobility kept them from performing another major life function, like shopping for food. Or picking up their kids on time. Or bathing.

    They aren’t telling you the real downsides because a) it’s none of your business, and b) they don’t think you’d understand or care anyway.

    I think the LOA and private office would be very good moves. I’m just challenging the thinking that this person stopped treatment out of laziness or not caring.

    Or that they are somehow obligated to make medical decisions based on “not bothering people”.

    People who base their self-care on not wanting to “be a burden” or not wanting to “trouble anyone” do NOT have better self-care. Not by a long shot.

      1. ImAGhost*

        It’s not ableism. There’s no reason for the coworker to continually moan and groan all day. Every person in that office is/has gone through challenges, and they keep it to themselves and go about their day.

        1. Samwise*

          Um, maybe there is a reason. Maybe the person is IN PAIN. So much pain that they can’t just “keep it to themselves and go about their day.” That’s a lot of pain. That’s a shitty way to have to live. And on top of it, the employee surely knows that everyone else is hearing them, thinking their thoughts about it, either pitying them (which can be terrible) and resenting them (also terrible) or both (the worst).

        2. Vermonter*

          I actually wasn’t talking about the “moaning and groaning” issue, but the judgement about the employee’s decision to stop physio.

        3. Kathy (counting the days until retirement)*

          ImaGhost, you are not getting it. “There’s no reason” is not your call to make.

    1. Dust Bunny*

      So, can I play my autism spectrum card to get a private office so this person’s moaning doesn’t drive my noise sensitivity off the meter all the time? Because that should really not be necessary, either. “None of your business” ends at the other person’s nose. Or ears. If this person has decided that treatment isn’t worth it, they’ve also decided to live with the pain, and at some point everyone else shouldn’t have to live with the consequences of that all day long.

      1. BethRA*

        A) this isn’t a card game.
        B) If X’s moaning was sincerely disruptive to you, than I would say yes it’s worth a conversation with your boss about possible solutions. But I’m going to suggest that you’ll have better results if you approach the conversation from a let’s find solutions perspective than a “X is suffering horrible pain at me” perspective.

      2. valentine*

        It’s not a card if you really need it, but/so yes, and I think OP would have sorted that for you ASAP.

      3. Feather*

        Bluntly: yes, actually, if it genuinely disrupts your work-flow to a point where you can’t handle it, then you should be able to work out an accommodation with an employer to provide a work-space that allows you to function. That’s pretty basic accessibility, and sometimes access-needs do, in fact, conflict and need to be sorted out.

        It’s a bit disturbing to see other autistics frame “asking for a reasonable accommodation for disordered sensory processing” as “playing the autism card”, just gonna say. It results in fantastic cases of “well DUST BUNNY’s autistic and THEY don’t need this, so you’re just FAKING.”

      4. lemon*

        They did not decide to live in pain. Random genetics, which caused their illness, decided they’d live in pain. We don’t know the reasons they are choosing not to get treatment, but as Lilysparrow mentioned, there could be plenty of good reasons why they’re choosing not to get treatment. If that’s the case, what they *did* choose was to not add additional pain to the pain they already experience.

      5. Yvette*

        Yes, just as if you were located by a window and could hear street noises like sirens, construction equipment, and the chimes of a tower clock, you could request accommodations. In your case it could be noise cancelling headphones, but you could request accommodations.

      6. Tinker*

        Speaking as someone who also lives in the glass house of “having a condition with complex features that many people still interpret as ‘lacking in virtue’ or ‘globally lacking in ability’, and where ‘surely you can just try harder’ is a constant refrain”, I usually want to avoid throwing “playing the X card” stones. That game is quite likely to end worse for me than it is for the other person.

        But yes, I’d recommend looking into solutions in any case where the noise environment in your office is interfering with your work. If this is due to reasons of disability it may be appropriate to bring that into the discussion — although I will warn you, having gone down this route, that a lot of well-meaning laypeople have an extremely awkward understanding of what it means to be autistic.

      7. Ewpp*

        Also why the op’s company could consider giving the employees who are the least to tolerate the groans an option to work from home. Possibly?

    2. Washi*

      I think this is a good mindset to proceed from – there’s nothing gained by annoyance with the employee for not continuing treatment.

      That said, voluntarily telling your boss that you stopped PT because it wasn’t fun and injections because of the waiting room is not really smart (no details were necessary at all, or just “X and Y don’t work for me right now”). I think the OP’s frustration is pretty understandable, based on the facts that the employee herself volunteered, but I agree that the best bet is just to proceed as if the employee never gave any reasons for what she is/isn’t doing, and just focus on the work impacts.

      1. KWu*

        These are really good points and the advice to proceed as if you never heard further followup about treatment details is helpful and wise.

    3. I'm A Little Teapot*

      I see your point, but I also have a right not to have to listen to someone moaning in pain all day long. It’s a crappy situation all the way around, but the current status quo is not acceptable.

      And yes, there is a point at which you are obligated to make medical decisions to “not bother people”. Vaccines are one of them. Mandatory quarantine because you got some disease or other (regardless of the availability of vaccines) is another.

      1. fposte*

        I can understand not wanting to listen to somebody moaning in pain all day–I don’t either–but I don’t think that actually is a right. It’s just a strong preference. If the sounds at your work are too disruptive for you, you can talk to your manager to see whether there are ways to mitigate the problem for you, but they would absolutely be allowed to say that no changes will be made and it’s up to you to decide whether you can work in that situation or not.

        1. Anonymous for this*

          It’s not necessarily just a “strong preference”. Listening to someone moaning and groaning in pain all day would easily trigger my PTSD, something my employer wouldn’t know about unless I was in this situation and told them about. I shouldn’t have to quit my job due to my medical condition because of another person’s medical condition.

          The LW, most likely, doesn’t know all the ins and outs of their employees health, but it’s not at all a stretch that this kind of thing could/would impact someone else’s mental health.

          1. fposte*

            I don’t disagree with that, but it still doesn’t mean you have a right not to hear it. You have a right to request accommodation, and a right to the interactive process. But there’s no right to have those without disclosing, and there’s no right for disclosure to get you what you want.

            And unfortunately, it’s not unheard of for accommodations to clash sufficiently that one person’s medical condition means that the other person chooses to leave the job. The most notable example is service dogs in a workplace with someone whose allergies or phobias/trauma make proximity to dogs a problem.

            I really don’t mean “too bad, so sad, you have to listen to whatever.” But I think people are positing an essential moral or legal principle here that doesn’t exist. Sometimes workplaces just have really disconcerting things that are hard for employees to live with.

                1. P peace*

                  Thank you. I understood that. I suppose I was asking more specifically. In the United States, the medical condition that is being discussed in the comment above is not ‘accepted’ and often times it’s dismissed or even made out to be something that needs to be gotten over. In an effort to cut short the struggle someone has who might be I’m a little teapot, it might be worth lessening the potential struggle.

          2. cryptid*

            Right? At some point we push up against competing accommodations. I highly doubt that this person is the only person in an office of 80 with chronic pain, or a disability like autism or adhd that might make working through the noise difficult. Allowing the employee to continue as is may be the best of a lot of not-great options, but it’s not a neutral choice. PWD are everywhere, and an accommodation for someone may cause harm to another. There might not be a choice that harms no one at all. So then it’s harm reduction, not elimination, that needs to be the guiding factor.

            Since it sounds like the employee is otherwise stellar, the LW might decide those accommodations are most important and that it’s okay to lose other workers who can’t tolerate the noise. That’s not an unreasonable calculus to do as the manager, but I think the LW should be clear to themself that’s what may happen.

            (This reminds me of the competing accommodations classic of someone needing a service dog and someone with a severe dog allergy in the same office. The dog is legally medical equipment for the first person, but still a dog that affects the second. There isn’t a good compromise here: ultimately, they can’t be around each other. Competing accommodations are emotionally and mentally tough for people who want to do right by everyone because you maybe can’t and you have to decide who gets helped and who doesn’t.)

            1. Feather*

              Competing access needs is absolutely a real thing, and sometimes they are simply unfixable.

              But often they can be handled by, for instance, *not being rigidly wedded* to one single way of doing things, and framing (for example) “having a private office” as something that will somehow destroy the order of the universe if someone below X Rank within the company gets. Or by working from home, or any number of other things.

        2. Mathilde*

          I don’t know if that is a right either (although the expression of pain can easily be a trigger for several things), but any employer in their right mind would see that, at least, it is very disruptive. It is not like having a strong preference for eggshells wallpaper ; at the very least, it would impede the other employee’s ability to do their job.

          1. fposte*

            I agree with that for sure; I’d find it disruptive as all get out. I just think the word “right” doesn’t apply here.

        3. Ewpp*

          I took teapot’s comments to indicate bringing teapot’s problems to their employer’s attention would be a necessity. But what teapot describes suffering from is not recognized in the US. I wouldn’t say not widely recognized. It is widely recognized in progressive European countries. But the stance you come from on it, and seem to consistently come from on it, is US based only. On the sites that ‘gossip’, the problem teapot describes suffering from is widely devalued. ‘A right’ was probably poorly chosen, but does the intent of the person’s message need additional criticism)?

        4. Baru Cormorant*

          I disagree. I think moaning in pain all day is unprofessional and inappropriate for the work environment. It’s heartbreaking that the coworker has to go through this, but that doesn’t mean the behavior is appropriate for work. What if their neighbor has to make phone calls with clients? What about the morale in the office, how are people supposed to pleasantly work with the coworker if they’re always moaning in pain? The reasons and causes are very valid and sympathetic but I think the resulting behavior is still out of line.

      2. Lilysparrow*

        Oh, come on. Vaccines aren’t about not bothering people. They’re about not *infecting* people.

        This employee’s degenerative condition isn’t contagious.

        But it’s really interesting that your completely inaccurate analogy articulates one of the subconscious fears that leads people to blame and shun chronically ill folk – the irrational fear that pain or disability might somehow be “catching.”

    4. Mathilde*

      Or that they are somehow obligated to make medical decisions based on “not bothering people.

      They are not. However, the employer wrote today, and is also concerned about the other employees, which are important too ; they have the right to perform their jobs without having to hear someone in pain all the time. It is just not reasonable to say they have to suck it up – notably because they also could have issues (mental health ones, for instance) which make it difficult to bear.

      The other employees should not have to bear it, yes. And their employer is right to worry about this.

      1. JSPA*

        Give the person in pain a private office, then, or offer a WFH or remote location solution.

        The “manageable” in the disease description is a statistical average. The idea that following the regimen correctly will leave everyone pain free–or that everyone can take pain killers that allow them to be pain free–is simply not so.

        People are in unexpected pain a lot more often and a lot sooner than they’re actually “disabled.” Forcing people out of the work force and onto disability because you somehow believe that they’re “not doing pain right” is way out of line. Implying that you’ll need to do so if the sounds don’t stop are a great way to drive someone to opioid addiction, kidney failure, or suicide.

        These are not screams that disrupt calls. This is policing of whether or not we have a right to pretend that pain doesn’t exist. We will all, if we live long enough, spend some time in pain. There’s no “right to not be aware that pain is part of life.”

        1. Mathilde*

          These are not screams that disrupt calls.

          You don’t know that, and event you are right, there are a lot of other ways the vocalisation of physical or mental can take a real toll on the other employees which would prevent them to do thier job well, and simply be in a place that doesn’t impact their mental health.

          1. Dahlia*

            Do you really believe that if the employee was SCREAMING AT WORK MULTIPLE TIMES A DAY, OP would not have mentioned it? Really?

    5. Sarah H*

      I have a chronic condition that can be managed with diet changes/restrictions. The diet changes might seem “easy” to most people, but they make being social difficult and having to explain to everyone, every time, why I can’t eat so many different things is exhausting at times.

      But! That doesn’t mean I get to sit at work complaining to everyone about how uncomfortable I am if I don’t stick to my diet. It’s 100% ok to make the care decisions for yourself that you are comfortable with. It’s not ok to make the people around you uncomfortable because of your decisions. As someone else commented on this, listening to someone moaning and groaning in pain all day can have a negative impact on mental health. That’s not able-ism, that’s just being part of a society and community.

      1. lemon*

        I think the ableism comes in with people thinking that the employee is “choosing” to suffer by not getting treatment. Not because the employer, rightfully so, need to address the impact that the employee is having on others.

        1. Mia*

          Yeah, to me the ableism is the notion that LW’s employee is just being obstinate and refusing to take care of herself, cause it’s likely a lot more complicated than that.

      2. JSPA*

        “moaning and groaning”=complaining.
        “moaning” = an involuntary pain related sound.

        Not the same.

        Yes, someone who grows up with pain or has training to handle it can often learn to suppress some of their otherwise automatic reactions to it, though YMMV; not everyone has that level of body awareness. Regardless, that’s not something one develops quickly.

        1. Sarah H*

          I don’t see where I said I grew up with this condition and learned to handle it. I’m aware of how my body and noises I make can bother people around me.

    6. Lilysparrow*

      One possible approach (and I don’t know how possible these would be for you, or the possible legal issues) if you have a great relationship with them might be:

      To have a conversation where you say something like, “I could see that your PT/steroid treatments gave you a lot of relief, but I understand you have obstacles to pursuing them. Is there anything we could do to make it easier, because I don’t want you to miss out on good options if there’s a way to make them feasible.”

      Maybe flexible work from home days? Maybe help with transportation on treatment days, like car service or Ubers? Maybe the company has discounts or group rates that the employee doesn’t know about for life-convenience stuff (grocery delivery, dry-cleaning pickup & dropoff, stuff like that.

      Does that fantastic insurance policy have visiting nurse service? Could the steroid shots come to the patient instead of them hauling to the drs office and back during the work day?

      Just brainstorming.

      1. OP*

        This is one of the most open-minded comments I’ve seen to the post so far. From my anecdotal opinion, the treatments absolutely were working, and any side-effects of the treatment were minimal compared to the chronic pain. While employee X was actively getting treated:

        -Their overall mood was 1000% better than it was at the onset of the condition and about 10,000% better than it is now
        -They came into the office with a cheerful and optimistic attitude, often going out of their way to brightening others’ days. This is in line with how employee X acted when first hired on. Since discontinuing treatment employee X is depressed and very pessimistic about many things.
        -They appeared well-rested and ready to take on the day, much as they did before onset of the condition. Now they are lethargic and seem to be suffering from sleeplessness (undoubtedly, because sleeping in constant pain is almost impossible).

        While every condition is different and people’s tolerance for pain varies, I’m far from ableist. 12 years ago I sustained multiple severe spinal injuries in a helicopter crash. I have chronic back and leg pain as a result. Some days it’s near unbearable. And I know what treatment and pain management entails. Again, each person is different, but after seeing the remarkable change in attitude and apparent comfort, I was baffled by X’s decision to cease treatment.

        1. Jamie*

          From my anecdotal opinion, the treatments absolutely were working, and any side-effects of the treatment were minimal compared to the chronic pain.

          The thing is there is no way for you to know that. Yes, you list many signs that could indicate that, but those could also be for other reasons including hope that things were going to get better before the effects of treatment changed.

          I would just caution you from thinking you know anything about how minimal her side effects were or weren’t or what was or wasn’t working. Those assumptions aren’t fair as you aren’t privy to all the details of her struggle.

        2. Feather*

          You know what *your* treatment and *your* pain management entails.

          If you’re not them or their medical team, you actually don’t necessarily know what *their* treatment and *their* pain management entail, because you are *not privy* to all of the details (yes, even if they “overshare” – that they’re sharing too much for your comfort does not mean they’re sharing everything) or their experience, and having one specific kind of injury-related chronic pain does not actually make you an expert on all chronic pain, particularly that linked to a degenerative condition that you do not appear to have.

        3. JSPA*

          That’s also what low level steroid mania can look like (but as the lack of sleep catches up to you, things can get very odd).

          Alternatively…depression is not an unusual response as the realities of a chronic condition set in. (Relationships can also fray as “essential interpersonal activities” become too painful.)

          Agreed that a “we’ll go over and above to make it possible to find solutions that leave you feeling as upbeat and functional as possible, in your private as well as professional life” might help. Some people feel they can’t ask PT to help them work towards non work relevant functions. (Men classically, famously ask the therapist about “doing pushups” which they need for their exercise regimen to stay in shape for work. Women classically don’t ask.)

          As OP has a story of dealing with pain to tell, that’s a great intro. Talking about how you had to define not just the accommodations but the daily, weekly and monthly goals for yourself, and how it was helpful to have guidance on thinking through that, and how you want to make sure she knows that’s yet another benefit she can access, so the pain and misery don’t get the upper hand… I’m thinking that should pass the legal sniff test.

    7. MatKnifeNinja*

      My mother had severe rheumatoid arthritis. She died basically because her bones in her neck crumbled due to 35 years of chronic prednisone use.

      I grew up with a mom who had total joint deformities, and horrible constant pain.

      PT and steroid shots are not a cure. It’s different if you have a knee replacement, and you Valhalla the PT and all the other stuff you are told to do. The light at the end of the tunnel is it’s worth it. You hopefully back at base line.

      My mom got to the point of f*ck it. Granted, f*ck it probably sped up her immobility by 20 years, but not everyone can keep fighting the “good fight”.

      OP, the person may be going through a big helping heap of depression too. You maybe only seeing the very best bits of her at work. Yeah, she could walk around without yelping treatment, but that doesn’t mean her life was waffle toast and ice cream at home. There is a cost to all treatment whether it’s time, money or emotional toll.

      People really dog piled my mom for “giving up”. A good chunk of giving up was the fact of knowing this sh*t was never going away and would never get better. Her chronic depression took over, so everything was why bother.

      I think a private office isn’t a bad idea. My mom would be exhausted “trying to play normal.” If employee is by herself, she could stretch, lay flat or make adjustments to position that one wouldn’t feel comfortable in the cube farm. You don’t even have to make the office permanent. Spin it as try it out and see if it makes things easier.

      1. Feather*

        This. Long-term steroid use has a HUGE, HUGE NUMBER of downsides.

        And this is but one reason you *should. not* assume that even if they have told you some details you are aware of a stranger or even casual acquaintance’s health issues and how they work. It is very likely that you don’t even know what you don’t know.

      2. juliebulie*

        Thank you for sharing all of this. I agree, it’s one thing to dread listening to the groaning; it’s another thing to make assumptions and judgments about the groaner’s motives and priorities. The private office seems the most compassionate solution all around.

    8. Mia*

      Yes, all of this. I find that even the most well-meaning able-bodied folks typically don’t realize that chronic illness is so much more complex than simply complying with doctors’ orders and being a-ok because of it. Coming up with a short answer like not wanting to wait is 100% something I would do if the real answer was actually a lot more revelatory than I felt appropriate for the office.

    9. GimpyGirl55*

      Thanks for posting this.

      I haven’t been able to walk for a year, go to PT twice per week, and have had chronic pain since July 2018.

      I don’t think most people in this thread get it.

      1. Kathy (counting the days until retirement)*

        GimpyGirl55 – No. They don’t get it. And probably won’t until they experience themselves.

    10. AntOnMyTable*

      LilySparrow – The writer knows a lot about this situation. A LOT. Seeing how appropriate they have tried to be I really doubt they solicited the information from the employee but instead the employee decided to freely share. To get upset at people for forming opinions based on what they were told is really odd. They were told the employee didn’t like waiting at the office and PT was hard. Why should they doubt the person telling them is being accurate especially since it isn’t harder to say “Waiting at the office caused more pain (or getting the shots) than they alleviated” if that is the truth.

      People *constantly* make short term decisions that cause more harm in the long term. All the time. In a zillion areas of health/finance/relationships/etc. So yes maybe it turns out PT and the shots have such bad downsides that it isn’t worth it but the employee decided not to frame it that way. Or maybe it really is exactly how they said.

  20. drpuma*

    I am wondering if the advice would be different if the LW had been a coworker and not the boss? Seems like someone with a coworker relationship would have more leeway to say something similar to the friend and family script of “Wow, you’re sure groaning a lot more than you used to! I’m sorry you’re feeling so much pain.” Of course even a coworker would have to let it drop fairly quickly, but the implied pressure is different. I’m curious what other people think.

    1. valentine*

      the implied pressure is different.
      If the purpose is to get her back to PT/steroids, especially if it’s because the coworker thinks they’re a sure thing/worth the financial cost/not a financial burden, it’s still wrong to do. I like Ann O’Nemity’s script because it doesn’t seek to change the employee’s decisions.

  21. Librarian of SHIELD*

    OP, it’s possible that the reasons your employee gave you for stopping treatment are not the real reasons.

    I had a terrible experience with a physical therapist several years ago. I only needed a handful of appointments to recover after an accident, but if I had been told I’d need to see this person twice a week for the foreseeable future, I don’t think I could have faced it. And finding a new medical care provider is not a walk in the park.

    If you do decide to talk to your employee about this, I think you should come at it from a place of care and concern. Don’t tell X that their coworkers are complaining about X’s very real pain. That’s not going to help anything. But if you can see your way to telling X that you’re concerned that they’re in pain so much of the time and are willing to try and work out a solution for them to get more/better treatment, you might get somewhere.

  22. Can't Sit Still*

    OP, addressing only the private office issue, I had a colleague who was a scream-sneezer who sneezed 8-20 times a day. She got an office as soon as feasible and there were zero complaints, even though technically, she wasn’t entitled to a private office just yet. (She was very, very loud, and it was more like shriek-sneezing. She sounded like a banshee, tbh. Incredibly disruptive to the rest of the office of 35 people.)

    1. RabbitRabbit*

      I would be deeply tempted to shoot rubber bands at her after each sneeze, to give her something to scream about. You can’t control sneezing but you can sure mitigate the output.

      I say this as someone who generally sneezes hard enough that it feels like I’m going to collapse a lung. I’m the only one in the wing of my office who actually muffles sneezes; everyone else blasts germs all over their workspace with pretty significant vocalizations.

      1. Jamie*

        You can’t control sneezing but you can sure mitigate the output.

        Tell that to my office-mate. Between his sneezes that can break the sound barrier and my hyper-startle reflex it’s like a very bad Laurel and Hardy skit in here between 10-20 x a day.

  23. Commuting*

    Does your company offer some sort of EAP or mental health counseling? There could be a depression component here, what with the nonstop pain and all.

    1. OP*

      I agree that X appears to be depressed. Our health insurance plan has free mental health counseling; that said, I’m not sure how someone in my position would go about recommending it, if even attempting to do so at all.

      1. Not So NewReader*

        “Employee, in the end what you chose is none of my business. I know things have been hard on you for a bit now and I wanted to be sure you knew that there is free counseling through our insurance here. Perhaps someone looking at the whole picture with you would be of some help.”

        IF you can tell a story or two of people who had success then vaguely relate the stories. “Years ago, we had a person who had a bad accident and they tried the counseling just to have someone look at the whole picture with them. The person said it was very helpful because of X and Y reasons.” (Only say something like this if it is true.)

        Then close with, “As I said, it’s none of my business what you decide. I am tossing out the idea because I would want someone to mention it to me, if our situations were reversed.”

  24. Not So Little My*

    There might be some reason they are not telling you about regarding why they are avoiding treatment. It might be something very private. It might be a good reason or a bad reason. You should try to make the workplace better for them and for your other co-workers, but it’s not anyone’s business but that person’s WHY they do what they do.

  25. Rockin Takin*

    As someone who has dealt with this personally and with friends/family, do not tell them to go back to therapy/getting injections. There might be reasons you don’t know for why they quit. Maybe they had a bad PT, and are nervous about trying to find a new one. Maybe even with good health insurance they still have a copay for every PT visit, and they simply can’t afford it (this has happened to me more than once). Maybe there’s side effects to the injection you don’t know about. Or maybe the insurance won’t cover the injections anymore. My friend just spent 6 months fighting for his Arthritis injections, even though they are definitely medically necessary.

    My mother is the queen of having serious health issues that she complains about, but not following through on action plans. It is really difficult having a chronic, degenerative disease, and sometimes all the extra work you have to do is just so overwhelming and exhausting you just give up.

    The option Allison gave is probably the best bet. Ask them to get checked out and get the list of work restrictions.

  26. lmt*

    The reasons the employee gave for stopping treatment may not have been the only reasons. People make private medical decisions for private reasons, and just because the OP received some information does not mean that they received all of the information. The cost could have been more than the OP realizes (and really, the employee’s budget is their business), or the treatment could cause the employee significant pain or other discomfort.

    There can always be more going on than we know about.

  27. Phony Genius*

    Many doctors I know would consider “fitness for work” in a situation like this to be defined based on the patient’s tolerance for pain. If the worker says they can tolerate the pain, the doctor may not feel that they have any basis to question that.

    Aside regarding one of the lawyer’s comments: I recently turned down a private office. It has a notorious climate control problem and becomes unbearable cold/hot depending on the time of day. Nobody else wants it, either.

    1. Risha*

      A doctor assigned to do an evaluation for SSA disability on my father once scattered a handful of change on a table and asked him to pick them up, and when he managed to do so declared him able to work because he would be able to make change as a cashier (never mind that he was in too much pain to stand in one spot for an entire shift). He did eventually get on disability, by the way, after getting a lawyer and jumping through many more hoops. But yeah, the chances of a doctor declaring this employee unable to work just because he’s moaning in pain while doing so are exceedingly low (unless the doctor just plain takes pity on him).

      1. Phony Genius*

        And if you ask your doctor to say that you are fit for work, he will likely declare you as such, unless you have a contagious disease or could seriously injure yourself while working.

        1. Risha*

          And honestly, that’s for the best. We don’t know enough about this guy’s personal financial situation to _know_ that he’s ok being on leave, and even if that aspect would be fine, being unable to work is psychologically devastating for a lot of people. It’s not a straightforward call from the outside.

        2. Bostonian*

          Yeah, this is spot on. I’ve been told by many regular primary care doctors that they don’t declare fitness to work. And if they do examine someone, unless they see something really egregious, they’re not going to say you can’t work.

          A visit to an occupational nurse won’t help either (although all of the ones I’ve seen have been FANTASTIC) because it has to be an MD who declares fitness to work for disability reasons.

          (Don’t) ask me how I know.

      2. Aquawoman*

        I used to review disability cases for an appeals court, and those things were appalling. I’d regularly read cases finding people not disabled because they could watch TV all day and go to church on Sundays.

        1. Risha*

          There’s a reason they say to always assume you’re going to lose the first attempt, no matter how sick you are.

  28. Crayola hippo*

    Oh man, I get this. I had a colleague that did this. Every time she took a step she moaned about her knee pain, and just the CONSTANT complaining. Every time she spoke it was about her knee pain. It was reeeaaalllyyyy hard to do the sympathy dance she so clearly wanted by the end of my 3 years at that place. I have no advice, since I ended up transferring to a new town, but I know that this position sucks.

  29. LGC*

    …am I missing something or is WFH not an option? (Like, at my job it wouldn’t be an option, but I feel like that’s another potential avenue. But that could risk feeling like putting the employee in the shame closet as well.)

    But yeah, a leave – especially a paid one if you can swing it – would work wonders for you guys! Although…what if the employee turns that option down?

  30. AnonForThis*

    I am baffled by this letter. Why do people continue to think, that they know better how to manage another person’s health than the person themself? It is not your body, and you are not their doctor! It is safe to assume you do not have the full picture. Honestly if they chose being in this much pain over treatment, my assumption would be that there is a damn good reason for that. People generally do not volunteer to be in constant pain.

    1. Kevin*

      Nobody wants to hear someone groan on continuously at work. It’s undignified and unprofessional.

      I have a severe knee injury I never got fixed from high school football (pretty sure it’s a torn ACL) and under certain conditions it pops and locks up and is extremely extremely painful. I’ve never said anything to anybody at work or groaned about how much pain I’m in.

      At some point you have to deal with your issues or shut up about them.

      1. AnonForThis*

        I’m sorry, that you are in pain and that messed up societal standards made you think, showing your pain is not acceptable. Being in pain is not a weakness or character flaw. And pain should not be this stigmatized or taboo.

      2. Dahlia*

        Having to worry about being “dignified” enough while you’re in pain is an incredibly ableist, messed up concept.


  31. Theory of Eeveelution*

    Something I was surprised Alison didn’t mention is that an employer should never, EVER assume an employee’s financial situation just because they know their take-home. Lots of people have financial obligations that make that number irrelevant. An employee could be taking care of an ill parent, or they could be paying down student loans, or fixing up a house, or any number of private situations that mean they don’t have a lot of disposable income. An employer making this assumption is so inappropriate!

    1. Ask a Manager* Post author

      While I agree with your general point, it’s possible the OP’s statement is perfectly reasonable to make. Let’s say the steroid shots are needed every 8 weeks (she said “occasional”), at $20/time (per the costs in the letter), so that’s $130/year. If the employee makes $150,000/year and just mentioned her new car that she bought without a loan and shares enough about her shopping/dining choices, it could certainly be reasonable to assume $130/year is not a significant obstacle to medical treatment for her.

      1. Theory of Eeveelution*

        None of that information is in this letter! Also it sounds like the person in this hypothetical situation probably has a lot of credit card debt, so I feel my original point stands!

        1. Ask a Manager* Post author

          I know none of that about her spending or income is in the letter :)

          I’m saying that there are lots of situations where someone could reasonably say “I’m pretty sure this isn’t about finances.” For the purposes of answering the OP’s letter, I’m willing to take her at her word that this is one of them.

      2. Mr. Tyzik*

        Alison, thats’s not a reasonable assumption. Maybe the steroid shots are cheap, but medication likely is not. Did you know that 3 months of Humira is $1oK? How much for pain meds? it’s ridiculous.

        We have diabetics in the US who are dying because they cannot afford insulin. One can never assume benefits even when working under the same plan.

      3. OP*


        What you’re saying is spot on. I know enough about my employee and their home life (as people are inferencing, employee X speaks VERY freely about personal things) to feel extremely confident in saying that $20 every six weeks is not a bank-buster. And the steroid injections would have been discontinued after 3 months anyway because they are not intended for long-term treatment.

        1. Dahlia*

          Honestly you need to back out of X’s personal life. You don’t need to know the details of their finances or their medical treatment. Keep the focus on work stuff only.

          1. a1*

            OP can’t get out of X’s personal life since X talks about without being prompted. OP isn’t asking about it. Some people just overshare all the time. Do you not know anyone like this?

        2. Kathy (counting the days until retirement)*

          An employer should EVER make assumptions about another person’s financial situation.
          Or their health situation.
          Or their pain management.

    2. Yvette*

      Exactly. No one knoww what other costs are being incurred by the employee and their family. They could be supporting other family members, an elderly parent or parents in a nursing home, or other sick family. You cannot assume the state of someone’s finances based on knowing their salary.

      1. Myrin*

        The employee is being very open with the OP, though, and about pretty privat matters, no less. So I think it’s at least not unreasonable to assume that they might be just as open about their financial status (although that’s not a given, of course).

  32. That Girl From Quinn's House*

    I’m going to make a counter-argument. I worked with a woman who was in need of a joint replacement who was in constant, awful pain. However, she plugged along doing a very physical job without much complaint, because she was very selective to whom she expressed that she was in pain.

    As a result, her boss was very uncooperative when she did have really bad pain days, or needed doctor’s appointments for her surgery. Because “you’re able to do X,Y, and Z, I don’t see how you’re injured, HARUMPF.”

    Squeaky wheel gets the grease and all.

    1. Filosofickle*

      It really can seem if you’re damned if you do and damned if you don’t! I once had a coworker who had ongoing, severe kidney issues but she took great pains never to let anyone see she was sick. Despite her being a rockstar performer, there was so much muttering about her, why was she out AGAIN she didn’t look at all sick yesterday. (This while she was in the hospital, but they didn’t know.) :(

      1. EH*

        I have a handful of chronic health issues, and do this dance at work all the time. How much crap do I admit to enduring? How much is too much? How much is not enough?

        These days, I am honest about where I’m going and what I’m doing (when I miss a day due to migraine, I say it’s because I have a migraine; when I have a doc appointment, I say so, but usually don’t explain what prompted it). So far, that’s worked well, but I’m in tech and work remotely 3x/wk, which makes a big difference in bosses/coworkers being cool with irregular hours.

        Chronic pain makes chemical changes to the brain and other body systems, and folks who haven’t had it often don’t understand and don’t realize that the don’t understand. It’s worth reading up on it, if only because age often brings chronic pain with it and it’s good to be prepared.

        1. Filosofickle*

          While I never discounted people’s chronic pain, until I experienced it myself I had absolutely no idea. It took a massive toll on every part of my life and wreaked havoc on my mental state and career.

          I remember expressing frustration about it to a coworker and said something like “it’s been FOUR MONTHS of this” and she looked at me and said “just wait til it’s been four years.” And the bottom fell out of my brain. (It’s been seven years for me and thankfully with spine surgery and lots of maintenance work it’s not too bad.)

          1. Lilysparrow*

            Yup. There’s an awful lot of folks going “but I would” and “but everyone knows” and “well, when I had PT.”

            You don’t have a clue until it happens to you. And even then, you don’t know what it’s like for someone else. You only know what it’s like for you.

            1. Feather*

              This. Seriously so much this. And just because someone’s sharing details that seem very private to you doesn’t mean they’re sharing the details *they* feel uncomfortable or private about because – and this seems to be an astonishing concept to many – *people are very different with what they think is private.*

    2. Quill*

      Because I am young and otherwise fit, I CANNOT get people to “go easy on me” in terms of physical activity when my chronic tendonitis flares up. It’s taken 10 years for my family to accept that I can’t go hiking with them for two hours or stand in line for a concert, and sometimes can’t wash the dishes.

      There’s a fine line to walk with pain between “am I annoying people?” and “can I make it clear to people that this is real and I’m not faking it to get out of something they want me to do?”

      Because when it comes to people like that you can’t win, because they equate health with virtue. “You wouldn’t be sick if you’d do crossfit (impossible) / Yoga (i do) / Keto (wtf) / This fad diet / prayer.”

      1. EH*

        I was told to cry more once. Fibromyalgia is caused by not crying enough as a child, you see, so if I catch up on the crying, my health will be perfect. *eyeroll*

        I worry about performing pain “correctly” a lot.

        1. Mel*

          Ugh this! I was being jerked around with dental appointment scheduling when I had a tooth that required a root canal. It was only when I broke down during an appointment in month 3, because I kept being told to come back for another appointment that was scheduled 1 month out. Because I have fibromyalgia, I was able to be quite stoic with the tooth pain, but the frustration of being told I’d need to wait another month to get *anything* done broke me. Right then, the provider told me to do just that to demonstrate how much pain I was actually in.

        2. MsChanandlerBong*

          That is a great way to put it. Even doctors don’t seem to realize that someone can be in terrible pain/feel terrible without moaning or looking miserable. When I had my heart attack, they nearly sent me away because I laughed at something my husband said while I was waiting. Then my troponin level came back at 26, and everyone started moving pretty quickly then.

        3. Alexandra Lynch*

          Oh, yeah. I’m not terribly big on performing pain. If I say, “Whew! I need to sit down now,” in a cheerful, “moving right along!” voice, it means that if I sit now I may be able to stand up and do more in 20 minutes, and I’m trying to make myself okay with having to work at the pace of my messed-up ankles and feet. If you want to wait til I’m limping and biting my lips and groaning, I’ll be unable to do more than walk to the bathroom for the next six or eight hours, and maybe longer if the fibro kicks in and amplifies it, as it is wont to do.

          The trick of how to perform enough pain without being obnoxious is a hard dance to learn. More so if the only way you got a lot of fussing and caring and sympathy when young was when you were sick.

  33. Kate R*

    “I wonder if the right way to handle this is to place the employee on a leave of absence (paid or unpaid) and require a fitness for duty before she is permitted to return back to work. If she’s groaning in pain all day long, I’d argue that she has a medical issue that is limiting her ability to perform her job, and require her doctor to certify her as fit to work.”

    This really surprised me. While I understand why the groaning is annoying, I don’t see how it has anything to do with her fitness to perform her job duties unless her job duties require her not to groan (or if she’s customer facing where the groaning could be deterring people from doing business with them or something of that ilk). We don’t know anything about X’s job duties or how well she is performing it, so I feel like claiming she’s not performing simply because she has a disability seems like a violation of ADA. And forcing her to take a leave of absence, particularly an unpaid one, seems like an ADA nightmare. IANAL, and Joe is, so I realize he knows better than me, but that to me seemed worse than the OP mentioning the groaning was distracting. I understand why Alison feels its inappropriate to have the “You’re in pain, go back to PT” conversation, but I do wonder if some middle ground might be opening up the conversation about possible accommodations for X. Would it be inappropriate to mention that other colleagues have commented on X being in pain if it was framed as, “Are there accommodations we need to make for you?” That kind of puts her on notice that people are noticing her noises enough to comment to the boss about it, but also gives her the opportunity request things that might help (e.g. a new chair, less walking around to meet with people, a work-from-home situation, etc.). And if that doesn’t work, then yes, I would move her to a private office.

    1. hbc*

      Yeah, this seems like some obvious hoop jumping that’s worse than just saying what you mean. It sounds like putting X on leave because of the noise, which is just nonsense.

      Now, if in reviewing the situation, OP really does believe that this has been a hole in the process (i.e., that X should have gotten a doctor’s approval for work based on the reported diagnosis, regardless of groaning), then have at it. But it sounds very likely that X’s doctor will find that doing a desk job is no more stressful than hanging out at home and will approve X for work, and then OP still has to deal with the moaning.

  34. Quickbeam*

    For me there is a huge difference between the care EE is choosing not to get…and the loud moaning. Many of us live and work in pain. The moaning behavior is problematic and disruptive. And it may be a behavioral thing.

      1. Quickbeam*

        Vocalizations are a behavior. No judgement.

        As a survivor for more than 50 years of a degenerative auto-immune disease, the most important thing I learned from rheumatology is that while I may not be able to control the disease, how I handle the pain will frame my view on life.

        More important to this letter, I feel it is necessary to push back against the idea that an employer has ANY input on medical care. I’m asked daily why I have’t had this or that joint replaced. I have a reason but it’s none of their business. My employer aggressively manages disability leaves with constant phone calls and letters to the MD about return to work. I am waiting until after I retire to have my surgeries on my own time without interference. As long as someone can do the essential functions of the job, it’s a non issue. Unless of course they are disrupting the work place.

  35. Kevin*

    This letter brings back bad memories. I had a co-worker who had severr arm/wrist pain the effected her ability to work and her KPI fell off a cliff. She went to physical therapy four times which was the max our health insurance would pay for in a year. It did help her but her work performance barely improved. Unfortunately she started getting insubordinate with the manager, belittling and talking back to her in front of everyone. She was eventually let go for insubordination and made a huge scene in the HR office claiming she was going to sue because she was being fired for a medical issue. She never did that I know of or heard about but it was ugly times all around.

  36. anon4this*

    Why not sequester the employee to a different part of the office or have them work remotely (if possible)? It could even be seen as accommodation for their illness.
    Past that, its a bit murky and I would be pretty alarmed if a workplace was telling me how to take care of myself (or judging me for not).

  37. JSPA*

    corticosteroid injections are of decreasing effectiveness systemically, and are actually counterproductive if over repeated, especially in that they can lead to degeneration at the site of injury. They’re also (personal experience) painful.

    “don’t overdo the corticosteroids” is the new dogma. It’s possible your employee is actually better-informed than the doctors, many of whom are still glad to keep the shots coming, long past evidence for effectiveness, and well into the zone of evidence for harm.

    So says the mayo clinic, from which I quote, with link to follow. This is particularly true for site-specific injections (which have an “ever-ever”) limit, as well as for generalized injections for a whole body disorder.


    “Complications of cortisone shots can include:

    Joint infection
    Nerve damage
    Thinning of skin and soft tissue around the injection site
    Temporary flare of pain and inflammation in the joint
    Tendon weakening or rupture
    Thinning of nearby bone (osteoporosis)
    Whitening or lightening of the skin around the injection site
    Death of nearby bone (osteonecrosis)
    Temporary increase in blood sugar
    Limits on the number of cortisone shots

    There’s concern that repeated cortisone shots might cause the cartilage within a joint to deteriorate. So doctors typically limit the number of cortisone shots into a joint.

    In general, you shouldn’t get cortisone injections more often than every six weeks and usually not more than three or four times a year.”

    1. LawBee*

      “they’re also possibly painful” – fixed that for you, because mine weren’t painful at all.

      1. JSPA*

        Depends which joint, apparently, and whether they’re trying to get inside, and how well – supplied with nerves the region is. And whether the comparison is to, “if this were a placebo” or just, compared to no intervention at all. Temporary pain and increased inflammation are a very common side effect, though. And we are (after all) looking for reasons someone might find the treatment problematic–because it evidently is problematic.

  38. Rebecca*

    I hope this OK for me to share, as someone with pain issues who works in a non customer facing office. I also have awesome insurance! I’d like to address a few things for the OP.

    Steroids: I had a bout of sciatica pain, and luckily, it was just that my nerve was inflamed, and it was easily resolved with steroids and muscle relaxers. The pain was surreal, and I hope it never happens again. But, the steroids made me feel enraged. I told my coworkers about it – as in, please know that I’m taking this medication, I feel terribly enraged, and if I lash out verbally it’s not you – I am having a terrible time here! I only had to take the meds for 5 days, and I told my doctor’s office, never again, unless I’m literally at a life or death situation. Perhaps your employee is having a bad reaction, so even though mobility might be better, the side effects are just too much.

    Physical Therapy – I have arthritis and was having severe pain issues. I don’t do PT, but I walk and hike regularly. I found new meds, and it’s been a lifesaver, literally. I can’t imagine doing the hikes I do now without the new meds. Perhaps the meds they’ve tried have too many side effects or they simply can’t take them. I’m just stating this from my own experience. I have a huge reduction in pain now, and I am so thankful I can take the meds prescribed, but if I couldn’t, I could see myself being the moaning and groaning employee, because yes, it hurts a lot sometimes just to stand up and start walking!

    So bottom line, this may have nothing to do with cost or inconvenience. I think asking how to make them more comfortable at work would be key. Could you get a personal laser printer for their area, to limit the times needed to go to a central printer? Maybe move their desk closer to the rest room or break area? I truly hope the employee can find relief; my heart goes out to them.

    1. Arctic*

      Yes, the steroid thing bothered me a lot. There are a lot of reasons why someone wouldn’t want to be on steroids. And sometimes the pain is actually better for some people than the adverse reactions or mood swings.
      The employee may not feel comfortable going into the reason why.

    2. JSPA*

      If it’s pills, then yes, atypical cortisone response is not at all rare–it’s a form of mania often coupled with rage, and it’s a complete contra-indication for steroids except under tight monitoring in extreme or life-threatening situations. Low dose or local injections are something quite different, though; most people tolerate them fine, mentally, even if they have a mania response to the pill series (a hugely higher dose).

    3. OP*

      Having had experience with steroids myself, the decision to stop using them hardly baffled me or concerned me. I was more confused by the decision to stop PT when, visibly at least, the employee’s attitude and comfort level were improved by leaps and bounds compared to the onset of the condition and definitely compared to present time.

      1. Feather*

        Again: you’re REALLY making the assumption that what you saw was/is everything that’s going on with their treatment, as well as direct cause-effect, when you are not them, their physician, their physiotherapist, or (you know)….them.

        Which is not a good idea.

        1. OP*

          I don’t want to tell them how to treat the condition, which I realize in hindsight is how it may sound. I was mainly frustrated that the employee had showed such visible improvement under medical care. I don’t think some of my assumptions are completely unreasonable given that the employee overshares to the point that I know more about employee’s mother-in-law’s ailments than her own doctor. Furthermore, the details volunteered to me regarding the condition and some of the therapy were so excessive and unrestrained that a reasonable person in my position would fully expect that no details have been left out. Regardless, at the end of the day I just want to know if there’s any way to restore peace to the office. I’m pursuing the possibility of WFH with company leadership.

          1. Feather*

            It very much did sound like that, yes – the significant connotation was “if they would only Do These Things I wouldn’t have these problems! I wish I could make them do these things!” So that is probably where a lot of responses are coming from.

            The problem of disruption of the office is totally legit, and it’s a tricky one. I hope the WFH works, or that you’re otherwise able to get across that the noise is disruptive without stumbling into all the problems of how people take things. (Which I also totally get: my impulse would be as their coworker even to go “hey did you know you’re audibly in pain a lot?” but it would depend on my read of them in general and also a coworker is different from a supervisory position, and I get that you’re navigating that.)

            I wish you all the luck, fwiw.

  39. PharmaCat*

    I think the performative moaning would make me crazy. Many of us are dealing with chronic health situations, quietly! Asthma, migraines, diabetes, arthritis……trust me, you really dont want status updates from everybody on their daily physical and/or mental health challenges. Did this person have a problem with boundaries before this illness?

    1. OP*

      The employee has always “overshared” their personal lives with their coworkers and with me as their manager. I’ve overheard people complain about X’s tendency to be super loose with long-winded details of their personal life. Sometimes I have to tell X that “I’d love to hear more about the injured hamster that you and your spouse rescued on your trip to the Virgin Islands in 2004 but let’s refocus the conversation on the work-related discussion we were just having.” I believe that’s why some of the others in the office might find the moaning/groaning noises to be somewhat of an embellishment, though I’m not so sure that they aren’t authentic and legitimate. I’ve watched through the window two floors up as X gets out of their car in the employee lot and they look to be writing in pain. What I do think may be a bit contrived is the seemingly over the top sighs that are sometimes uttered. They’re pretty elaborate.

      1. fposte*

        You’ve asked a thorny one here, OP, and I’m glad you’re being thoughtful about it.

        I think that some people just process their lives more out loud than others, and it sounds like your employee is one of those. For those of us who don’t, it’s hard to grasp that the things that would make *us* make that noise aren’t necessarily the things that would make somebody *else* make that noise.

      2. JSPA*

        General oversharing is totally something you can address if the WFH doesn’t work out (or even if it does). And it’s fair notice to shut that down sooner with the next person, so you and everyone else are not already fed up before something serious comes up. Because the level of irritation makes so much more sense in a pre-irked context.

    2. Bibliovore*

      Here’s the thing. If I sit for a long period and then get up, there may be a sudden stabbing pain. I get the same pain when I get out of bed in the morning. Or up from the table. Or turn suddenly. Or if I stand too long. Or sometimes out of nowhere. It is unpredictable. On the kind of bullsh*t pain scale of 0 to 10. I am a constant 4/5, and on bad days 6/7. I had an emergency once and the first responders asked about my pain. I said 6. When the EMTs arrived, they asked me about the pain, the first responder said 10. I suspect unless X is moaning the same amount as breathing, they are keeping it to themselves as best they can.

  40. Buttons*

    If there hasn’t been a change in their performance, they are still an A+, then I wouldn’t think this is a performance issue that could be addressed by a LOA. This sounds to me like the same kind of behavior as a whistler, sigher, groaner, or the person who talks to themselves. I would probably ask them if their desk/chair were still comfortable and meeting their needs, and if they answered yes then I would say “you are probably unaware of it, but you moan as if you are in a great deal of pain, often. I want to make sure you are ok or is this just an unconscious habit?”

    1. OP*

      “This sounds to me like the same kind of behavior as a whistler, sigher, groaner, or the person who talks to themselves.”

      It’s funny, but in hindsight, you just described employee X under “normal” circumstances. Not that I don’t think they’re in a lot of pain, but what you said really is spot on. Prior to all this, X regularly whistled up and down the hallways, and sometimes at their desk. When their computer would run slow, X would sigh or groan in frustration extremely loudly. And when deeply focused on something, X would often talk out loud. I actually addressed the whistling and the talking out loud with X one time, and X told me they weren’t even aware of it. That’s why, as I mentioned in another comment, I’ve always wondered if X is even aware of the pain-related noises. As much as I wanted to, I just never felt like I could ask if they were aware of it because it’s disability related.

      Now that you jogged my memory, I wonder if it wouldn’t be out of bounds to ask something like “seems like you’ve been in a lot of pain recently; because you weren’t aware of your whistling and talking to yourself in the past, I’ve got to ask, are you aware that you’re making a lot of loud and really audible groaning noises? If they’re related to the pain you’re experiencing, is there anything more we can do to make you more comfortable here?”

      1. NYWeasel*

        That’s the direction I was thinking of—not jumping to a (potentially involuntary) LOA, but starting with “Hey, is there something here you need help with, bc the moaning sounds like you are really suffering.”

        As for stopping the PT etc, its not up to an employer to demand an employee undergo specific treatments, and as Alison always suggests, it’s not the actions themselves so much as whatever the impact is to the workplace. You wouldn’t care so much about the employee not going if they weren’t moaning all day long. So it’s not worth trying to address it with the employee.

  41. Arctic*

    Just as a practical matter, I’d say that every time my office has done a fitness for duty eval on a borderline case like this it has been a mistake. (It comes up more than most for reasons that would be doxxing.)
    Every time it is borderline doctors have said they are fit for duty. And it puts a strain on the employee-employer relationship as it is invasive and can feel like a punishment (when it is not.) And people often feel like you are trying to force them out.
    There has never been a case where we weren’t legally allowed to do it. But many where it was not wise, in the long run.
    This is just anecdotal, of course. Anecdotes aren’t worth much. But I am internal legal department and I would not have that be my first move in this case.

    1. Manders*

      Yes, I think trying to push this employee to get evaluated by a doctor would be a mistake in this case. It sounds like this is a desk job and the most taxing part of this employee’s day is walking to the desk–I really don’t think it’s likely a doctor will say they’re not fit for duty.

      I sympathize with the OP! Something about this setup probably will have to change. But pushing for a fitness for duty evaluation is not the way to go, and it might make this employee more resistant to proposed changes that could actually fix the noise problem.

  42. CM*

    An LOA seems like a drastic solution unless the employee wants it. Why isn’t the solution to talk to them first? I think my first move would be to say, “Hey, I know you’ve been suffering from this medical condition for months and we’re all concerned when we hear you moaning and groaning in pain every day. Can we discuss some possible changes? Would you be more comfortable if you worked from home, or moved to a private office, or went on a medical LOA for a while [or whatever the OP wants to propose?]”

  43. Not a Blossom*

    It is a shame the groaning can’t be addressed, because honestly, some of it could be suppressed. I’ve watched one family member grind away with PT after a knee replacement that had some complications and he didn’t groan constantly. I have another who has a medical condition that causes constant pain, and again, she’s not groaning with every little move.

    I get that constant pain is miserable, but I also don’t think that gives X the right to be selfish. I think the fact that the noise is constant combined with X giving fairly flippant reasons for not continuing treatment (as I said above, I don’t think she should have given any reasons, but that ship has sailed) is really contributing to the OP’s aggravation. I am all for people doing or not doing whatever medical treatments they see fit, but I am also about trying to mitigate the amount of annoyance I cause others.

    1. Delphine*

      Please don’t frame a person’s personal medical decisions as “selfish.” And just because you know people who suffer from pain but don’t make noises doesn’t mean that it isn’t completely involuntary for X.

      1. Not a Blossom*

        I didn’t frame anyone’s medical decisions as being selfish. I framed constantly moaning and groaning in an open office as being selfish. I’m not saying X has to be completely silent, but making noise all day every day in the office means that either she is not being a considerate colleague or she should not be at work.

      1. OP*

        Yes! This gets down to the crux of my frustration and my overall feeling of helplessness in regards to the situation I’m in. What I so badly want to do is say “I know that you’re in pain and I truly feel for you, but there’s something you may not be aware of that needs to be addressed…” Because I really do think that X may not be aware of the extent to which it’s happening.

        1. fposte*

          Maybe it would be helpful to think of this as being more like the scream-sneezers discussed upthread, because that takes away the “performing chronic disability correctly” issue. Sneezing vocalization is a habit. It’s likely changeable for most people with some breath practice and time, but it’s really, really ingrained, not a voluntary choice that they can turn on and off just for being asked to. (Now I’m reminded of the post where we gave instructions on how to burp and fart quietly to an OP who didn’t realize such things were possible.) Your employee seems like she’s been a scream-sneezer in many ways.

  44. hbc*

    OP, I think it makes sense to figure out what you would do if this was a condition that had zero treatment options and no chance of improvement. X is making disruptive noises due to a documented medical condition–the end. How do you accommodate that given the environment and job requirements?

    It’s probably going to be impossible to completely shake the idea that X has the solution right there and is choosing to make things worse for everyone, but the safest moral and legal path is to not let that affect your accommodations.

    1. Lilysparrow*

      “…figure out what you would do if this was a condition that had zero treatment options and no chance of improvement. X is making disruptive noises due to a documented medical condition–the end. How do you accommodate that given the environment and job requirements?”

      Yes, exactly.

  45. Clementine*

    Oof, this is a tough one. I think that forcing a LOA could be an ADA issue and would tread very lightly. A LOA like that is the foundation for “proving” that the employee cannot do the essential functions of their job and is ok for dismissal.

    FWIW, I have a lifelong, degenerative and extremely painful condition and its tough for everyone to deal with. Sometimes, groaning is something that I can’t control, almost like a reflex. This is with treatment- PT, pain meds, stem cell therapy, etc. The employer likely doesn’t have a full understanding of what is going on and treating the employee differently because of their disability can have negative consequences.

    My situation escalated and resulted in an EEOC complaint and ongoing legal action, which could have been avoided if it had been approached correctly.

    1. Jamie*

      I’m sorry you’re going through that. I can’t imagine how hard it must be to deal with chronic pain, then have work related legal stress on top of that.

  46. MsChanandlerBong*

    I wonder if the excuse about waiting for the shots was just that–an excuse. I have had 16 surgeries in my life. Four of them on my spine, multiple open abdominal surgeries (laparotomies vs. the less-invasive laparoscopic surgery), etc. In other words, I have a pretty high tolerance for pain. When I had a cortisone shot for pain/inflammation, it was honestly the most painful thing I ever had done to me up until that point (it has since been replaced by the cardiac cath in which they didn’t give me a local before piercing my femoral artery; I was sobbing and begging for pain meds the whole time). Maybe the employee is embarrassed to admit they were painful for him.

  47. Canadian union rep*

    As a union staffer, if an employer put one of my members on an involuntary medical leave and demanded evidence of fitness for groaning – without evidence or even a reasonable belief that they might actually be medically unfit – I would be VERY MUCH in the employer’s face and it would be extremely unpleasant. And in my jurisdiction it would very likely be a human rights law violation.

    I’d be arguing that the employer may have a duty to enquire as to whether the employee has a medical condition that may require additional accommodation, and there are delicate conversations that can be had around disturbing others (a private office might be an accommodation the same way it could be if an employee’s medical condition made them, say, cough or hum), but this would be dangerous ground for an employer in my context.

  48. blink14*

    As someone with chronic health issues (one recently diagnosed that will require lifetime treatments), and as someone who has been to hundreds (literally) of physical therapy appointments, people who refuse to help themselves in a health situation frustrate me SO much.

    Yes PT is not a fun time, and can be really painful/uncomfortable/require sweat. Steroid shots hurt like hell, and can cause side effects. But when you have the option to treat a degenerative disease, or a chronic disease or injury, and you don’t, frankly that’s your own fault and you should stop whining about it. Completely would understand if the treatment was putting this person in a serious financial hole, and then it becomes a juggle between which treatments to do and how frequently, if at all. But regardless of their personal financial situation, they have access to, and PAY for, what sounds like a great insurance plan.

    Maybe all of the completely and refusing treatment is denial, but at the end of the day, take the treatment available! You will regret it later.

    I’m not sure if there’s anything you can do as an employer, but I feel your pain on this one!

  49. animaniactoo*

    My mom is currently recovering from a major setback with a degenerative condition that leaves her struggling to breath all day every day. PT is painful and tiring. And she doesn’t WANT to be unable to walk the 15 steps to the dining room and pick up her glass of water herself. But at the same time, sometimes the PT exercises are just more energy than she has left while she struggles to breathe. Even though those exercises will build up her capacity a little bit. My father has not yet truly accepted that it’s going to be a little bit and the only reason a little bit is worthwhile is because it staves off the absolute extreme she’s slowly pulling back from.

    But… by that same token, my mom is so busy struggling to breathe and figure out her life and her new normal that she is totally oblivious to things that she does at points. She is so zoned out at points that she doesn’t realize that in the middle of a visit with some family, when we finally had some conversation going, she did her *best* imitation of my grandfather in his later years, and reached out her hand to…. turn the baseball game up cuz she couldn’t hear what the announcer was saying. She didn’t realize it at all and laughed at herself when I pointed it out to her a couple of weeks later as a “you might want to keep an eye on that before it becomes a habit”. In large part, because it always frustrated her about my grandfather and because I know that it’s not who *she* has wanted to be and taught us to be in terms of how you treat and interact with guests.

    All of which is to say – there’s a strong likelihood that the employee has some decent reasons for not continuing with treatment at this time (who knows. they may hit a point in the future where they are more up for it mentally and so on). Possibly may not be up for it ever, but that’s their struggle to manage. However, they may not realize how much they are vocally expressing what’s going on with them physically. Towards that, I think the private office might be a decent solution if you can swing it, but I would also address the groaning completely from a standpoint of concern for them.

    “Hey, I don’t know if you’ve realized this, but you’re pretty much groaning in pain all day every day and I’m concerned about you. I know we’ve done a lot to accommodate you, but I’m wondering if what we’ve set up is making enough difference for you. In an ideal world, what would help you? We may not be able to get all the way there, but let’s figure out if there’s something possible between here and there.”

    1. animaniactoo*

      FWIW, a large part of my thinking around this is stuff where my mom can’t do as much as she’s being asked to do at points, and gives up. I’ve been working with her around that to say “Okay, if you can’t do that, what CAN you do”, and that opening the door to realizing that my dad’s been awesome. Her doctors are pretty amazing. But all of them are talking to her about what they can do for her and what she needs to do, and being pretty authoritative – my dad in particular – about it without stepping back to say “okay, what’s getting in the way of this”. As soon as we started unpicking some of the hurdles, we were able to make changes like rearranging the living room furniture to provide her more space to do what she *can* do without having to ask anyone to “temporarily” move the furniture so that she could do it. Installing grab bars in the bathroom is great, but it’s not enough of a solution to her overall needs. She’s starting to look at that a lot more deeply and be able to ask for what she needs, but that started from a mindset of somebody asking her what was standing in the way (other than general ability to breathe), and what she *could* do even if it wasn’t the whole megilla of what the PT wants her to be doing.

  50. Medical care isn't cheap*

    Has OP considered that the employee may not be able to shoulder the COST? I recently went to two weeks of PT sessions (four total) and my bill was over $500 (and I have great insurance). I don’t have $1000+ per month for medical expenses, and I imagine their reasons for ceasing the treatment have more to do with the monetary burden than “not wanting to wait.”

    1. LawBee*

      Her PT is covered, per the letter. The occasional shots are $20 co-pay, per the letter. Yes, finances may be an issue, we don’t know, but your examples don’t meet the facts of the letter. Her insurance is better than yours. (And mine, for what it’s worth.)

      1. Medical care isn't cheap*

        Insurance covering something doesn’t mean she has money or that it’s free to the patient. Just because the co-pay is only $20, doesn’t mean it’s something in that person’s budget — no matter how much they are making. My PT was “covered,” too. It still wasn’t anywhere near regularly affordable. I find it strange that OP knows in detail how much each medical bill is when, ostensibly, is not getting the same type of care.

        My overall point here, though, is perhaps the “I’m bored by PT” is an excuse because the real reason they aren’t getting treatment is something else – financial – and they are embarrassed to say so.

  51. Mannheim Steamroller*

    [I’m not sure I’d tell the employee to stop moaning in pain. I’d be concerned that the employee might perceive it as harassment and it will create more problems than it fixes.]

    The cynic in me suspects that the employee might WANT to be told to stop for the specific purpose of perceiving it as “harassment” and then suing.

    1. fposte*

      This is an A+ employee across the board, according to the OP. That seems like an unlikely stretch.

  52. Miranda*

    My first inclination would have been to bring it up directly with the employee, not in an accusing way, but in an, “We can hear your discomfort all day, and are there any things we could arrange to make you more comfortable while you’re working?” Better chair, a sit/stand desk or treadmill desk if motion helps, allow an electric heating pad to ease aches (or other temperature controls, like a heater/cooler, some conditions are temperature sensitive), work from home days, adjust work time to come in when things are at their best (like with some forms of arthritis which are better after you’ve been up and moving for a bit versus first thing in the morning). My second inclination would be to go the complete opposite direction and “almost” ignore it completely, while making sure everyone else had noise cancelling headphones and the option to use them, or arranging for the moaning employee to be somewhere the sound won’t carry so far. Not because you don’t want to be compassionate, but because sometimes just letting people be is the most compassionate thing you can do. They still get their pay and good insurance for doing their job well, and no one else has to listen to all of their moans. This way, especially if the moaning is involuntary, they don’t have to feel guilty when they can’t stifle things. Maybe arranging for a bit of both would be best, if possible, like the new office idea ( better sound blocking for everyone else) plus arranging to let them pick new seating/equipment for said office that could reduce their pain. If they’re able to be more comfortable, then they’ll be able to continue putting in that A+ work for longer, which helps everyone. Good luck in working this out, however you manage it OP.

  53. RUKiddingMe*

    And sometimes no matter how much PT, medications, etc. it still hurts and FWIW in my case…groaning is not really something I realize until someone points it out. When they do of course I make a conscious effort to it in.

  54. Probably Nerdy*

    I’m kind of a passive-aggressive turd sometimes, so a couple times when coworkers had intractable noisy health problems I went the route of “concern trolling”, like calling the EAP alert line, pretending like it seemed way more serious than it was.

    “I was just SO CONCERNED!”

    Probably don’t do that, though.

  55. Ann Nonymous*

    Please make sure that all the other employees aren’t continually exposed to the employee’s moans and groans. I work (often alone) in a studio-type situation where there is a Vietnam vet living next door with a shared wall. I guess this guy is often in a lot of pain where he is shouting obscenities and loudly yelling and groaning…although I think he also does this when he plays loud, violent video games. It bothers and scares the heck out of me. In OP’s situation it is not reasonable for the other employees to be subject to a constant, daily stream of expressions of pain, and even moreso as it is unnecessary fro the moaner to be in pain.

  56. Kathy (counting the days until retirement)*

    As someone who has osteo-arthritis in every joint, I really sympathize with the “groaner.” I am in pain 24/7. I don’t think I groan out loud, but I sure feel pain in every movement. I’ve done PT and I’ve had cortisone shots, neither of which cure the situation. I’m currently PT and I come home in so much pain that I can’t do anything but get to work and home again for a few days after. I understand that hearing the groaning is annoying, and maybe the person could be asked to be more aware of their utterances. But please don’t make assumptions someone as not putting in enough effort to help themselves. This is not your place to judge.

    1. blink14*

      I think though that people would feel differently if the person in the letter was doing everything they could do, and were still in pain, vs stopping treatment for valid reason given (there may be one, but it hasn’t been relayed to the OP). I certainly would.

      I’m very sorry to hear you are in so much pain and I hope you get some kind of relief soon.

      1. Kathy (counting the days until retirement)*

        Thank you. It’s changed my life, and not in a good way.

  57. Koala dreams*

    1. I don’t think it’s strange that the employee don’t manage to go through with the suggested treatment. It’s stressful enough for healthy people to find time for personal appointments and exercise, and when you are already ill and in pain it’s easy to run out of energy just doing your normal life activities (personal care, chores and work), let alone doing the medical appointments, going through treatments with all the side effects, and still have energy for exercise.

    2. You mention that the employee takes time “off the record”. I wondered when I read that if that meant that they have to make up time or that they would still need to do the same amount of work, but in less hours. I can see that being a deterrant when it comes to take time off for medical things.

    3. It’s great that you are thinking of the well-being of the coworkers and the conflicts that might arise in the office. It’s a stressful situation and it seems like people have complained of health problems (if I interpret the letter correctly?) due to hearing the sounds of pain so often. I think it’s important both that you make sure people are behaving respectfully towards the moaning coworker and don’t take the stress out on her, and also that you look into which accomodations you can do for the coworkers so that they can focus on their jobs. Sound-proof earphones or earplugs is the solution that comes to mind first. Of course you’d need to talk to people first so that you can find solutions that actually fits them.

    1. RUKiddingMe*

      “I don’t think it’s strange that the employee don’t manage to go through with the suggested treatment. It’s stressful enough for healthy people to find time for personal appointments and exercise, and when you are already ill and in pain it’s easy to run out of energy just doing your normal life activities (personal care, chores and work), let alone doing the medical appointments, going through treatments with all the side effects, and still have energy for exercise.”

      So much this.

      I am procrastinating doing some stuff….online because the effort it takes (reading/thinking/choosing/etc) is just more than I can make myself do right now. I got a text a couple hours ago that a prescription that I need is ready…but it’s too much effort to go pick it up…I am overdue for a (regular bi-weekly) blood test, because, it’s just too much. We have no idea what OP’s employee’s limits are.

  58. Argh!*

    It doesn’t sound like the accommodation request included tolerated loud vocalizations in a large shared space. Is it possible that the person can predict which motions will be painful, and remember to cover their mouth to keep the moaning quieter?

    I used to work with someone who coughed loudly, which I realize in hindsight may have been a tic. It was really annoying and worried customers. I told her many times that I could take over for her, but she just refused to consider that her noisiness could be a problem for others. I have a coworker now with a quieter cough-tic, and people have requested to be moved away from her. I don’t blame them.

  59. Argh!*

    p.s. I also wonder if people on the phone are hearing this. That would be very distressing to callers, who would wonder how the other employee could be so blasé about it. And does the employee have to talk to people on the phone, who would hear the moans and groans?

  60. nêhiyaw ayahkwêw*

    Okay so I am chronically ill, live with constant and severe chronic pain, and that leaves me real cranky, so I’m gonna try my best to reign in the sass here.

    Physio hurts. So fricken much. If they aren’t finding that physio isn’t helping them out, that’s that. Its exhausting, and difficult, and regardless of how great the insurance might be, all that travel and time off can still be expensive, both in terms of money, time, and spoons.

    I’ve had to use steroids, both in pills and injections, for some of my illnesses. One of the main issues with taking those steroids all the time is that they drastically increase your risk of cancer. So i dunno, maybe your employee just doesn’t wanna die young? Or deal with the bruising, bleeding, nausea and vomiting, hair loss, and other awful side effects of taking such an incredibly intense medication.

    This kind of mind set is so common for disabled people to deal with. I’m really sorry that their constant, excruciating pain is so unbearable for you. But working next to people, you’re gonna have to deal with chronic vouchers, allergies, fans and air conditioning running etc, this is part of working in an office setting. Get headphones if it’s that bad. Someone is in so much pain that they’re vocalizing it, and you’re worried about the annoying sound. It could be so much worse. Have some empathy, and leave them alone. That shit is hard enough without judgey coworkers, trust me.

    Sorry for not being at my most chipper, but I’ve had to live through this exact damn situation on the other side. And it’s crappier than I have the words to explain.

  61. Robbenmel*

    So, here’s my question…how would you go about sending someone on a LOA when they haven’t asked for it? When they are doing a stellar job even with all the pain they’re in? I can’t frame that meeting in my head.

  62. willow19*

    Is it possible the employee does not realize that she is moaning out loud all the time? Like loud eaters and snifflers and coughers and the like? Not sure what my advice is, just throwing that out there.

  63. coffeeandpearls*

    Is it legally problematic to pull the employee aside and say something along the lines of “I know that living with your condition is normal for you and your pain tolerance has probably increased, so you might not be aware that you groan in pain throughout the day with every movement. I’m very concerned about you. Is there anything we can do to accommodate your schedule or environment like Fridays PTO or a remote office? I want to make your doctors appointments and related care as accessible as possible for you on our end”?

  64. Kathy (counting the days until retirement)*

    What about not mentioning or judging their pain level at all, and merely stating that the noises they make need to be reined in? Just because they try to pull you into a discussion of their pain doesn’t meet you have to discuss it.

  65. tripichick*

    can you fire the attention whore? Can’t believe your medical plan is that generous, but sure a qualified alter-abled person with a work ethis might turn up?

  66. NotTheSameAaron*

    Steroid therapy can cause edema which can give the appearance of weight gain, something that people go to serious lengths to avoid. Perhaps you could point out that the constant groaning and pain is not worth any side effects of the treatment.

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