This article examines the organisational and cultural factors, both formal and informal, which lead to the inappropriate non-use of sick leave or 'presenteeism'. A two-stage research process supplies the empirical data for this paper. Preliminary quantitative research was gathered from 200 questionnaires sent to staff at two centres; however, the results from this stage were inconclusive. The article therefore focuses on the findings from qualitative data, gathered through the use of in-depth interviews and focus groups with 30 workers at a single site in the public sector. Taking further the study by McKevitt et al. (1997), we consider whether presenteeism results in subsequently higher rates of sick leave. By understanding the fears associated with taking sick leave, we suggest that sick leave can be understood as a 'risk-taking' activity rather than a health-promoting one. In addition, informal discussions with management suggest that managers do not appreciate that policies designed to reduce sick leave may ultimately increase it. We suggest that a tendency to construct ideal models of the social and working environment may result in unintended and negative consequences for both employers and employees. Finally, we address briefly the social representation of sickness and the sick role. It is not usual for people to resist the sick role, and we consider not only the factors which contribute to reluctance to take sick leave, but also the attitudes of fellow workers to those who resist.