> In the US most employers don't care if you take a normal number of sick days, don't require a doctor's note

In .nl (and .pl also, although I'm less familiar with actual practices there, just because we haven't had anyone sick there in the last decade or so) there is no "normal number of sick days", and a "doctor's note" is also entirely unheard of.

If you cannot work for medical reasons, you report this to your employer, which will then (in most cases) hand off things entirely to a medical consultancy working for them. Obviously, this will not be done for 4-to-8-hour absences (again, in most cases), but definitely for anything beyond that, and if an employee tries to game the system, there are safeguards for the company there as well.

The medical consultancy will establish a plan for working hours for the next month or so (depending on the severity of the condition) and submit that to the employer: they don't get any details beyond that (in fact, that would be highly illegal). Depending on the duration of employee absence, there are various levels of insurance that (may) kick in, but the main focus is to provide a (literally) workable schedule.

Oh, and if an employee gets sick while on holiday, the same scheme applies. I found that one really gets everyone nonfamiliar with "European" working culture going...