Quoted: Talking to PD about medical condition

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I am a 4th year, diagnosed with MS the day before my rank list was due. I have since successfully matched, and am trying to decide if and when I should talk to my program director about this. Although I have had symptoms since the end of first year of medical school, they have always been extremely mild and have never impaired my ability to function and perform at or above expectations. Due to the timing of my diagnosis, it was not an issue during interviews. I would prefer to keep this as private as possible, and so am considering not saying anything at all, but I am concerned that at some point it will become an issue (either due to an eventual attack that does impair me, or someone voicing complaints due to my needing to leave for treatment). How have program directors reacted for others to surprise news like this, and should I tell my program director? And if I should, when? I feel a little guilty, like I will come across as having misrepresented myself, but it was never suspected until well after the interviews were over.

First of all, I wish you the best with all of this. Some patients with MS have a relatively benign, non progressive course, and I wish this for you.

Thoughts about your situation:

You are under no obligation to tell your PD about this, either when you were interviewing, nor now. Whether you want to tell your PD is completely up to you.

What ADA reasonable accomodations will you require? As you likely know, the ADA requires that employers comply with "reasonable accomodations" for employees with disabilities. MS will clearly qualify as a disability under the law if it's causing you problems. If you don't require any accomodations, then I don't see why you have to tell anyone. If you do, then you'll probably need to tell your PD. You can still simply say that you have a "disability" that needs accomodation, but the discussion ends up being very difficult if you try to keep your PD in the dark.

What is "reasonable?". Entire legal careers have been built around this question. The law does not define it specifically. Instead, the courts have tried to define it based upon whether the job position / work environment can be altered such that the employee can perform the "essential functions" of the position. The courts also weigh 1) how disruptive it would be to the business; 2) how expensive it would be (which is measured based upon the finances of the business)

In general, the following are thought to be reasonable:

• modification of a building or work location may involve making the area accessible and usable by an individual because of a physical or mental disability.
• job restructuring by exchanging marginal duties between co-workers
• part-time or modified work schedule
• flexible leave policies
• acquiring or modifying equipment or devices
• adjusting or modifying examinations, training materials, or policies
• providing qualified readers and interpreters
• altering when or how an essential job function is performed
• permitting use of accrued paid leave or unpaid leave for necessary treatment
• employer assistance getting to and from an inaccessible job site.
• reassignment to a vacant position

However, employeers are not required to accomodate every request. They do not need to change the "essential functions" of the job. Employers are also only required to respond to employee requests for accomodation -- if you don't ask, an employer doesn't need to do anything. One thing that employers are not allowed to consider is how "fair it is to other workers". For example, if someone hires a secretary who cannot reach the top file drawer, they either need to find a way to accomodate that (i.e. some process to let the sec reach the files) or assign that task to other workers in the office, even if they don't think it's fair. Schools are also not allowed to consider whether you'll ultimately be able to work -- if they can accomodate your education, then they should. Whether future employers will be able to accomodate you is not their concern.

So, let's say you've matched to my IM program, and you come to talk about it. Here are some accomodations that I think would be reasonable (and that we have in fact done for residents in the past):

1. If your MS caused problems with typing, we would offer you voice recognition software for dictation.
2. We could offer you a smaller / lighter laptop (although battery time would be less). Or, you could have a computer on a rolling cart. If this caused you to walk slower than other team members (when changing floors, when you need to take an elevator), they would be required to wait for you.
3. Reasonable leave / time off for treatments and doctor visits (although these would need to be scheduled to avoid interruptions in patient care if possible)
4. If your disease / treatment made it difficult for you to work a full schedule, we could create a "low intensity" schedule. We have (like many other programs, I expect) busy/hard months and lighter/easy/elective blocks. Usually, residents work 2-3 busy months followed by an easy month. We could consider making a schedule that alternated busy and easy months. However, you would still need to complete all blocks of training, so your training would be extended.

Here's what I would consider unreasonable:

1. Having a personal assistant to type in your computer for you, or otherwise help do your work (financially unreasonable, HIPAA issues, computer security issues)
2. Carrying a decreased load of patients (Unreasonable adjustment in curriculum, unable to supervise an intern at a full workload)
3. Extensive LOA's, or random frequent LOA's that require emergent adjustments of the schedule (not safe for patient care).
4. Not having you rotate on certain services (unreasonable asjustment in curriculum)


Last, we should consider whether your field procedure oriented? If so, how safe will you be doing procedures?

This is certainly more than you were looking for, but it seemed best to try to cover the whole topic. My advice would be to assess whether you think your PD is a good/honest person. If so, then I'd talk to them about this even if it's not causing enough problems at present to require any changes to your training. But, I realize that the best option might be very different if you're in a Surgery program, depending on your own personality style, or how understanding you think your program would be. Also, you can assume that this is unlikely to remain a secret in your program if you bring it up.

From another poster:

does PD knows anything disclosed on employee health form?

Theoretically, no. This should be kept private.

If i disclose my degenerative lumbar disease which doesn't require accomodation as of now, will PD know it ?

Theoretically, no

can u disclose later when u think u will need accomodation without any negative consequences?

Not sure what you mean. Yes, you can claim accomodations later without "negative consequences" -- i.e. they can't say that you "missed your chance" or anything like that. However, you can't blame past poor performance on your lack of requesting accomodations, and the program may or may not grant your request for accomodations.

so for the above ms case for example or lumbar disease case, do you need to disclose it to employee health at all? just clarifying

This is a good question. Your program will likely have a health screening at intake. They are assessing whether you are medically able to perform your job. They may also be looking for disabilities, perhaps to help set up accomodations prior to problems evolving.

The question is whether you are required to disclose something like this. I believe the answer is yes. Lying on your employment medical exam, if discovered, could be cause for termination.

Although I can't completely vouch for it's accuracy, here's a nice summary of the issue:http://en.allexperts.com/q/Human-Res...t-physical.htm

Basically, if the system "works", you'd disclose your issue (MS) to the physician doing your physical. They would compare your history / exam with the written job duties. The only report your employer would get would be whether you were qualified, qualified with accomodations, or not medically qualified for the job. This way, an independent physician assesses you, and your employer can feel confident that you are OK to work safely. If your MS worsens or causes problems, then you can return to your physician for assessment, who can then recommend accomodations to your employer. Theoretically, your employer can be kept in the dark regarding your diagnosis, as your physician could simply tell them your limitations -- i.e. only able to stand for 30 minutes in a row.

I have MS and have not disclosed it to any of my PD's until it came up that I needed time off for an exacerbation. I have only had 2 during my entire residency and 1st year of fellowship. Both times required IV steroids and "reasonable accomodation" was made for me to get the treatment. If you have more severe MS and require frequent IV therapy or need more time off then I would probably warn the PD up front. But if not then treat it like any other chronic disease and deal with it when you need to. I have always disclosed it on my emplyment physicals etc. My residency PD and current fellowship PD both know and have been very helpful. This should not be an issue.