Doing Residency with a Disability

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DocDanny

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I am doing a Categorical IM Residency in the Midwest. I'm very happy. But there are also a few things I am worried about.

I have Osteogenesis Imperfecta. It is mild. No fractures in 15 years. I walk with no cane, but a very noticeable limp. I am only 5'0. I have chronic pain in my legs from 8 fractures. I control my pain by biking and using a heating wrap.


I did a few rotations at this hospital, and we ranked each other highly. I even honored my ICU month there for some reason. But I didn't do alot of procedures. And I'm no genius. I want to know what difficulties I may encounter, and how best to conquer them.


Also, my disability has affected me in other ways. I'm not shy, but I am introverted. I get embarrassed about how I look, and worry I slow people down. I know I have low self esteem. I've never dated, either. A combination of my height, limp, disability and self image.


I guess I'm just looking for advice on all this.
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I don't have a lot of details but there was a guy where I trained who was doing IM with cerebral palsy. He seemed pretty spastic on one side, and walked with a pronounced limp. He seemed to do fine. I know that when he was on call overnight in the ICU, there was a plan in place for procedures. I think he did them, he just needed more back-up than average.

I say go for it. LIfe will be hard at time, and harder for you than others without OA. But you've been dealing with that your whole life.

You say you ranked the program highly. If you auditioned there as a medical student, then they know your limitations and wanted you. Audition rotations, at least in surgery, often hurt more than they help. If they'd doubted you, you would have been pushed down their rank list for nebulous reasons.

One thing I would advise is getting in touch with the EAP (employee assistance plan) early, and seek counseling early, more like preventative maintenance.
 
I'm interested in reading the responses to this thread. I am a pre medical student with scoliosis, back pain and a paralyzed right foot. I do not use a cane, brace or orthotic, but it does slow me down. I can empathize with the emotional suffrage and self esteem deficiency this causes you.

Good luck to you, my friend. Keep paving a path for future doctors to follow.
 
They also mentioned codes, and how you really aten't SUPPOSED to run to them.
 
DocDanny said:
They also mentioned codes, and how you really aten't SUPPOSED to run to them.
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There will almost always be someone else who can get to the code quickly and get stuff started. They don't need to be a doctor. Plus remember that in any code the patient is technically already dead. They can't get any more dead, they can just fail to come back to life. They often don't come back to life and you running there is not likely to be the deciding factor. You mention leg issues but haven't said anything about your arms-do you anticipate having more than the usual technical difficulty due to your condition (everyone fumbles some their first time doing anything). Also, you said you limp, but are you also slow (one of our ED attendings limps and uses a cane, but can put a little speed on if needed)? If you are slower than the usual speed of rounds (which probably isn't super fast in IM) then you will have to let your team know as early as possible so you don't get told to "hurry the hell up" (maybe not a problem in IM-I'm a surgeon so we tend to think and act differently). Will standing and rounding for hours be a problem? Maybe it is different at different places, but in school and here IM seems to be all about long rounds. This should also be something discussed early on. Maybe you can introduce your team to the joys of table rounding (over food preferably). I can't think of much else that would medically be an issue (aside from if you got a new fracture), but you may need to focus on doing the best you can and not on how you are disabled. Most interns feel like they aren't good enough and with your baseline self esteem issues this can easily turn into a problem. Let people know what any absolute can't do thing are and suck it up for the minor stuff. If you try to make up for anything you can't do, it will help your colleagues feel better about the things they have to take on because of that (I think that would be true for any issue temporary-like pregnancy-or permanent).
 
dpmd said:
... Let people know what any absolute can't do thing are and suck it up for the minor stuff. If you try to make up for anything you can't do, it will help your colleagues feel better about the things they have to take on because of that (I think that would be true for any issue temporary-like pregnancy-or permanent).
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I kind of disagree with this. Never announce you can't do anything. Say "I'll give it a shot". You always get more points for giving it a shot. You don't want to get a reputation for using your disability as a crutch (pun intended). Plus it's way way too easy to say "I can't" to lots of things once you start down that road. Better to never start down this road. Your program auditioned you, they had opportunity to see what you could do and felt you were adequate. Don't second guess them.
 
My arms and hands are fine. I never broke them.

My limp is bad, and my legs do hurt, but when I need to I put the pedal to the metal.

Most of my rotations involve rounds. Some of them on IM or ICU could take 5 hours. I lived.
 
Get in touch with the HR department in your hospital and be sure to apply for the necessary "reasonable" accommodations even if you do not intend to use them. You will be surprised on what things pop up in residency that normally do not pop up in a single month rotation. But, since you are legally an employee, you have legal rights as one does. And by having close contact with the HR for your disability, you can have more protection in case of problems with colleagues.

I don't think you would have any issues accomplishing procedures and other necessary requirements with your disability. However, discrimination and prejudice is still out there and VERY common among healthcare workers. I have seen first hand the results of that, and it is NOT pretty. So, best is to contact the EAP / HR department as soon as possible and be sure to keep them up-to-date in case anything happens.
 
Thanks.

Does anyone have advice on dating? With my busy schedule, height, disability, self confidence and complete lack of experience ever, I've become very disheartened and frustrated. I'm tired of feeling lonely.
 
DocDanny said:
Thanks.

Does anyone have advice on dating? With my busy schedule, height, disability, self confidence and complete lack of experience ever, I've become very disheartened and frustrated. I'm tired of feeling lonely.
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I think you need to work on your self esteem before trying to date. I think it is really awesome that you have done what you have with your condition. Although OI shouldn't stop anyone from doing medical school, I still think it takes a huge amount of grit and determination to do what you've done. I hate all the standing around I have to do on rounds and am sick of my legs and knees hurting. The fact that you have done all this with OI is really impressive.

I know next to nothing about how to fix self esteem issues, but I would think a short course of cognitive behavioral therapy with a good psychologist would do the trick. Clearly you are intelligent and driven since you have made it this far. Keep your head up.:thumbup:
 
DocDanny said:
I am doing a Categorical IM Residency in the Midwest. I'm very happy. But there are also a few things I am worried about.

I have Osteogenesis Imperfecta. It is mild. No fractures in 15 years. I walk with no cane, but a very noticeable limp. I am only 5'0. I have chronic pain in my legs from 8 fractures. I control my pain by biking and using a heating wrap.


I did a few rotations at this hospital, and we ranked each other highly. I even honored my ICU month there for some reason. But I didn't do alot of procedures. And I'm no genius. I want to know what difficulties I may encounter, and how best to conquer them.


Also, my disability has affected me in other ways. I'm not shy, but I am introverted. I get embarrassed about how I look, and worry I slow people down. I know I have low self esteem. I've never dated, either. A combination of my height, limp, disability and self image.


I guess I'm just looking for advice on all this.
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Hi there,

From someone who has chronic and pretty severe (but controlled) health problems, I can tell you that it's tough, but not impossible. I guess in addition to having health issues as well which I've battled for a long time, I am also shy at times, but have had a very supportive family and have found people along the way who have allowed me to grow and flourish and sort of see me for who I am, vs. seeing me for what my health problem is. I think you can certainly make good friends in residency as well, and will have people who support you. You've made it a long way with tough health issues so you are probably a very strong person. I think you'll be just fine. :)
 
DocDanny said:
I am doing a Categorical IM Residency in the Midwest. I'm very happy. But there are also a few things I am worried about.

I have Osteogenesis Imperfecta. It is mild. No fractures in 15 years. I walk with no cane, but a very noticeable limp. I am only 5'0. I have chronic pain in my legs from 8 fractures. I control my pain by biking and using a heating wrap.


I did a few rotations at this hospital, and we ranked each other highly. I even honored my ICU month there for some reason. But I didn't do alot of procedures. And I'm no genius. I want to know what difficulties I may encounter, and how best to conquer them.


Also, my disability has affected me in other ways. I'm not shy, but I am introverted. I get embarrassed about how I look, and worry I slow people down. I know I have low self esteem. I've never dated, either. A combination of my height, limp, disability and self image.


I guess I'm just looking for advice on all this.
Click to expand...

First, you shouldn't worry how you look and whether you slow anyone down. You have what is given to you. Truth be told, if you are worried about dating, just go on e harmony or any of those website. Any girl would be lucky to be dating a doctor.
 
If you are doing IM you don't have to worry too much about doing procedures, if your arms and hands work OK. Some people are just naturally better at stuff but a lot of it is just about being prepared (have all the right kits, needles, etc. and wash your hands really well, get the patient arranged and prepped so you can easily reach the area of interest). For IM you basically only need to know central line, paracentesis, and probably the occasional LP. If you end up hating procedures there is usually someone else around who is good at them to help you.
 
Law2Doc said:
I kind of disagree with this. Never announce you can't do anything. Say "I'll give it a shot". You always get more points for giving it a shot. You don't want to get a reputation for using your disability as a crutch (pun intended). Plus it's way way too easy to say "I can't" to lots of things once you start down that road. Better to never start down this road. Your program auditioned you, they had opportunity to see what you could do and felt you were adequate. Don't second guess them.
Click to expand...

I really meant to let them know if something was physically impossible or medically not allowed. perhaps nothing fits that, in which case my suck it up advice goes along with yours (but yours is nicer)
 
You should be upfront with them. Tell them you'll work hard and do your best but there are just some physical limitations you have. With OA, I would be worried about you breaking your bones if you try to do chest compressions (interns are expected to participate in this) or running to a code. I'm sure your program will be accommodating.
 
Don't forget that you have protective statues under the Americans with Disabilities Act. You are legally entitled to reasonable accommodations.
 
Poetic Silence said:
... You are legally entitled to reasonable accommodations.
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yes, but bear in mind that what you feel is "reasonable" is irrelevant. The program is going to determine what accommodations, if any, they have to provide to stay within this requirement. It may be pretty limited, like giving you an elevator key and a closer parking space. Doubtful they will tell you as an intern you don't have to do procedures or help out in Codes.

However I think more important than keeping the program happy will be keeping your co-residents happy, because it's very much a team sport, and if they feel they are constantly carrying you on procedures etc, they will start to resent it and that can work out bad for you. You thus need to give a shot at anything conceivably doable. And be prepared to bring in donuts for morning rounds pretty regularly. It's hard to resent someone who brings you donuts.
 
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Keep in mind also that early hearing loss can occur with osteogenesis imperfecta. Make sure that there aren't any significant problems with your hearing. You'll need it for ausculation.
 
I'm well aware of all the complications, dude.

Not only have I had this my whole life, but I'm a doctor.
 
Top Gun said:
Keep in mind also that early hearing loss can occur with osteogenesis imperfecta. Make sure that there aren't any significant problems with your hearing. You'll need it for ausculation.
Click to expand...

I'm deaf and it hasn't been an issue for me. Plenty of deaf doctors out there.
 
Yeah, I'm well aware of the purpose of residency as well.
 
Nah, not arrogant, really. Just found it odd that someone implied I don't know what a residency is for. I don't get the point of the post.

It's for training to be a doctor. But we are still doctors.
 
You know what? It's easier to come off as rude on the Internet than real life, so I apologize. The advice here's been mostly good, and I needed it.
 
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DocDanny said:
I'm well aware of all the complications, dude.

Not only have I had this my whole life, but I'm a doctor.
Click to expand...

Well, hey, I was just giving some advice, but whatever. You know everything. Fine. I'm done now. :rolleyes:
 
I don't think OP is being overly cocky, just a reasonable reaction to some well-intended but ultimately stupid advice (do you think someone that's gone through 4 years of med school and had OI all their life doesn't know about premature hearing loss??). You will probably be able to do more than you think you can once you get into it. If you have gone 15 years of fairly normal living you should be good to go with the majority of medicine procedures minus chest compressions and maybe marrow biopsy. Stepstools can easily be brought into patient rooms to put in central lines, etc.

Ultimately though the only people that can determine if this residency will work will be you and the people running your residency. If you do get accommodations made that put a burden on other teammates make sure you help make up for it by maybe managing all the crosscover issues that come up during procedures or writing some notes for the intern that is helping you. As long as the time to leave the hospital at the end of the day is the same as it would have been if you weren't on the team the vast majority of non-crazy people will not have a problem with it.

Last regarding dating I think you should try speed dating- you get to meet like 10-15 new people, you are in a social situation that is fairly structured and expectations are clear, and you can find out in 30 seconds if your OI is a dealbreaker (no pun intended) as to not have to waste a lot of time getting to know people that will not like you bc of your condition.
 
I do use a step stool for chest compressions. One attending told me I should just jump up on the bed Gray's Anatomy style.

My endurance has also improved. I'm golden as long as I can go home and take a hot bath. And maybe someday have a gal to rub my back too...
 
DocDanny said:
I do use a step stool for chest compressions. One attending told me I should just jump up on the bed Gray's Anatomy style.

My endurance has also improved. I'm golden as long as I can go home and take a hot bath. And maybe someday have a gal to rub my back too...
Click to expand...

Not too many of those opportunities during residency.
 
Hopefully I can find time to bathe most evenings.
 
Hello all. I hope I'm not out of line replying here. I am not
a dr, I am pre PA, but I to the undertaking with
a disability. I am 34 with for boys ages 8,4,3 &1.
I do feel that you proved strength and worth and determination getting through med school. This is something to take strength from. I recently found out that I likely have myotonic MD even though I have been dealing with symptoms for 4 years. I want my kids to see that strength is in crawling when you must....in my case literally at times but don't give up. I can completely relate to the what ifs but all you can say is do you think you can do it right now and id it worth the try. Good luck. Message me if you would like. I admire all
Of you for sticking with it
 
DocDanny said:
Hopefully I can find time to bathe most evenings.
Click to expand...

Despite what people say, there is time for all sorts of things, you just have to prioritize. I love to sleep, so I sleep 8-9.5 hrs each night. Obviously in the days of 30 hr call that didn't happen, but when I got off post call I would sleep to make up for the previous night then sleep for the current night also. There are only so many hours in the day so it meant that I slept instead of waking up early to do my hair and make-up, or instead of staying up to watch that show/have sex/read/etc. If a bath is important to you and it needs to be long (I also like baths, but even 10 min in my hot tub does a good job at relaxing me or helping the leg cramps I get sometimes) then you will just have to figure out what to sacrifice. TV watching would be a good thing to sacrifice. Reading for education is a bad one (although I have been guilty of it at times-although much easier to read in the bath than while sleeping). Even with intern call being decreased to 16 hrs, it may not be a simple thing every night unless you figure out how to work it in (those pink basins for patient work really well as a foot soaking basin during downtime on call, and having a hot tub in your back yard means not having to wait for a tub to fill or taking time to change into a bathing suit-assuming your backyard is covered enough or you don;t care who sees you).
 
QUOTE=DocDanny;12357974]Thanks.

Does anyone have advice on dating? With my busy schedule, height, disability, self confidence and complete lack of experience ever, I've become very disheartened and frustrated. I'm tired of feeling lonely.[/QUOTE]


Don't push yourself it will happen when time is right. Know it is the person inside that your future mate will love they will barely notice your disability. I have a deformed eye and once I accepted the way I look and realized I did not want to marry a girl that was so shallow she could not get past it dating came along pretty easy. Medical school is just lonely, period. I married the prettiest girl in the class behind me. We are in Houston and I see you are in Indiana, I almost took an oncology fellowship in Indianapolis but wife shot it down. Keep your head up and love yourself for the person you are and realize there are more people than you think that are lonely and have disabilities also. Have you spoken to a psycologist or therapist, I never did but wish I had when I used to get really down about my eye and being lonely. Trust me you will get through this. Best of luck.
 
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Just a pre-med here. I have a T6 spinal cord injury, always rolling in a manual chair. I can't wait to deal with all the hoop I'll have to jump through and BS I'll have to wade through throughout medical school.

It sounds like you're kicking ass. Keep it up .
 
captainwelch said:
Just a pre-med here. I have a T6 spinal cord injury, always rolling in a manual chair. I can't wait to deal with all the hoop I'll have to jump through and BS I'll have to wade through throughout medical school.

It sounds like you're kicking ass. Keep it up .
Click to expand...

I'm currently a 2nd-year medical student (almost M3 now) with a T3 complete spinal cord injury. I am completely paralyzed from chest down so I am without any trunk support and I also use a manual wheelchair.

There is a 1st year in our medical school who is in a wheelchair, although her injury level is much lower and I believe she may be able to stand.

Don't worry. Things are challenging, but definitely not impossible.

My clinical skills professor wants me to make a guide or a video series on how to perform the physical exam with these challenges, since there is no literature out there on this. One of the administrators for the Step 2 took a keen interest in me as he was showing me how to perform the male and female GU/rectal exams to my class, since he has never had to deal with a student like us.

I can go into more, but I am not sure what specifics the OP was inquiring about and what questions you may have, captianwelch. I should be starting 3rd year clerkships this summer. We have been visiting the local hospitals every other week this past year to perform patient history and physical exams, and I have found no significant problems.

Although I must say, I am comparing my physical challenges to the traumatic brain injury I suffered, which has been much more challenging to overcome.
 
DocDanny said:
Thanks.

Does anyone have advice on dating? With my busy schedule, height, disability, self confidence and complete lack of experience ever, I've become very disheartened and frustrated. I'm tired of feeling lonely.
Click to expand...

As a someone who has to ambulate 100% of the time using a manual wheelchair because of a T3 complete spinal cord injury, trust me when I say the dating scene does not take a hit. I thought it would but it doesn't.

What do females look at more than anything? Confidence. Someone told me that and I didn't think that was true, but trust me, it is.

I am currently dating one of the most beautiful girls I know and who has guys always trying to get with her.

Girls are impressed with how you carry yourself and how you deal with challenges. Work on yourself first, and success in the dating scene will come. I wish you all the best.
 
DocDanny said:
I am doing a Categorical IM Residency in the Midwest. I'm very happy. But there are also a few things I am worried about.

I have Osteogenesis Imperfecta. It is mild. No fractures in 15 years. I walk with no cane, but a very noticeable limp. I am only 5'0. I have chronic pain in my legs from 8 fractures. I control my pain by biking and using a heating wrap.


I did a few rotations at this hospital, and we ranked each other highly. I even honored my ICU month there for some reason. But I didn't do alot of procedures. And I'm no genius. I want to know what difficulties I may encounter, and how best to conquer them.


Also, my disability has affected me in other ways. I'm not shy, but I am introverted. I get embarrassed about how I look, and worry I slow people down. I know I have low self esteem. I've never dated, either. A combination of my height, limp, disability and self image.


I guess I'm just looking for advice on all this.
Click to expand...

One year after my accident, I started medical school. I did not have time to fully "heal" (emotionally speaking) and adapt. I had to do that on top of dealing with 1st year of medical school. Thankfully, I have had very supporting family members, friends, classmates, deans, and professors.

Do not worry about slowing people down. You bring something to medicine and to your patients that no one else can ever bring: true empathy. Do not forget that. You and I both have experienced more pain than most other physicians and medical students out there. People who look at you will be able to see this. Carry your head high. Everyone has struggles, and although you have been given more obstacles than almost everyone you know, you have also been given the gift to handle these. You are much stronger than everyone else because of this.
 
OP, in response to one of the comments by one of the posters, what qualifies as reasonable is ultimately determined by the courts, not the hospital or the training program. There was a recent case in the California Supreme Court with a Berkley law student who required a computer text enlargement program + voice in order to pass her Bar (I believe she was using Zoomtext with Speech or Jaws with Speech). She was refused the accommodation for the text + voice program (compared to the text enlargement only version) because the State Bar felt it was unnecessary and/or unreasonable. Anyway, to sum up, she appealed the decision, was finally granted the accommodation by the California Supreme Court, retook the bar and passed.

So, just to reiterate the point, your hospital is not the one that ultimately decides what is considered to be "reasonable" accommodations. The Supreme Court does. If you ever encounter a problem like that in the hospital, consult an ADA specialist or attorney regarding what is considered to be a reasonable accommodation.

Also, as another note, under ADA, you are not legally required to disclose your disability to your employer/residency program if you do not wish to. However, it is definitely recommended to discuss it with them, especially if you may need any accommodations.
 
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ladybuggy said:
OP, in response to one of the comments by one of the posters, what qualifies as reasonable is ultimately determined by the courts, not the hospital or the training program. There was a recent case in the California Supreme Court with a Berkley law student who required a computer text enlargement program + voice in order to pass her Bar (I believe she was using Zoomtext with Speech or Jaws with Speech). She was refused the accommodation for the text + voice program (compared to the text enlargement only version) because the State Bar felt it was unnecessary and/or unreasonable. Anyway, to sum up, she appealed the decision, was finally granted the accommodation by the California Supreme Court, retook the bar and passed.

So, just to reiterate the point, your hospital is not the one that ultimately decides what is considered to be "reasonable" accommodations. The Supreme Court does...
Click to expand...

Technically yes, but practically no, unless there is exact precedent. On a day to day basis a program decides what is reasonable accommodations. If you don't like it, sure you can go to court. And yes, a court will have the final decision, potentially many years later if it has to go up the appellate process, just like it would on any question of law. And whether you win or not depends a lot on whether you happen to be in a more judicially liberal state like California, or one of the other more judicially conservative states. Which won't help you any in terms of completing a residency in the near term, but might help the next person. So in a practical sense for the day to day things the program will be deciding what is reasonable, not you. That's my point.

If you want to make a federal case out of it, it's your right, and you may even end up being right, but all your co-residents will have become attendings long before you get the resolution you seek. But the law puts the onus on the employer to make reasonable accommodations, and by the use of the word reasonable, allows the employer a lot of wiggle room. And yes, you can always sue them if they are being unreasonable, but it's always a punch -counterpunch set up -- THEY get to make the initial decision of what's reasonable. And unless you'd rather spend your 20s in the courtroom instead of the wards, in most cases what they decide is reasonable is going to be the end of the story.
 
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Law2Doc,

Yes, the programs can make the initial decision. The law does allow for that. However, keep in mind, the residency program is not specially trained in ADA law. So, while they can make an initial decision, you can very easily (and quickly) appeal it. You don't need to take the time to sue them. That is not necessary at all. That would be only as a last resort. You honestly have several options to choose first before resorting to taking it to court.

Basically, the steps would be this, if residency program says no, talk to Human Resources/Disability for the accommodation request. If the Human Resource/Disability department were to refuse the accommodation, they have to state a [valid] reason why. For example, they can say "we do not have the monetary capabilities of supplying that accommodation" (this is an acceptable excuse and has been used several times in the past). That is where an ADA specialist would be the best help. An ADA specialist is very well educated with the ADA law (of course) and they generally are the ones that step in as the intermediary and assist the program in working out a quick and easy solution. If the accommodation has been approved in the past anywhere in the US in a similar setting (regardless of the state the residency program resides in), then it would be pretty easy to work with. And, in fact, the state could even assist the hospital to provide the necessary accommodations (for example, supplying a special computer program for a low vision employee). These things generally take weeks to maybe a couple of months to work (this means, you need to start early with your accommodations request before July!).

The only time when it becomes an issue is when the accommodation request is refused and is considered to being "within reason". This includes accommodations such as requesting a secure storage locker to store your adaptive equipment or being able to have a chair/bench in a particular location for a physically disabled employee to sit on during rounds, or even having a large print hardcopy of a case report provided during a case presentation. Even requesting a wheelchair ramp in the parking lot of a hospital that does not have one is considered reasonable and necessary. And let me tell ya, I have heard some horror stories.......
 
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