hidden health problem: give PD a heads up?

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FamilyDoc

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My topic title pretty much says it all. I have MS, fortunately didn't cause me a single problem during all of medical school, but if it recurred I could have difficulty performing my intern responsibilities. The thing is, it's been SIX YEARS since I had any problems and I hate to even mention something that might never happen. OTOH I heard from interns in my program during the interview that our PD "will absolutely go to bat for you if you have a problem." So it seems to me that if I talk to the PD ahead of time, it would help just in case I need that kind of advocacy.

Note that the ONE time I raised the issue during a rotation in med school, the rotation director at one site refused to place me because of the concern. (yeah, yeah, I know but it wasn't worth fighting, I just went to another site and it turned out fine.) So I am a little leery about exposing myself to potential discrimination I guess...... one advisor has already counselled me that I'd be best keeping this to myself unless it became an issue, that bringing it up now when I'm not having any problems is just going to make people nervous.

Would love to hear from anyone else who's dealt with this or who knows someone who has... or from senior residents who know what the PD's perspective is likely to be, thanks!
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i don't think it's a bad idea tolet the pd know and you're almost obligated to tell the institution anyway, since as part of a credentialing packet (and for malpractice purposes) you'll have to indicate if you have any conditions which could affect your performance.

I have a few friends with MS and stress really affects their symptoms and there are few things more stressful than residency, especially that first year. it will be important to have 'allies'.


good luck
 
Ah, this is what makes life so fun and crappy at the same time.

Basically, you are looking at this: do I do the right thing, or do I do the expedient thing? That's what life comes down to.

The right thing to do would be to tell them. Not only because it can interfere with your job, but also because it could leave them in the lurch if you ever get a recurrance. You are releasing all of your information and being as complete as possible.

The expedient thing to do would be not to tell them. Because you know - both from common sense and from past experience - that it will be considered (fairly or unfairly) detrimental. And you may be penalized for something that may never be an issue.

Complicating matters further is the fact that when faced with those same choices it is clear that medical institutions - despite all the hot air they blow at you about ethics - choose to do the expedient thing and rationalize it by saying "hey, it's a business ...we have to look out for ourselves (but we sure as hell don't like it when you take the same tack)". If anyone disagrees, then realize that in theory there should be no discrimination against FamilyDoc based solely on a medical condition, but we ALL know that it will be factored into the decision.

So the question is: do you want to stick to principles and do the right thing, maybe suffering the consequences? Or do you want to take the easy route, stoop down to their level, and escape unharmed?

That's a choice we all have to make sooner or later in our lives. I guess I'd take the harder road and rationalize that "if they don't want me, screw them", but that's cold comfort if you get screwed in the match, right? This is life, not some after school special where the "right" thing gets you a reward. But I'd still do the right thing. ;)
 
You already matched, so you're somewhat safe.
I say tell them. I do think you have to disclose any medical conditions somewhere in the liscensing paperwork anyway, and if you lie on that I imagine you could get in trouble. Your MS may may never cause you a problem during residency, but if it does, at least you won't have the uncomfortable feeling of your PD thinking you purposefully hid something from them. Best to be honest up front. It's reasonable that you didn't mention it on interviews (especially since it hasn't affected your performance in med school at all), but at this point your PD would probably appreciate knowing the situation up front, especially if you've heard he's generally supportive of the residents.
 
Oh, whoops, I thought FamilyDoc was getting ready for the Match ...for some reason, I thought FamilyDoc was referring to the PD at their home institution ...sorry about that.

Still, that doesn't change my opinion on how to approach the issue - just change "that's cold comfort if you get screwed in the match" to "that's cold comfort if you get screwed on the job".

Certainly a PD could be understanding and supportive. However, PDs are quite often - by the nature of their position - very calculating individuals and that is where the problem lies.
 
Don't ask - don't tell. 6 years is a long time. It's like a refurbished car that was in an accident "a long time ago" but runs great. Still interested in buying this car?
 
I think you have an obligation to tell them, once you've matched. It was irrelevant information prior to matching, because your performance stood on its own merits, and was good enough to get you the spot. But now that you've matched, they need to be able to plan for contingencies.
 
No offense, but if the information is relevant AFTER the Match, then is it relevant BEFORE the Match, as well (i.e., during interviews). In other words, you are rationalizing - now that I have been accepted somewhere and they can't do anything about I feel that it is "important" to tell them. Huh? In a purely theoretical sense, why should programs be put in the position of having to "plan for contingencies" in the first place? Would you appreciate it if you Matched somewhere and they called you up and said, "oh, by the way, there's a 10% chance the program will shut down during your training, so plan accordingly ...I didn't want to mention it during the interview, but I think that it's important that you know now." Sheesh. Don't be so self-centered.

By the way, I am not defending the program on this. I still believe that most programs will do the expedient thing, rather than the "right" thing, given the chance. So make your decision accordingly. Like I said, you might do the right thing and get burned for it.
 
Originally posted by FamilyDoc
My topic title pretty much says it all. I have MS, fortunately didn't cause me a single problem during all of medical school, but if it recurred I could have difficulty performing my intern responsibilities. The thing is, it's been SIX YEARS since I had any problems and I hate to even mention something that might never happen. OTOH I heard from interns in my program during the interview that our PD "will absolutely go to bat for you if you have a problem." So it seems to me that if I talk to the PD ahead of time, it would help just in case I need that kind of advocacy.
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Hi there,

Your Program Director is a physician and as a physician, he or she should know that MS is a aliment of exacerbations and wanings. You may never have a problem throughout your residency or you may have an exacerbation during the first week. This is your job and your education, thus you need to let your PD know. For that matter, you are probably going to need to let your state board of medicine know too.

MS is probably not going to affect the way you practice medicine during residency. My aunt who suffers from MS was board certified in pediatrics, internal medicine and neurology. She became head of her neurology department and practiced until retirement. She even practiced part-time after she retired.

You made sure that MS was not a factor in your obtaining this residency so now make sure that it is not a factor in your getting the best educational experience out of this residency. Your PD has no control over the illness or you or any of your fellow residents. Last year, we had an intern who suffered a ruptured berry aneurysm and became quite debilited by this sad event. Another resident broke a wrist. My point is that you or any of your colleagues may look quite healthy now but over the course of a residency, anything may happen to anyone. Your MS may or may not re-occur during your residency.

Tell your PD and let the chips fall where they may. You need to have a good honest relationship with your PD and your faculty advisor because these folks are your advocates. If not, find another program after next year because you have chosen badly.

Good luck
njbmd:)
 
I would concur with full disclosure for the following reasons:

1) You will be responsible for the well-being of others; sudden debilitation without backup can have drastic consequences for the health of your patients.

2) Guess who will be the scapegoat if the worst-case scenario above happens?

3) Even if no patient suffers harm as a direct consequence of a flare-up, your reputation will; it is exactly the purpose of the question in your licensing paperwork to discover such medical conditions- evading the question or outright lying about it will leave a bad taste in your PD's mouth that may linger well beyond your residency.

In short, I believe it's safer to front-load your pain since everyone has 20/20 hindsight vision.

Good luck.

(and for what it's worth, I don't know first or second hand what it's like to be in your situation, so my thoughts- well-intended as they may be- may carry less weight than others who are more knowledgable).
 
Originally posted by njbmd:
Your Program Director is a physician and as a physician, he or she should know that MS is a aliment of exacerbations and wanings.
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This is what you guys aren't getting. It is commendable that we - as idealistic young physicians - are sitting here all advocating the ethical thing (even me). But I guarantee that PDs are looking out for their program. Understand that disclosure WILL impact the way you are perceived by the program. If it would make no difference, there would be no reason to disclose! (Example: you don't need to tell them how tall you are and they don't care - this is truly something that will have no impact.) So this is a faulty argument. It is pointless to pretend that disclosure is something that will have no impact - what is necessary is to determine if you are comfortable in accepting those consequences.
 
Originally posted by kinetic
No offense, but if the information is relevant AFTER the Match, then is it relevant BEFORE the Match, as well (i.e., during interviews). In other words, you are rationalizing - now that I have been accepted somewhere and they can't do anything about I feel that it is "important" to tell them. Huh? In a purely theoretical sense, why should programs be put in the position of having to "plan for contingencies" in the first place? Would you appreciate it if you Matched somewhere and they called you up and said, "oh, by the way, there's a 10% chance the program will shut down during your training, so plan accordingly ...I didn't want to mention it during the interview, but I think that it's important that you know now." Sheesh. Don't be so self-centered.
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You have no legal responsibility to disclose at ANY point. The PD is not allowed to base his decision on your candidacy based on whether you have an illness that MIGHT affect your performance. You have every right to let your med school grades, scores and letters stand on their own merit, adding nothing. You don't have to tell your prospective PD that you're Islamic, or that you smoke 3 packs of cigarettes a day, or that every woman in your family has died of breast cancer. I'm sure that some of these factors would affect their decision--and you'd have a very difficult time proving that that was the reason. AND THAT'S WHY YOU DON'T HAVE TO TELL THEM. Discrimination exists, and it's wrong, and if there's any obligation here, it's to avoid placing that stumbling block in front of the people deciding. You actually have no ethical obligation to tell them afterward either. But I think it's the decent thing to do. At that point, the ethical obligation is to ensure that your patients will be taken care of in the event you have a problem. But this is really not much different than planning for coverage in the case of any emergency.

I think that as society becomes more enlightened on this subject, front-end disclosure will become less harmful. But right now, I would say that the chances of it harming your prospects unnecessarily are greater than the chances of it affecting your work in a manner detrimental to the program or your patients once you have the position. Disclosing to a credentialing board probably wouldn't have the same kind of consequences, unless that information was somehow made available to prospective employers or program directors.
 
Sorry Samoa, but the OP does have a legal obligation to disclose their diagnosis of MS to a residency program.

Teaching hospitals provide malpractice insurance for housestaff. When you sign your residency contract and other paperwork, you must agree to disclose your medical history to the hospital. Failure to do so makes the resident ineligible for coverage. If the resident fraudulently claims not to have a longstanding medical condition (e.g. MS), he/she runs very serious legal risks. If the resident were to be named as a defendant in a lawsuit, he/she would not be covered by the malpractice policy, and would be fully liable for legal expenses (not to mention having credibility problems in front of a jury).

Although there might be a real question of discrimination, I think the legal implications of hiding this diagnosis are too great.
 
Boy, this is a BIG issue in my opinion. My advice would be to see an ADA attorney about this. It's my impression that this issue has the potential to impact your career pretty seriously if not handled correctly. You probably have certain legal responsibilities, but you also certainly have certain legal rights under the ADA. And then there is the issue of it being in remission for six years.

As an attorney, I can think of all kinds of ways this could get very complicated for you, and at the same time see how as long as it does not interfere with your duties, there may be no obligation to disclose. A disclosure that is not legally (or contractually) required may interfere with your ability to practice medicine needlessly.

My honest advice is to spend a few thousand dollars and see an employment or ADA attorney. This is a serious matter, and you don't want to go into it without some technical advice.

Judd
 
Having MS is a big deal, but it's no bigger than some of the other health/mental/family/social issues the rest of us have. I have serious chronic health problems, and I have friends with even worse issues, but I try not to make a big deal about it. I troop along and don't ask for any extra support in the hospital.

Frankly, I think it's easier that way. I hate pity. It's much easier for me to endure silently at work and nurse my wounds at home. I have had attacks that last a week at a time, but it's better than getting that look of 'should I push him too hard?'. I've tried telling people at work what's going on, and it never turns out well.

So far, my work hasn't suffered, and I've learned to adapt my habits in the workplace. I know when an attack is coming on, and I have figured out ways to keep going or even prevent the attacks. I know that for all of my problems, there are people out there that go through much more and still come out smiling, so why can't we?

You've made it this far by yourself without telling anyone, why start now? Why be discriminated against, or even worse, pitied because of your condition?
 
Posted by juddson:
As an attorney ...[m]y honest advice is to spend a few thousand dollars and see an employment or ADA attorney.
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I hate lawyers SO much. Not only do you not contribute any insight into the discussion, but you use it as an advertisement for your industry. Great. Thanks for your "technical advice".

This is the modern form of ambulance chasing. Trolling through forums and looking for people who are in dire need of a lawyer. Yay!
 
I don't think it is necessarily a bad idea to get a lawyer before disclosing; some of them may be pretty corrupt but you want to cover your ass. I have well-controlled bipolar disorder and I do not plan on disclosing it in my residency application, however, when I am obligated to tell the program director after the match, you can bet I will get an attorney in case they try to dismiss me or prevent me from teaching medical students. Unfortunately, these kinds of things can and do happen to anyone who has a medical condition, whether it be pregnancy, diabetes, MS, or any kind of psychiatric illness (especially the latter). you have to tell the PD, but you have to find a way to protect yourself too.
 
Originally posted by kinetic
I hate lawyers SO much. Not only do you not contribute any insight into the discussion, but you use it as an advertisement for your industry. Great. Thanks for your "technical advice".

This is the modern form of ambulance chasing. Trolling through forums and looking for people who are in dire need of a lawyer. Yay!
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I have to disagree; I think Juddson is right on, because there are a lot of self-righteous shmucks in residency programs and on state medical boards who are only too willing to screw people.
 
Originally posted by Apollyon
I have to disagree; I think Juddson is right on, because there are a lot of self-righteous shmucks in residency programs and on state medical boards who are only too willing to screw people.
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I agree that there are a lot of self-righteous shmucks. Fine. Let me just point out, though, that you should then never get angry at frivolous litigation. (Apologies to FamilyDoc for getting off the subject of the OP.) I mean, that kind of 'get a lawyer to cover your ass' mentality is what has caused lawyers to become so ubiquitous. Did you ever envision a time growing up when not shoveling your sidewalk meant that you might have to retain the services of a lawyer? Or that you were mopping the floor in a store and had to retain the services of a lawyer? Or (more relevant to us) that you treated a patient following acceptable standards of care and had to retain the services of a lawyer? If you advocate turning to a lawyer every time you're uncertain about something, then don't be shocked when other people do the same thing. (If I have to continue with this topic, I'll start a new thread. Again, sorry, FamilyDoc - I know this is not what you're interested in.)
 
Kinetic,

I'm not sure what you problem is. I don't practice law anymore and could give two ****s whether somebody pumps money into the profession. I'm hardly "trolling around" these forums looking to divert business to the Bar. I'm starting medical school in the Fall. Let's face it, Kinetic, you make yourself look pretty stupid with comments like that.

This is a matter that requires legal expertise, NOT because lawyers have created in a situation that puts the OP in peril, but because the response of his PD may put her in peril.

I didn't offer any "technical advice". Your dishonest missreading of my response is typical of the disabilities you must endure as a result of your blinding hatred of attorneys. It is exactly this kind of attitude that gets people like you into trouble. I made it pretty clear that I don't know what the OP's rights and responsibilities are, that is WHY she needs to see an attorney - in order to get some "technical advice".

I can only imagine if the OP had complained about a medical condition on a nursing forum. Imagine the response were somebody to say "geez, this sounds like you need to see a doctor - this sounds serious". I very much doubt it would be "****ing doctors trolling around our forums looking for business".

This OP needs a lawyer. His (or her) career is at stake. And your answer to her is to counsel blindness and ignorance of her legal rights because you hate lawyers?????? Is THAT the best advice you can give??? That this OP shouldn't even FIND OUR what her rights are because, god forbid, you hate attorney??? You've decided to put your personal animus against an entire profession before the OP's continued advancement through a medical career.

As said this before (but perhaps not directly to you), and I'll say it again here. . .you need to get over your holier than thou attitude. It's already conspired to cause you to give this OP some pretty lousy advice, and one days its going to bring you down as well.

Judd
 
Originally posted by juddson
[Y]ou make yourself look pretty stupid with comments like that ...typical of the disabilities you must endure as a result of your blinding hatred of attorneys ...[you] counsel blindness and ignorance of her legal rights ...get over your holier than thou attitude ...its going to bring you down as well.
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Man, you must have been a great lawyer! Try not to sound too defensive there, chief. And great debating skills. Did they teach you to name call in law school as an effective tool of communication?

P.S. Like I said, posting "sounds like you need to get a lawyer" or "sounds like you need to get a doctor" is singularly unhelpful and confers a total absence of advice in either case.

P.P.S. It may be a tough concept for you to grasp, but PERHAPS the reason everyone needs to get advice from lawyers every time we have a random bowel movement is precisely BECAUSE lawyers troll around with advertisements to litigate against everyone - and OTHER lawyers troll around saying you need to PROTECT yourself against litigation. Nah, that can't be it.
 
Originally posted by kinetic
P.S. Like I said, posting "sounds like you need to get a lawyer" or "sounds like you need to get a doctor" is singularly unhelpful and confers a total absence of advice in either case.
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Um.

"Go consult a professional" sounds like pretty solid advice to me, chief. But don't let me interfere with your rational, well-reasoned blind hatred.
 
Originally posted by aphistis
"Go consult a professional" sounds like pretty solid advice to me, chief. But don't let me interfere with your rational, well-reasoned blind hatred.
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Really? OK, let me help out everyone all at once, chief. Everyone on the forum who has questions about the Match should contact the NRMP - now nobody should have Match questions. Anyone with questions about choosing a residency should contact their Dean's office - now nobody should have residency questions. Anyone with questions about various medical schools and residencies should contact those institutions - that eliminates those forums, too.

This constitutes solid advice, according to aphistis. Or, is that my blind hatred talking? Good thing I didn't post a reply talking about how ignorant, stupid, blind, disabled, or hateful people are ...although I guess it's OK for others to do so (reference juddson and aphistis).
 
I think consulting an attorney wouldn't be such a bad idea, especially since you have to "sign on dotted line" for residency...to OP, it sucks, but always remember once you're labeled with something it sticks; so if there's a legal way to avoid disclosure...
 
Originally posted by kinetic
Really? OK, let me help out everyone all at once, chief. Everyone on the forum who has questions about the Match should contact the NRMP - now nobody should have Match questions. Anyone with questions about choosing a residency should contact their Dean's office - now nobody should have residency questions. Anyone with questions about various medical schools and residencies should contact those institutions - that eliminates those forums, too.

This constitutes solid advice, according to aphistis. Or, is that my blind hatred talking? Good thing I didn't post a reply talking about how ignorant, stupid, blind, disabled, or hateful people are ...although I guess it's OK for others to do so (reference juddson and aphistis).
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:confused:
 
Originally posted by kinetic
Really? OK, let me help out everyone all at once, chief. Everyone on the forum who has questions about the Match should contact the NRMP - now nobody should have Match questions. Anyone with questions about choosing a residency should contact their Dean's office - now nobody should have residency questions. Anyone with questions about various medical schools and residencies should contact those institutions - that eliminates those forums, too.

This constitutes solid advice, according to aphistis. Or, is that my blind hatred talking? Good thing I didn't post a reply talking about how ignorant, stupid, blind, disabled, or hateful people are ...although I guess it's OK for others to do so (reference juddson and aphistis).
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LOL:laugh: :laugh: :laugh:

Kinetic, you're going to do JUST fine.

Judd
 
To the OP: I was just reading my licensing and pre-residency application material, and it looks like you may need to reveal your dx to both the licensing board and to whoever does employee health at your program. I don't know for certain, but it seems to me that with a dx that could physically effect your ability to function, this dx may be revealed to your PD anyways. If I were you, I'd set up a meeting with your PD or just send him/her an e-mail about your concerns. I think that according to the American Disability Act, they can't fire or discriminate against you for it, and your PD is a physician so hopefully he or she will understand and be sympathetic to whatever limitations you may or may not encounter during residency as a result of your illness (but as a side note, I once saw a 60 minutes special on how docs were notorious for ignoring the ADA when it came to protecting their employees). I'm certainly not an employee legal expert though, but I definitely think that you should at least be honest when asked on those forms (dishonesty seems to be grounds for license revocation and dismissal). Good luck!
 
hey everyone, thanks for the various perspectives. Even the legal sidetrip gave me something to think about. Kalel, my program doesn't send out contracts for a while yet so I especially appreciate your looking at them and passing that info on to me. To be honest, before I even posted this I had figured I would talk to my PD but I just needed a little more of a sense of what I might be wading into... and I sure have that now :wow: But it's all good. Thanks everybody!
 
The fact is, anyone who is going to sign a contract of any type, (real estate, partnership, employment) needs a lawyer. The same way people who are sick need doctors. It's only to protect yourself.
 
JUST FOR THE SAKE OF DISCUSSION let me ask, does anyone think that there is any duty to inform the other members of the resident class. They are the ones who will have to take up the slack should badness occur. I know that in my residency we had a lot of pregnancies and others in those classes got hosed (25 12s in a month, this was pre 80 hour week rule) and others lost thier electives to fill in the ER shifts. For that matter should people have to disclose their pregnancy plans? As before, just a topic for discussion. No virulent hatred please.
 
(I'm assuming that FamilyDoc doesn't mind the hijacking of this posting to answer docB's question.)

I think it all depends on what is taking you away from your duties. My opinion is if you are planning an event (e.g., a pregnancy) which will take you away from your duties, you should let people know - it's really no different than going to a wedding for the weekend (except it's more protracted, obviously). You are consciously participating in something which you know ahead of time will take you away from duties for a set period. So I think if you had any respect for your colleagues, you would discuss the situation with them.

On the other hand, in the case of a medical illness like FamilyDoc's there is a different issue. That is, whether you feel comfortable telling people about the illness - it's still your right to privacy about the issue. I think in that situation, you don't necessarily have an obligation to disclose the information (i.e., no reason to tell others about that neurosyphillis you've got, right? :)) If you do feel comfortable about telling people about your medical condition, then you also have to decide how relevant it is. In other words, if there is only a small chance it will become an issue you probably can still keep it to yourself. If it probably will become an issue, it would probably be better to bring it up sooner rather than later.

By the way, pregnancy is the bane of many residency programs. It can become quite a strain, as you have experienced.
 
Kinetic makes a really good point. Pregnancy for many residents is a planned event that causes hardship to others in the class. Now that being true shouldn't the question "Are you planning on getting pregnant during residency?" be allowed and if the answer is yes shouldn't programs be allowed to discriminate based on the planned disruption to the program? (Sorry to the OP for this tangent but it is kinda interesting)
 
This gets back to my original reply to FamilyDoc: it is a choice you have to make between what is perhaps the "right" thing to do and what is expedient. (Refer to my original reply for the whole thing, because it is kinda long.)

But basically, in the case of pregnancy (as far as the issue of inconveniencing the program and other residents):

The "right" thing to do would be to fully disclose and let the program and residents know of your intentions ahead of time. This is because you know that you will be impacting the lives of others by a decision that you (hopefully) consciously made.

The expedient thing would be NOT to tell because, let's face it, as with FamilyDoc's issue it is something that will affect your acceptance - whether people want to admit it or not. Programs that are short on manpower (classically Surgery, which has class sizes of 2-3 residents in many places, for example) are hesistant to taking women for precisely this reason.

So, it's a choice for each person. Do you do the "right" thing and (probably) take a hit or do you do the expedient thing to avoid that hit? As I told FamilyDoc, hopefully we would all do the right thing. But - again, like I said before - this is life, not some after school special and some people might do the expedient thing rather than not get hired or lose their job.

You think people who get pregnant are unaware of the impact it will have on their colleagues? Or that they don't know the impact of telling a PD during an interview of their intention to get pregnant (if they know this at the time)? Or any other thing like that (such as FamilyDoc's situation)? No! We're all intelligent and we all know that it will have an impact - otherwise we wouldn't be so hesitant to disclose that information!
 
i would keep it to yourself. And on a side note about PDs, as much as people say they will do anything for you, that's a load of bs when it comes down to the wire. Trust no one.
 
We just had a neurologist give a lecture on MS this morning. Interestingly, he went out of his way to mention that he advises all of his MS patients to keep the diagnosis strictly to themselves and family members. He said the risks associated with discrimination (both intentional and inadvertent), healthcare, insurance, etc. are far too great. This guy knows what he's talking about, so I would keep the diagnosis from any employer (hospital, private practice group, residency program, etc.).
 
You would lose your medical license, because those things are required to be disclosed, along with meds, I believe. It would come out eventually, anyway, I imagine. The 'layperson' would almost certainly want to keep it secret, but not in this case. Just my opinion.
 
i have something similar going on...

the dean of my school knows i have lupus because it flared when i first started med school [now 3rd year] - before getting insurance in med school, i did not know i had it and just struggled along with these wierd flare things. the diagnosis was made after an extremely [terribly] embarassing incident before one of my med school tests - i had to go to the er and tests from the neurologist and rheumatologist were in short positive for lupus.

now that i know its lupus and i take medicine for it, everything has been normal - i feel like a normal human being again with symptoms pretty much gone. i thought my future was crushed at that time and was miserable to receive the diagnosis, but i realized it is actually the beginning because the flares and pain is gone and i function like any other person.

but now i wonder, does this mean the dean will have to mention this incident years ago on my dean letter, or that i was given this diagnosis which they know of...
 
Well, my own opinion is that there's no reason why your lupus should be mentioned on your Dean's Letter, which is simply an accounting of how you did academically and clinically throughout med school. You got the diagnosis, you're being treated, you've kept up with school if I'm reading your story correctly. If you had had to drop out and start again the following year, that is going to require some explanation.

It seems to me this is something you could discuss with your dean prior to the writing of the dean's letter, too, and make it clear that you don't feel it's relevant. (Does everyone get to review their dean's letter? We did.)

Good luck, and glad to hear that you are doing well now.
 
I think the specialty you are going into makes a difference. Obviously, there are good PDs and bad PDs in any specialty but family medicine as a whole seems to be more humane and less self-serving. Same with PM&R - I have seen more residents, faculty, department chairs with physical disabilities (post-polio, spinal cord injury, cerebral palsy, and yes, even MS) during my interview trails than I have seen in any other specialty. I think family medicine is similar in that people who go into the specialty tend to be more warm and open minded. When I rotated through FM, a resident was diagnosed with brain tumor. NO ONE complained about taking extra call, no one called her a pain, everyone was supportive, and the PD made it a point to tell her that she needs to take care of herself first. In a more labor intensive field like surgery, ob or perhaps ED - there's more of a "survival of the fittest" mentality. Things that would increase the already stressed residents' work load are frowned upon.

I think you are lucky that you are going into family medicine. :clap: I would still consult a lawyer - if $$ is an issue, you may be able to contact the local MS society or other associations. Also, why not ask your neurologist for his/her opinion? Ask him what the possibility of having a flare up during your 3 yr residency would be? I think that there's also an association of docs with disability.

American Society of Handicapped Physicians
c/o Jericho Peden
3424 S. Culpepper Court
Springfield, Missouri, 65804
United States
Telephone: (417)881-1570
Fax: (417)887-9830

You could try to find other resources like that for support.

interesting links:
http://www.ms-doctors.org/gmarone.shtml

http://www.adelphisystems.com/ms-gateway/med-reg.html

http://www.ama-assn.org/amednews/2001/01/15/prsa0115.htm

http://www.conillinst.org/guestbk/default.asp?PagePosition=7

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Patient created website by physician with MS
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Handy glossary to difficult language in the research
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http://www.aclu.org/DisabilityRights/DisabilityRights.cfm?ID=9112&c=69 "In one dramatic example of stigmatization in the public sector, a physician with multiple sclerosis was denied a residency in psychiatry, because ?the devastation, guilt, pity and rage that can be stirred up in his patients by his physical condition appears to be too much to ask of his patients or of him.? Pushkin v. Regents of the Univ. of Colo., 658 F.2d 1372, 1387 (10th Cir. 1981).36


hope this helps
 
Hi, FamilyDoc.

Anything worse than the vice of advice?

Good to hear you haven't had exacerbations for the last 6 years. As you know, this is a VERY favorable prognostic sign. You should certainly talk to your neurologist about residency, as I'm sure you have already. He may be very helpful.

No matter what you decide (or have already decided), I'm sure you've already gotten a feel for your program director as a person. Some PDs are cool, they're very pro-residents and will go to bat for you. Others at the hospital here are real f---ers who I could imagine going nuts and getting angry at you for what they would perceive as hiding information from them. So if former, tell. If latter, hide it.

My advice is that one sure way to turn a program director who is sympathetic to your position into the latter kind is to even give a hint of lawyering up. If the interchange between Juddson (who isn't even a laywer anymore) and others teaches us anything, its that doctors do not like interchanges with lawyers. I can't imagine your program director is an exception. By getting a lawyer, you're going to mark yourself to even the most humane PD: problem resident.

Otherwise, as I said, I don't find any compelling reason to weigh you one way or another. It can be argued either way. Good luck.

By the way, I've heard that something like 80% of interns fit the DSM criteria for major depression. This is an illness and no-one really cares about it. Is it just an assumed part of the job? Is MS different?
 
Originally posted by neglect


My advice is that one sure way to turn a program director who is sympathetic to your position into the latter kind is to even give a hint of lawyering up. If the interchange between Juddson (who isn't even a laywer anymore) and others teaches us anything, its that doctors do not like interchanges with lawyers. I can't imagine your program director is an exception. By getting a lawyer, you're going to mark yourself to even the most humane PD: problem resident.

Click to expand...

Whoa. . .I'm not saying that you should confront your PD with an attorney. I said you should ask an attorney what your legal rights were. At such point that it would be necessary to actually let your PD know you had an attorney, things will have already gone to hell for you.

I suggested you see an attorney to determine whether your hospital would have a legal right to dismiss you or make your life otherwise difficult, and whether you have a legal obligation to inform your PD anyway. I'm not suggesting you use her as some kind of a hired gun - that's the last way you'd want to approach this.

BTW, Neglect, I think I am still an attorney.

Judd
 
I'm still a first year medical student, so I understand if you all tell me I don't belong here.

I mainly wanted to thank axm397 for posting those links. I'm trying to plug myself into a network of students and doctors with disabilities, and every little bit of information helps. Also just knowing there are others out there with disabilites and/or chronic health conditions is a great source of encouragement for me - most of my classmates seem almost absurdly healthy, and according to the disabilities coordinator here, the few other students with disabilities here want to maintain confidentiality at all costs, so there has been no one for me to relate to on this topic.

Unlike FamilyDoc, my disability has the potential to impact my education on a day to day basis (it affects my hands) so simply not telling people is not an option for me (and when I've tried, it's simply backfired). The advice I was given when applying for teaching jobs about six years ago was to tell people AFTER the job offer was made to you, but BEFORE you chose to accept it. Obviously, The Match makes that advice impossible to follow in this instance. But you could apply that to the idea that it wasn't the PD's buiness during the application process (you didn't need any accomodations during the application/interviews), but it might be so now (in case you need accomodations in the future.)

Employers are required to give reasonable accomodations for known disabilites, and if you can fulfil the essential functions of the job, they have no legal grounds for discriminating. They don't have to do anything if they don't know you have a health issue. They also can't leagally just use your diagnosis to make assumptions about your health status and abilities. Of course, we all know that what is Legal and what actually Happens can be very different. They could also argue that missing work is not fulfilling an essential function of residency.

The Pushkin case that was cited - just to mention that it was pre-ADA (although post-504) Not that attitudes have changed between then and now - although in many cases I actually believe they have - but at least the law has changed substantially. Coincidentally, I went back to my Disability Law text just the other day to re-read that very case, before, once again, trying to convince my accomodations coordinator that there have been doctors before who have difficulty with manual tasks.

Anyway, FamilyDoc, I have no advice but just to wish you luck in what you decide - there's a lot of good arguments on both sides. Thank you all for inadvertantly making me feel less alone, and I'll just scuttle back to my little first year life.
 
Hi Nightengale,

Don't be so hard on yourself for being a first year! We were all first years at one time. At least you're not the type to go around with a big ego telling everyone you're a medical student and you know everything ;)

Anyways, just wanted to let you know - (you may already know) amsa (American Medical Student Association) has an advocacy group for diability. The link is:

http://www.amsa.org/adv/cod/

Although their national meeting already passed, you can still get on the listserve and start connecting with others. I LOVED my experience in AMSA - the students are, on the most part, very open and warm.

just a little trivia - famous ppl with disabilities
http://www.amsa.org/adv/cod/famous_cod.pdf

I also rotated at JFK rehab in NJ where the chair has cerebral palsy - his story is really inspiring.
http://www.healthsciencefaculty.org/profile_gallery/strax.html

here's a link to center for disability issues and the health professions
http://www.westernu.edu/xp/edu/cdihp/pnp.xml

http://www.ama-assn.org/amednews/2000/09/11/hlsa0911.htm

also, advocacy for admission of ppl with disability into med school:
http://www.physiatry.org/education/whitep1.html


Hang in there - first year's tough but it gets better!
 
Thank you for the links. Some of them are new to me and I will find them very useful. The accomodations coordinator and I go back and forth over the "technical standards" list all the time - I keep trying to convince her that there are many fine doctors out there who can't do everything on her arbitrary list. On Monday I thrust a paper at her called "The myth of the undifferentiated medical student." We'll see what happens.

AMSA I shall have to look into. I didn't want to join a group if it meant filling out credit card applications.

Dr. Strax is COMMING here (Jefferson) to speak at the end of April! (That sound you hear is me jumping up and down with glee. One of the deans in the diversity office here knows him from Robert Wood Johnson. She and I are so excited about my chance to meet him. I just hope people come to the talk.)

?t's not that I feel bad about being a first year in general (although this year has been awful,) but that I wasn't sure what my welcome would be on the "General Residency Forum." Since all I know about residency is that I want one in Pediatrics, preferably in or around Philly. As far as knowing everything, I think I knew more before I got here! I was a teacher for five years and I do have experience and knowledge in the disability field. That is completely useless in histology, however.

Thanks again.
 
Thank you for the links. Some of them are new to me and I will find them very useful. The accomodations coordinator and I go back and forth over the "technical standards" list all the time - I keep trying to convince her that there are many fine doctors out there who can't do everything on her arbitrary list. On Monday I thrust a paper at her called "The myth of the undifferentiated medical student." We'll see what happens.

AMSA I shall have to look into. I didn't want to join a group if it meant filling out credit card applications.

Dr. Strax is COMMING here (Jefferson) to speak at the end of April! (That sound you hear is me jumping up and down with glee. One of the deans in the diversity office here knows him from Robert Wood Johnson. She and I are so excited about my chance to meet him. I just hope people come to the talk.)

?t's not that I feel bad about being a first year in general (although this year has been awful,) but that I wasn't sure what my welcome would be on the "General Residency Forum." Since all I know about residency is that I want one in Pediatrics, preferably in or around Philly. As far as knowing everything, I think I knew more before I got here! I was a teacher for five years and I do have experience and knowledge in the disability field. That is completely useless in histology, however.

Thanks again.
 
I don't know how they recruited at Jeff but the credit card application is totally optional. It must have been some kind of a promotion. AMSA listserves I think are free. 4yr membership is $60 but don't think it's mandatory.

Dr. Strax is a GREAT guy. I was a bit intimidated by him at first but he is full of funny but thought-provoking stories. you'll enjoy him. You may even suggest to the dean that inviting the Jeff/Temple/UPenn PM&R residents to the talk may increase the audience numbers. (Since he is the past-president of the AAPMR - American Academy of PM&R)

Anyways, good luck with histo - sounds like you have a really good head on your shoulders. pm me if you ever need to talk.

:clap:
 
thankyou very much for the links.

although most of my classmates seem like the healthiest people ever and illness is frowned upon by some, especially in surgery which is what i plan to go into - it is my belief that those with chronic illness are some of the most dedicated, compassionate, and maybe talented physicians. while it is true that sometimes i was stuck in my own mind while trying to deal with illness rather than focusing on other people, i made it here to medical school for a reason.

for someone to go through undergrad or med school while just learning and struggling with a new illness and making it through well i think says alot about the person. i mean, what kind of person could go through medical school with ms - it takes a special dedicated and focused individual, someone who really knows what they want to do in life and truly derives satisfaction from helping others.

i have and always worked my tail off despite having lupus. i have mild lung d/s from it and not afraid to take my inhaler and pills out the 'or' just before i scrub. residents and attendings frown, but i still hold my head high and plow through my work. they watch what i have to do to stay healthy and i won't flinch or expect any kind of empathy as i do it. i am reliable and responsible, they can see that, and i think that is what's important.

i understand with chronic illness that although you may have not flared, you probably have some residual daily struggles from having ms, and these are things you already know how to manage well. when i apply to residency, i do not intend to tell the pd about lupus which may not the smartest thing to do. fellow residents and attendings expect to know about these things to anticipate what to do if a flare were to occur, this is part of teamwork.

but if you have the kind of denial about your illness as i do and are willing to take the risk of not telling them, then i hope you can do all you can to take care of yourself to avoid a flare. but i don't know if ms is as easy to control as lupus. if something were to happen to me, there is immediate prednisone to stop it, which is what i do when signs are starting to occur. there is plaquenil i take daily and is like prophylaxis. if your illness is well controlled and fairly easily managed, you may not need to tell the pd about the illness. i'm sure there are so many other physicians out there with some illness that they don't tell the pd because they know they can keep it relatively controlled.

good luck
 
This is an interesting forum. I'm amazed the high and mighty stance many have taken. I think everyone needs to look at what they would do if they were forced with revealing a medical condition.

What would you do if you had well controlled lupus or MS? Although we'd all like to believe PDs are there for our support, is the first impression you want to leave the PD with a potential problem? Although the law may not discriminate, the real world does, especially in fields like surgery.

My good friend has bipolar disorder. She had 2 manic episodes as a teenager and since has been controlled on medicine with 2 visits to the psychiatrist a year. She will graduate AOA and will attend a prestigious ER program. I'm one of a few people who even knows of her illness. When she asked me what I thought about revealing her medical info, I told her to keep quiet. I've heard enough sarcastic comments about patients with mental illness along the way to know that people make assumptions no matter how talented you are. Why does someone deserve to deal with this b/c they have the misfortune of having an illness that is now controlled?

I also thought the issue of pregnancy that some brought up was interesting. I'd be curious to know what percent of women entering residency actually are planning on having a baby during their residency.
 
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