I used to do disability exams for the state, so I'm quite aware of the legal definition. Nice try there. There are also lots of bull**** conditions people are on disability for, doesn't actually mean they are disabled. I have a cousin on disability for his back pain. 3 years ago he built a fence for his backyard. NPR even did a neat piece on this a year or so back:
http://apps.npr.org/unfit-for-work/
Of course uncontrolled problems can screw with your job - residency isn't special in that regard. If its bad enough that you can't do your job, you take a medical leave of absence (allowed), get it under control, and go back to work.
The vast majority of medical problems can be brought under control given time as both of your examples showed. If it can't, maybe medicine isn't for you in the first place.
So much wrong with this, that despite you doing these exams, you are clearly biased in a way that you sort of miss the point. Were you doing exams for Social Security? Just because you did the exams still does not mean that you are knowledgeable beyond what a physician's role is, in a very complex process.
I don't know your cousin with respect to his particulars besides this fence incident, his back pain, and the rest of his life. I will use the example to make some points many people don't think about with disability.
1) - his back pain could easily be such that he can exert himself for a one-time task over which he has total control of pace. Perhaps he was quite altered, even on pain medications? When the task is finished, he may well need an amount of rest etc to recuperate that wouldn't be consistent with similar employment should employment cause similar strain.
The fact he put in a fence really tells me jack **** about how his back pain affects his ability to be employed in the national economy with accommodation including sedentary work with a sit/stand accommodation or at reduced production speed, how putting that fence in affected other areas of important functioning, subjective pain and mental illness/symptoms.
It is not proof of his ability to sustain enough effort to be employed AND not worsen his condition AND maintain functioning in other areas considered important enough one is no expected to sacrifice in order to be employed, and in effect may keep one from employment (ie ability to do ADLs such as bathe, obtain groceries, cook meals, etc).
2) - people frequently
improve on disability when they stop working. Of course that would be the case for many conditions. If full-time work in a field for which one is qualified, exacerbates the condition, (there are many like this), people can get better when they stop.
They might get better enough to regain a lot of function in a lot of areas (putting in a fence for example), however, if they were to go back to full-time work, they would in not tall order find themselves back to meeting the definition of disability. If it is reasonably believed that employment would substantially worsen a patient's condition, then again, they are not expected to participate in the national economy.
Thankfully we don't expect people to work themselves into the ground, just because when they stop doing so they may get well enough to try working themselves into the ground again.
3) - the fact your cousin put in a fence tells me nothing about the nature of his pain or his ability to hold a full-time job in the national economy taking into account his skillset, prior work history, current conditions, needed accommodations, or work pace.
4) - perhaps your cousin would be expected to need to miss 2 or more days a month due to his back pain, without notice to his employer. Even on a good week when he doesn't put in a fence, he just does ADLs. That would make him considered unemployable.
I too am quite aware of the definitions. I get the sense you aren't too sympathetic to people with disabilities, and that your general attitude is "suck it up." It's typically the physicians that feel that way that get a lot out of doing the disability exams and denials. Perhaps I'm wrong and shouldn't read too much into your posts on the topic.
You did the exams, but you are not a vocational expert. Have you listened to one when they go through the hearing process with a judge, attorney, and disability applicant? From what I know of what the physician's role in these determinations, figuring out if what YOU have determined about a patient from a medical standpoint is
consistent with any job in national economy, is not part of your job and I wouldn't expect you to be knowledgeable on it. Physicians are
part of determining FRC (functional residual capacity),
they do not determine if you are employable or not, although they may give an opinion on how employment would likely affect the patient and their conditions.
As far as what happens with a vocational expert, For example, say you used to be an attorney and you're applying for disability. The vocational expert may find that you are able to spend 8 hours a day with a whole host of accommodations, watching a security monitor and merely hit a button should you see a bad guy appear, then they will deny your claim because even if that is ALL you can do, then you are employable. If you could put shoes in shoeboxes at pace that is 80% production speed, the government would actually subsidize an employer to employ you. Nevermind how one even goes about actually getting such jobs.
I don't deny there are people gaming this system.
Now, do people figure out internet blog start ups or other part time jobs and get along financially? Sure. But the
government even with laws in place to protect the disabled, does not consider it
reasonable accommodation for an employer to provide a full time job to someone that may miss more than 2 days per week without some amount of notice. Employers are not held to that standard. I think that is completely fair to employers. It can leave a lot of people up the creek with no paddle. Once the government recognizes that this is not a reasonable accommodation, then it begs the question, how do we expect people to be employed when we've basically just said that we won't expect any employer to employ them given their limitations?
So they are approved for disability, and if they are able to get well enough while on it, go back to school, do vocational rehabilitation, or are able to find employment, or a source of income where they either no longer qualify to receive payments, then they are supported in doing so!! If none of that works, then they have a safety net. There's nothing like having no income and being unable to work.
Lastly, for why I explained so much about this, the idea that whenever your conditions get bad enough that you take a medical leave of absence and then return to work, is willfully ignorant, not even naive. I posted quotes why residency IS special in this regard. The environment is far more structured and punitive than other workplaces, and there is great resistance to accommodating even healthy workers - let alone those that struggle health-wise.
You statement literally dismisses without even a comment what the whole point of this entire thread is - discrimination. The whole point is that when you get too sick for residency, try to invoke RIGHTS from LAWS, those rights are infringed, the law is broken, residents suffer greatly, and they have little recourse about it.
The examples I gave you - was literally to demonstrate how migraines and asthma can be disabling, since you asserted that you didn't see how either was a disability or would need accommodation. Just because the examples I gave, the training was successfully completed
does not mean the people in question were not subjected to discrimination. You think the only illegal bad thing that a medical school or residency can do to you about your conditions is terminate you? JFC.
The next point - just because your conditions are controlled,
just not mean that you no longer need workplace accommodations.
The vast majority of medical problems can be brought under control given time as both of your examples showed. If it can't, maybe medicine isn't for you in the first place.
TLDR:
-suggesting that a person on disability putting in a fence as evidence of employability, proves my point that someone does not understand how disability or coping with chronic pain works
-people frequently have improved function and health on disability - this does not mean they are not disabled, and in fact, is one reason it is granted
-I brought up asthma and migraine to illustrate how they can cause disability in medical training and require accommodation, because it was asserted they were not on a list of disabling conditions
-the fact people may take time off or return with accommodations,
does not mean they are not subjected to illegal discrimination or denied full reasonable accommodations
-it is naive to think people can just leave and return as the law allows without discrimination taking place
-residency shouldn't be so difficult healthy people can be expected to fall ill, given that is the case, I don't think it's a surprise that those already with chronic illness may not keep up
-if people are getting sick or too sick to keep up with the pace, which DOES NOT have to exist to train doctors, I don't think the solution is to say "maybe medicine isn't for you in the first place"
-the fact someone would even say that about this problem of exclusion, is part of the discrimination