How to apply for disability accommodations

[PercutaneousKnowledge]

Hi,
Unfortunately due to a degenerative condition, I am no longer able to walk (I was healthy and able for 2.5 years of medical school). I need to continue with rotations, however, things like surgery and obgyn are highly physical and I am not able to perform then upright. How do I go about getting official documentation to allow me to either perform surgery while sitting or perhaps skip this rotation entirely? Does anyone have any experience with working with the American Disability Association to get my disability in writing? School seems to be dragging their feet and will eventually make me graduate a year late since I am on medical leave, unable to finish my core rotations (due to inability to stand/walk). Thank you so much.

PS: I had pursued a career in surgery (good scores on boards) and as my condition progressed thought about anesthesia. Now I am thinking radiology or edit. psychiatry. Very depressing, but I suppose this is life.

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[Crayola227]

Everyone will blast me, but you can look through my post history on topics about disability.

1) Get a hold of the as much of the Student Handbook, school policies, by-laws, anything written about rules etc and read in detail, especially the section on technical/physical requirements, disabilities, ombudsmen, appeal processes, legal representation.

2) You needed an attorney yesterday, call your local bar association stay anonymous and see if there if you can get a referral to someone that specializes in education or disability discrimination, you don't need to let the school know and I don't suggest you use an attorney to slap them in the face or anything ridiculous, but it is good to have someone who knows your rights, can help you document and navigate this, because if this is going to delay your graduation a year I can already tell you the school is either clueless, lazy, or not on your side. If an attorney says it's not their area, ask them if they know ANYONE you can call and keep calling. Also google. You can often get a free initial consult, or where you would only pay for the time if you continue forward with the attorney's services.

3) If there is an ombudsmen you can contact them, again be sure of confidentiality

4) Go to all the health providers you can and have them document your disability but also outline what accommodations you may need and what you are capable of doing, go to your PCP, if there is a student health service go there, possibly PT/OT for equipment recommendations

5) Every school MUST have a diversity/disability accommodation office, they are the KEY to all of this, they are usually very helpful, if they are not, again, nothing like having an attorney to get people busy. In education having an attorney is not as antagonizing as it is in employment, especially since you are just seeking disability accommodation. I don't know how much of the above you have done and how helpful people have been. This office is where it all happens - they gather the data from your physicians on your limitations and what accommodations you need, and then they talk with the dean or whoever on the education side to see if that will work within the educational requirements of the program, and come up with an actionable accommodation plan. This is where it all works or it all falls apart. This is why an attorney and having some idea of what you can do to engage in these rotations is going to help you get the info you need from your providers to the disability office, where you will help them craft a plan to make the school help you.

6) Contact occupational health for your facility, they will likely do an eval or will be the ones to help arrange say a mobility scooter and where to park it, etc. They may have to contact the Fire Marshall or OSHA because of all idiotic things canes, crutches, mobility scooters in the hallway of a hospital are considered hazards and some places will not allow employees to use them at work. Read that again: some hospitals will not allow you to park your wheelchair in the hallway for a few minutes. Or they will try not to allow you which is why this post is so long with so many steps.

7) Make clear that you fully intend to participate as fully as possible, do not suggest skipping surgery or ob/gyn or anything like that, that CANNOT be your suggested solution. The flexibility I have seen for some students with the OR is that they observe and do not do much - which funny story I've seen residents of every level scrubbed that only got to watch. Watching is 90% of your surgical rotation. It's great if you can do some sewing but if all they were gonna have you do is hold a retractor, you'll learn as much by watching. In a wheelchair you can still get close enough to watch, hell if there's space you can still drive camera or retract if they were going to have you do that. You can definitely help close, or with scissors for cutting sutures. You don't know what the role of medical student is during surgery so it's hard for you to suggest solutions. That's why I'm writing all this.

8) Contact the Dean that you are working with the Disabilities office. The Dean is not neccessarily your friend (their only concern is really maintaining the educational requirements, how much they help you is...?), so email them and meet with them and whatever chats you have should be followed up with emails essentially confirming whatever you talk about.

9) Sounds like you will need some sort of mobility device, and the hard part is going to be, how are you going to get around the hospital/clinic/OR with one? Will you need to be transferred, say, to a stool to observe/hold retractors in the OR? Will you need a personal assistant to do this? In some cases the school may be able to hire one, or a hospital volunteer. Would faculty, residents, students, nursing staff be able to help you do this? The truth is that they can't officially be held to do that for so many reasons. So you need a plan that allows you to get around on your own, but yeah, in a pinch people will help move you if you are there and they have to.

10) You could be proactive and contact the clerkship director (not coordinator) for both surgery and ob/gyn and ask them how you can participate with your limitations. Talk to disability office and/or attorney first, you want to be somewhat careful in talking about your medical stuff to anyone that is not your provider, an attorney, or the disability office. Without giving away too much, you want to know what can be done. They may say they've dealt with your situation before, gutting any issues from the Dean, or they may say they can't imagine how to help you.

I know someone in med school who was able to walk but could not stand for any real length of time, and they were given permission to be seated for OR activities, observe, and participate wherever possible. For ob/gyn surgeries this is fine, you can be seated on a stool between the patient's legs holding the uterine manipulator most of the time watching on the monitor, like every other student. For deliveries, depending on the institution the most you would really do is deliver placenta, which can be done from a stool, a resident will have to help you but you shouldn't ever be doing that alone anyway. Depending on positioning you may still be able to catch a baby but I see that as trickier for you.

Guess what though? Plenty of med students never catch a single baby on ob and still pass. The biggest obstacle I see with ob is the constant in/out of patient rooms to do cervical checks. Whatever - you're going to suggest that you are going to scoot your ass in and out all over the damn place - in reality the intern is likely to just run off and not make you follow half the time, and have you write the like q2hr delivery notes that have to be written. That's fine - I didn't get my fist in a single delivering woman the entire week on L&D, I just watched the intern do it because it's painful and they didn't want to subject the women to extra checks. Is that how your school would officially like to present how the ob rotation should go down for you? Probably not so don't suggest it.

You being a in wheelchair can totally work - it's just a complete pain in everyone else's ass to have to wait for you to "zip" around (in your scooter, and moving those around, in/out of patient rooms is not zippy) and then having to adjust the height of everything, the patient's bed, the surgeon's step or stool, your stool, the stares and the foot tapping while everyone waits forever for the elevator rather than the stairs. I am writing all this so you can grasp the reality that this is literally a problem of movement and height - all of which can be adjusted.

TLDR
haters gonna hate on my advice
I don't know your whole situation and how much the above applies to you
feel free to PM the hell out of me

 

[Crayola227]

Hi,
Unfortunately due to a degenerative condition, I am no longer able to walk (I was healthy and able for 2.5 years of medical school). I need to continue with rotations, however, things like surgery and obgyn are highly physical and I am not able to perform then upright. How do I go about getting official documentation to allow me to either perform surgery while sitting or perhaps skip this rotation entirely? Does anyone have any experience with working with the American Disability Association to get my disability in writing? School seems to be dragging their feet and will eventually make me graduate a year late since I am on medical leave, unable to finish my core rotations (due to inability to stand/walk). Thank you so much.

PS: I had pursued a career in surgery (good scores on boards) and as my condition progressed thought about anesthesia. Now I am thinking radiology or psychology. Very depressing, but I suppose this is life.

Sorry, I wanted to reiterate that your school has someone who's job it is to coordinate this by Federal law, get a hold of them and they will let you know what info they need. They actually have paperwork and very strict definitions that outline exactly what documentation is needed. Sometimes they will insist on certain evals, so they can send you to any number of providers/experts to document the disability. You don't have to figure this out on your own.

I see you sneaking in your feelings as a PS note and a "that's life"
so I hope you take this more as sympathy you deserve than anything that brings you down, but
what you are going through is one of the hardest suckiest things that could ever happen to a young healthy person all on its own, and I think is even harder on a medical student/resident
Being a medical student/resident is already one of the most difficult undertakings there is occupationally and personally, a very singular experience that hollows out the most high functioning without adding in any personal health challenges
And you are dealing with both!!
So I don't minimize what you are going through. It sucks and you are still fighting. I want to recognize you for that because I think you deserve it
When you graduate medical school all things will not be equal, you will have suffered and triumphed in a very unique and challenging way
For now, I think it would be quite understandable to feel sad, depressed, grieving really

You have likely already gathered that there may not be as much sympathy and help as you might think rational from a profession of healing.
Which is my way of saying that you may have been made to feel like a bother in the for profit meat grinder that now runs our noble calling
There is no rational reason why not being able to walk should be a barrier to being a physician

As you identified, you will likely have to adjust some of your goals as a physician, and that just sucks.
You may need to grieve the image of the doctor you thought you would be, and start constructing a new image.
I will point out, it is psychiatry, not psychology. Big difference. One is a physician the other isn't, get it straight!

You are still so early on in exposure to specialties and the day to day life of being a doc that it might seem like there are more closed doors than open ones. Medicine really is as broad with as many different opportunities as they say it is.

Truly, truly, there is more than one type of doctor any of us can be good at being, and just as well, enjoy. People who tell themselves otherwise, as you might expect, feel otherwise. All of human experience would tell us that we are all capable of being more than one thing in our lives. Just stating the facts, I wouldn't be surprised that they are of little comfort right now.

Hang in there.

Let me know if there is any way I can help you.

 

[DokterMom]

Sorry, I wanted to reiterate that your school has someone who's job it is to coordinate this by Federal law, get a hold of them and they will let you know what info they need. They actually have paperwork and very strict definitions that outline exactly what documentation is needed. Sometimes they will insist on certain evals, so they can send you to any number of providers/experts to document the disability. You don't have to figure this out on your own.

Truly EXCELLENT advice from @Crayola227

 

[DokterMom]

Oops - hadn't finished there... Props to Crayola --

I'd like to think her advice to get a lawyer isn't necessary -- and in the best case, you won't need yours for much. BUT she's absolutely right. Find yourself a disability lawyer and get the advice and guidance you need, and do it quickly.

The office that is responsible for disability accommodations should be able to provide you with everything you need and help you navigate the process. And once they know you have a lawyer, they'll probably do exactly that. Before you have a lawyer? Eh, not so much... The rules are complicated, and 'spinning' things to their benefit/your detriment is all too easy.

The best place to find the right lawyer is probably going to be through organizations that specialize in educational advocacy for children with disabilities -- autism in particular. They're well-organized and you've got some tiger parents there. Pick a disability lawyer who works more on the parent's side than the schools. Recognize that if s/he saves you a year, that's $XX tuition dollars plus an extra year of physician income, so don't cheap out. (Disability lawyers as a rule are much more sensitive to your budget than other lawyers.)

One other thing -- If you have a personal tendency to be accommodating and conflict-averse, start addressing that now, and with short-term counseling if needed. You will need 100 different ways to say "That's not acceptable" with varying tones, and also the guts to say it -- over and over and over -- and to people way above you in the food chain.

I'm pulling for you --

 

[PercutaneousKnowledge]

@Crayola227
Thank you so much for this information and encouragement. I honestly thought that there would be perhaps a smattering of advice here and there - I did not expect such a thorough and detailed guide to dealing with these sorts of situations. In my case, my disability happened so suddenly that I had no way to really prepare for any of this. I was literally able to work in a rotation one week and the next I could not stand. I took the entire day to go over and look over the disability paperwork and I getting all my affairs in order. If I don't receive a response by the school by the end of the week, I'll probably look for a lawyer. Also, thank you @DokterMom for advice as well - I am certainly an accommodating and conflict-averse person and I have found that it does not help when it requires the other party to do some of the lifting.

Thank you so so much. This is a trying time for both my family and I - we certainly did not see this coming and this has become a financial nightmare with trying to pay for medical bills along with living expenses. The last thing I need is my own school to not help me graduate on time so that I can start paying off my medical school loans and practice medicine.

I also fixed the psychiatry portion

 

[Goro]

Very sorry to hear about your woes, OP. Can you handle being in a standing position for a period of time? if so, maybe this is a solution:

I just call them "standing wheelchairs". I'll bet your school will piss and moan about being required to buy one, but I suspect that understand ADA guidelines, they may have to as a "reasonable accommodation", if you can, well, stand standing up.

Pathology could be an option for you.

Hi,
Unfortunately due to a degenerative condition, I am no longer able to walk (I was healthy and able for 2.5 years of medical school). I need to continue with rotations, however, things like surgery and obgyn are highly physical and I am not able to perform then upright. How do I go about getting official documentation to allow me to either perform surgery while sitting or perhaps skip this rotation entirely? Does anyone have any experience with working with the American Disability Association to get my disability in writing? School seems to be dragging their feet and will eventually make me graduate a year late since I am on medical leave, unable to finish my core rotations (due to inability to stand/walk). Thank you so much.

PS: I had pursued a career in surgery (good scores on boards) and as my condition progressed thought about anesthesia. Now I am thinking radiology or edit. psychiatry. Very depressing, but I suppose this is life.

 

[PercutaneousKnowledge]

Thank you so much for your suggestion Goro. Unfortunately for me, my main problem is that I can stand up for periods of maybe five minutes or so but need to be a seated position otherwise - it's mainly a bloodflow issue rather than a structural/muscular one.

 

[Crayola227]

Thank you so much for your suggestion Goro. Unfortunately for me, my main problem is that I can stand up for periods of maybe five minutes or so but need to be a seated position otherwise - it's mainly a bloodflow issue rather than a structural/muscular one.

Even better - sounds like you could transfer from one chair to another on your own/min assist, and if you are able to sit for extended periods of times, then it really is just a question of getting you to/fro with a scooter.

I think they make versions of Goro's device that are electric where it can move you from sit/stand quickly and easily since it sounds like you may need to be able to do that.

I wanted to mention in addition to PT/OT, occupational health, that PM&R, ortho, neuro, podiatrists can be saavy about assistive devices.

My friend's school did not have to pay for personal assistive devices, however, through the disability office they were able to ask around the hospital depts and get a motorized scooter on loan from ortho.

so don't be afraid to curbside any providers or supportive mentors about this stuff

I don't know your whole situation, but if the only accommodation you need is a scooter and being able to sit wherever possible, that is 100% accommodatable for ob/gyn and surgery rotation participation. You can most definitely finish medical school that way! Others have and so we'll just hope your school gets their act together for you and follows suit.