Medical New diagnosis of epilepsy during a surgical residency, do I have a future?

[NotAProgDirector]

Hello,

I am a PGY2 in a surgical residency. I was recently diagnosed with epilepsy and am starting medication. I have simple focal seizures, which means I cannot communicate or understand anyone for about 1 minute, but I maintain consciousness and control of my body. Is this something that needs to be disclosed to my program director if I am not seeking accommodations? They only occur once every few months. From what I've experienced sleep deprivation is not a trigger and I'm not a fan of caffeine/alcohol anyways. Do I have a career in surgery, or will malpractice insurers refuse to insure me as they are concerned I may have a seizure during a crucial portion of the operation? Unfortunately the only study published about doctors with epilepsy was published in 2007 and the one surgeon they detailed had to go on disability. Do I need to switch into a non-procedural specialty?

From the state medical board side, it seems that only if my seizures are uncontrolled that it becomes an issue.

This is a really, really tough question.

If while on medication your seizures are well controlled (i.e. you don't have any at all), then I think an argument can be made that you can continue. If you're still having seizures on medication, even if just once a month, I think this is going to be a real problem. You'll end up having one when people notice (even if it's not in the OR) and everything will unravel from there -- then there will be two concerns, that you have seizures and that you hid it from your program.

Even if your seizures are completely controlled, it may still be a problem. If there's a complication from surgery, people could argue that "maybe you had a seizure that caused the problem". Hard to prove otehrwise. And once it gets out that you have seizures, will patients choose you as a surgeon? Seems unfair, but the exact same thing happened to HIV+ surgeons early in the epidemic despite the fact that there have been zero (or near zero) documented physician to patient HIV transmissions in the OR.

So:

I would disclose this to your program. You may need an Occ Med evaluation to get a 3rd party opinion. If your seizures are completely controlled with meds, you can probably insist on completing training based on the ADA. After that, you would not need to disclose your seizures prior to hiring, but almost certainly would after being hired. It is likely to come up with licensing -- but you get a medical license to practice any type of medicine, so they should give you a license.

If you don't disclose and then a problem occurs, you're going to be under a microscope.

Only you can decide if this is "worth it". Your life would probably be a lot less stressful in a different field of medicine.

Getting disability insurance may be impossible, especially as a surgeon.

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[TheBoneDoctah]

Wow. Hard situation here. I would disclose this to your program. The reason being if you don't and it's found out and you did not disclose and you have a complication, you could be in hot water. If you were in primary care where you aren't holding a knife, it wouldn't be such a problem, but as a surgeon...that's a totally different story.

Another thing too...thinking down the line. What if these get worse to where you cannot work? I am fairly certain you won't be able to get disability insurance as a surgeon with epilepsy. They literally put you under a magnifying glass and will find every reason NOT to cover you. If you don't have insurance, and then down the line cannot operate, you are now without a job/income. Just another thing to think about.

 

[NotAProgDirector]

Thank you everyone for the advice. I am not concerned about disability insurance as I am not planning on living an extravagant lifestyle. My resident salary is already enough, and I can find work in a different field if I cannot work as a physician. I am more concerned about malpractice insurance but it looks like the companies care more about prior lawsuits than the health of the insured and use state board licensure as a proxy for health.

I will plan on notifying my program director, but I won't tell anyone else at work unless absolutely necessary.

Best of luck, but unfortunately I expect this will be a challenge. Your PD may be very concerned about this. You need to be prepared for a very negative reaction. As I mentioned, much depends on the frequency of your seizures while on medication.

 

[KidPharmD]

I can't speak for being a surgeon since I don't carry that kind of risk if I had a seizure at work. But I wanted to offer you some encouragement. I was diagnosed with epilepsy as a kid and have intermittently been really open about it and really terrified of telling people. It hasn't been extremely problematic in my professional life, but I have near perfect control, something that isn't possible for everyone. So, I guess just good luck with your goals.