Quoted: Disability and Medical School

[NotAProgDirector]

I've recently developed an autoimmune disease (RA with Secondary Sjogrens) that results in impairment that requires accommodation. I was wondering if anyone here could comment on how this plays into medical school. Below I have copied and pasted Harvard Medical School's Technical Standards, with comments on how I match up to each.

You will certainly not be the first physician with RA. In general, there is nothing about RA that would prevent you from being a medical student, resident, or physician.

I. Observation: The candidate must be able to observe demonstrations and experiments in the basic sciences....a patient accurately at a distance and close at hand. Observation necessitates the functional use of the sense of vision and somatic sensation. It is enhanced by the functional use of the sense of smell.

There would be no issue with observation.

Agreed.

II. Communication: A candidate should be able to speak, to hear, and to observe patients in order to elicit information, describe changes in mood, activity, and posture, and perceive nonverbal communications...Communication includes not only speech but reading and writing. The candidate must be able to communicate effectively and efficiently in oral and written form with all members of the health care team.

For the most part, there would be no problem with communication that I can see. The one hurdle that I can imagine is that, on days where my hands are particularly stiff and/or experiencing an intense amount of pain, writing can become quite difficult, though still possible if I push myself. On these days, typing is significantly easier and, as such, I am currently allowed to type notes even in classes where the professor would not otherwise allow it (is this a possible accommodation to request in medical school? I can also use a tablet in these situations).

It's interesting that you bring this up. My experience is that those residents with arthritic/neurologic problems often find using a computer more challenging rather than less. Common accomodations would be using a mouse instead of a touchpad, and ergonomic place to work, and voice recognition software for typing.

III. Motor: Candidates should have sufficient motor function to elicit information from patients by palpation, auscultation, percussion, and other diagnostic maneuvers. A candidate should be able to do basic laboratory tests (urinalysis, CBC, etc.), carry out diagnostic procedures (proctoscopy, paracentesis, etc.), and read EKGs and x-rays. A candidate should be able to execute motor movements reasonably required to provide general care and emergency treatment to patients. Examples of emergency treatment reasonably required of physicians are cardiopulmonary resuscitation, the administration of intravenous medication, the application of pressure to stop bleeding, the opening of obstructed airways, the suturing of simple wounds, and the performance of simple obstetrical maneuvers. Such actions require coordination of both gross and fine muscular movements, equilibrium, and functional use of the senses of touch and vision.

This sector does concern me. Even if I am experiencing no pain, my joints and muscles are weaker than they should be. It's just a fact that I cannot change. As I am CPR certified, I know that I can do CPR, though it does cause noticeable physical pain; but I am at loss as to applying pressure to stop bleeding. Can anyone compare it to CPR in amount of pressure and can anyone give an average amount of time one would be expected to apply said pressure?


As for the rests, my joints can be stiff and difficult to move [resulting in less range of motion] but they are usually not so severely inflamed that they become useless or anywhere close to it. Except on very rare, severe flares, I can continue to grasp and use even thin/small objects. The main issue is duration -- as stated, writing a lot can be difficult; however, writing a few sentences is not, if that makes sense.

If you can do CPR, you can do all of the physical tasks required of a medical student and resident.

You do bring up an important point at the end. There is a difference between being able to "do" something and "do it fast enough / long enough" to get the work done. This is sometimes a problem. For example, I have seen students who, with accomodation, can type their patient notes. All is fine while a student and they only have 1-2 notes to do. Then they become a resident and now have 8-10 notes to do, and the accomodation doesn't work well for that. Asking to have your team size reduced is (usually) not a reasonable accomodation.

IV. Intellectual-Conceptual, Integrative and Quantitative Abilities: These abilities include measurement, calculation, reasoning, analysis, ...synthesis...Problem solving...able to comprehend three-dimensional relationships and to understand the spatial relationships of structures.

No issue here.

Agreed.

V. Behavioral and Social Attributes: A candidate must possess the emotional health required for full utilization of his intellectual abilities, the exercise of good judgment, the prompt completion of all responsibilities attendant to the diagnosis and care of patients, and...relationships with patients. Candidates must be able to tolerate physically taxing workloads and to function effectively under stress. They must be able to adapt to changing environments...in the face of uncertainties...

While my behavioral and social attributes are not lacking, the bolded does concern me. Physically taxing workloads can do a number on my body and, while still very possible, there are certain situations that I cannot function in without accommodations. These include:


a) Walking for long periods of time. I can't without the help of some mobility aid.

b) Standing for long periods of time. I can't. My knees would likely give out. I assume this would be problematic during a rotation like surgery. That said, I know there are paraplegics who complete medical school and, obviously, they cannot stand independently, meaning that there must be accommodations that can be put in place here. The first thing that comes to mind is a standing wheelchair.



I also have difficulty picking up dropped objects, getting up and down a lot (without the assistance of a cane or other aid to help me counterbalance), going up and down a lot of stairs, carry heavy objects, carrying objects for a long time period and a few otherrelated tasks.


As an applicant to medical school and as a student, how would this impact me? What would schools be willing to do? Obviously, though nobody here can answer ins absolutes, do you think my level of impairment permits me from succeeding?


Comments on residency would also be appreciated. I am interested in going the MD/PhD route and pursuing a career in Psychiatry.



As a side question, how do medical schools feel about assistance animals, either that be service, hearing or guide? I do not have one and will likely not get one; however, as someone who is friends with a few disabled pre-meds, the topics has come up and curiosity strikes.

As you mention, case law here is quite clear. Medical schools must accomodate your issues. You'd still be expected to be on surgery and in the OR, but as long as you can do so with an accomodation, you should be "fine". That's in quotes because don't expect the surgeons you are working with to be happy about this. If you can't walk as fast as them and keep up, your grade is likely to suffer. This is unfortunate (and probably illegal) but it's life.

If your ultimate career is Psych, then many of these issues become moot.

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