Quoted: medical student with chronic illness and residency

[Doodledog]

This is one for aProgDirector. If he doesn't see it here (he usually does), then PM him

I have had a chronic, hereditary gastrointestinal disease since childhood. The genetic form of the disease is extremely rare, misunderstood by many and no strides have been made in terms of medical therapy. For the majority of my adulthood I have been asymptomatic and high-functioning with self-limited illness occurring at most once a year. Furthermore, I do not have any outwardly signs of chronic GI illness, many physicians remark on how healthy I look despite my condition. I excelled during my high school, college and preliminary medical school years and never had any medically-related absences, missed schoolwork or exams. In fact, I didn't even disclose the information in my medical school applications as I felt my illness would never interfere with my education.

Unfortunately, during this past year I had an acute flare and subsequent life-threatening event which required a month-long hospitalization. I had to withdraw from the rotation I was on at the time. I returned to school on research fellowship before I officially had to declare medical leave. I'll return to clerkships during the next academic year. My advisor is aware of the situation and has been very supportive in the aftershock of my hospitalization.

My concern revolves around residency applications, which require that any period of extended absence from school be explained. What are my HIPPA rights in terms of disclosing the reason for my absence? I feel that I am stuck between a rock and a hard place, as simply stating I had a "medical illness" may mislead programs or raise concerns about a psychiatric issue which is not the case. However, if I do disclose the true extent of my illness, programs would be made aware that this is a chronic, at times severe, and unpredictable process that is not controlled by any medications or therapeutic interventions. Because the disease is so rare the prognosis in my situation is unknown and physicians have no way of predicting if an event like this will occur again or in the near future. Furthermore, the disease process in its genetic form is misunderstood by many and they have a difficult time accepting that someone of my age and functional capacity could have such a severe illness.

I feel that disclosing this illness despite my excellent academic record would seriously affect my chances of obtaining the residency program of my choice. I am an optimist but have a hard time believing evaluators will remain impartial during the application process. I feel I will be judged based on my illness and the fact that I had an extended absence from school, which could occur in residency training as well. What are my options, if any, in this situation? Thanks in advance.

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[NotAProgDirector]

First, the law:

The fact that you took a long leave of absence will of course be public knowledge. The only place this will be officially documented is in your MSPE and transcript. Your Dean will have a discussion with you regarding what you would like to disclose. As you mention, you can simply call it a "medical leave" without any further detail. Or, you can put as much detail in as you want. You could even just call it a "leave of absence" and not put any more detail in that that. This is your choice -- the Dean can't disclose anything without your consent (other than the dates of the leave itself).

If you leave it vague like this, then no one can officially ask you about it. Theoretically, anyone interviewing you is not allowed to ask what the leave is for. That won't stop some people from asking outright, or obliquely. You'd need to decide how much you want to divulge when asked. You could say anything from "I had a personal issue to attend to that made it impossible to focus on my studies" to telling some version of the actual story. Or, you could say "It's none of your business", but I expect that might not go over well.

You could also say "I had a medical condition that required a prolonged hospitalization, but have made a full recovery and do not expect this will affect my future performance". This is a difficult one to assess without knowing what your illness is (and honestly, I wouldn't post it here). If you can, in good conscience, say that a re-flare is unlikely then it's "true" and you could use it. It borders on fraud, but would be impossible to prove. However, if you put this in your app and then had a flare while in my program, I would (perhaps) be quite upset, and you might find that we would give your spot to someone else.

BTW, this has nothing to do with HIPAA.

Second, for the real world:

This is one of those issues that can cut both ways. If you're vague about your leave, PD's may (as you suggest) assume the worst and decide not to rank you at all. Their concern would be that you have a chronic medical/psychiatric problem that might flare during residency and create havoc with the schedule. Without knowing what the problem is, they might worry that it would be likely to reflare, and hence be gunshy about ranking you.

On the other hand, if you're completely honest and talk about your disease, then that may scare PD's for the same reason. Or, it's possible that you could convince them that a recurrence is unlikely.

There is no easy, right answer in a situation like this. It's probably going to make it harder to match -- that doesn't seem fair, but that's the way life is sometimes. How much it's going to affect things is unclear, and will depend on how competitive you are as a candidate, how competitive the field to which you are applying is, and how high you set your sights. If you were to have a flare in residency, your ultimate outcome would likely depend on how honest you had been up front with your PD -- the more honest, the more likely the PD would be to help you get back on your feet.

 

[ForamenMagnumPI]

The previous post was a very good one. I have a chronic illness as well. When I applied to residency programs, I chose to be very up front about the diagnosis when I was directly asked. I did not volunteer the information.
When I matched, I went straight to the program director and told him about my diagnosis and treatment regimen. He had not been aware of my condition before the match, but I found him to be very supportive. I made the decision that I would use my vacation time very sparingly during residency, so that if I became acutely ill, I would be able to take time off. That plan worked quite well for my program and for me. Ultimately, how you handle this is your decision, but I think that most people are more reasonable than we might expect.

 

[dragonfly99]

It's hard to know what to advise you to do when we don't know what your medical condition is. However, I am of the opinion that it would be much better to divulge that you had/have a medical/physical condition. If you do not, many interviewers and programs will likely assume that you had psychiatric issues, a drug problem or some personality disorder that made you unable to cope on your clinical rotations.

IMHO it would be much better to have them know it was more of a physical medical issue. I think if you are an otherwise good student, this might be easier to deal with than you think, especially if you are not applying to a surgical field. It also might help if you are applying to some specialty like internal medicine to try applying to programs that are larger. If you are one of 30-40 medicine interns, it would be a lot less of a big deal if you ever got sick and had to be gone for a month...people have to take time off for things like maternity leave...it happens. Unless you are doing general surgery or neurosurgical residency, most people will probably not be as malignant as you think about this. For what it's worth, I think a lot of those killer diller specialties are overrated...the lifestyle is crap, and I'm not just talking about during residency...but your entire life after that. But I'm glad that someone still wants to do them...LOL!

If your disorder is as rare as you say, you could always gloss it over a little during your interviews...a lot of interviewers are pretty busy and they might not figure stuff out as much as you think. If you don't make too big a deal of this, it may not affect you as much as you think. However, I really don't know what your medical issue is so hard to judge...if it's likely to cause you to miss 6 months of a 3-4 year residency, then that could potentially be a big deal.

 

[Doodledog]

OP is satisfied with the responses and asked that the thread be closed.