Medical What kind of disability accommodations can I request after being accepted?

[Goro]

I recently received several acceptances and I’m ready to put down my deposit!

However, I’m gearing up to disclose a disability and I’m extremely nervous. I meet all technical requirements of every medical school I have applied to but I am still very nervous. Does anyone have any advice or encouragement about disclosing disabilities after acceptance? ADA allows me to keep this information private in the context of employment but I’m not sure if I messed up royally by not disclosing this up front.

Some context: I have absence seizures and they are refractory (I have tried every medication indicated for absence seizures with little to no success and severe side effects). I have experienced these seizures for 21 years. Shockingly and against all odds, they have remained stable through all of those years and my neurologist expects them to stay that way considering how long I’ve had it. I continue to have seizures daily that list for 30 seconds max. How often I have them is variable but it has never held me back from anything except driving and extreme sports. It can sometimes make people think I am briefly ignoring them but I usually just snap out of it, apologize earnestly, and ask the person to repeat themself. Most people don’t notice I have them as I have adapted to it and can reorient myself very rapidly when I become conscious again. There is very little literature relevant to a case like mine and it’s mechanism of action was only recently discovered by a lab at Stanford in 2016 investigating optogenetics.

I have only ever had to disclose my disability in an informal way and this will be my first time formally doing so. I am really nervous because I used to work for a disability advocacy consulting firm. The endless stories of people disclosing their disability and then losing their jobs (yes, it’s illegal under the ADA but it’s almost impossible to prove that an employer explicitly fired you for your disability) was very disheartening.

I am also concerned about transportation. I have been accepted to all DO schools and am thrilled to matriculate but this comes with the possibility of having to drive to other clinical sites or be placed in very rural areas with little to no transit if the lottery doesn’t allow me to stay in the city for clinical rotations. I have never been able to drive but have been able to live a relatively normal life by using public transit and cycling a LOT. Would it be an unreasonable accommodation to request staying in urban areas for clinical rotations?

Thank you! Any advice is immensely appreciated. Just writing this out makes me nervous.

Now that you have been accepted, it is the responsibility of the medical school to provide you with whatever accommodations you need for success. That's the law.

You will need to discuss all of this with your schools Department of student services

@lord999?
@Angus Avagadro?

---

Members don't see this ad.

 

[Mr.Smile12]

Now that you have been accepted, it is the responsibility of the medical school to provide you with whatever accommodations you need for success. That's the law.

You will need to discuss all of this with your schools Department of student services

@lord999?
@Angus Avagadro?

Absolutely. Student services offices should know what resources to contact regarding any questions on accommodations for learning services, testing, and clinical test accommodations that are kept confidential and only with those who should know in the student services team.

 

[TheBoneDoctah]

Would it be wise to call them now to discuss my options and what resources they have? Is it typical for students with disabilities to do so when deciding what offers to accept? I guess I have just never felt comfortable enough to discuss things like this candidly with people who may have power over me. It’s just very new and scary.

Thank you so much for the reassurance @Mr.Smile12 and @Goro

They will help you and work with you on this. Make sure to let them know sooner than later though so that these services can be set up when you start.

 

[Mr.Smile12]

You've been accepted. Unless you do something seriously unprofessionally stupid, your acceptance won't be rescinded. To that end, ask them with the appropriate professional decorum. It is in their interest to help you because you can still drop your offer.

 

[lord999]

@Mr.Smile12 and @Goro are mostly correct, though I would temper it with the "reasonable" is up to the office rather than you (you do not choose the "reasonable" in this case), and 504 specifies a degree of technical standards that irrespective of disability, you are required to meet (so total blindness would be a disqualifying disability for a medical student due to the inability to meet the technical standard of examination on sight). Since you know the ADA rules on this, the university ADA office will probably order you to get a medical exam with a provider of their choice due to the condition not being under control. Should your condition be found to be unacceptable for the technical standards in performance, this becomes a problem where many things could happen. In most cases, it is going to result in a nondisciplinary practice restriction.

ADA is not an unlimited accommodate-everything proposition, but it is something that protects everyone that a disability does not necessarily mean disqualification. That said, you need to disclose this formally. There are no disciplinary issues with having this, but there are disciplinary issues with failure to disclose and inappropriately risking patient care should your condition trigger during a clinical episode of care and contingencies were not executed. You need to get your medical records on this together, and your neurologist will certainly be contacted as while I am not a neurologist, this seems clinically complex enough that the school will need to work up a history.

 

[NotAProgDirector]

It's a complicated situation. As mentioned already, you are under no obligation to disclose this prior to application as long as you can reasonably state that you can perform the essential functions of the position with reasonable accommodations. You don't need to tell them what those accommodations might be.

But, the question that may arise is whether you meet the technical standards. You probably do, so they will probably accommodate this somehow. But how? Other than telling everyone who evaluates you that you have absence seizures and so may "zone out" for 30 seconds and that they shouldn't hold that against you, I don't know if there's some form of technology that could help. Don't worry about being sent to distant sites -- a very reasonable accommodation is that you get all local sites.

The real problem occurs at residency. Is this an accommodation that can be reasonably accommodated? Seems like surgery (and all the surgical subs) is simply out -- it would be unsafe to have a scalpel in someone's abdomen and have a seizure. Similarly, anesthesia isn't a possibility. I think Emergency Medicine would likewise be a dangerous situation for you.

So, could you complete a residency in Family Practice, Internal Medicine, Neurology, Peds, etc -- the more "cerebral" rather than procedure based specialties? That's an interesting question for which there's no clear answer. All of those fields have some procedures in them -- placing a central venous catheter, draining ascites or a joint, or a lumbar puncture. A seizure during the key part of any of those procedures could be problematic (although might be fine). It's difficult / impossible for many residency programs to arrange it so you don't do procedures -- when on night shifts, if you're the senior resident you may be responsible for them (or supervising others).

Perhaps more to the point, would it be OK for you to be interviewing a patient, have a seizure, and ask them to repeat what they just said? I could imagine patients being very upset about that. In Psych, imagine a patient telling you that they were suicidal and you missed it. Much of this concern really depends upon how well you can recover / fill in the blanks.

I wish you the best of luck. For certain, this won't be easy for you.

 

[NotAProgDirector]

Thank you for such a thorough response and for weighing in on the idea of whether or not having local sites is a reasonable accommodation. That is very reassuring to me.

I am at peace with not being able to do a surgical specialty or emergency medicine, although both of those would be at the top of my list if I did not have epilepsy.

I am humbled by my limitations and will not put my ego before patient safety. However, after doing many google searches I am well aware that I am not the first person to pursue medicine with a significant disability, or even epilepsy specifically, nor will I be the last. Perhaps a patient will be thrown off by a lapse in my consciousness. However, I have been disrespected, humiliated, or have been cared for inappropriately almost every single time I have ever had to go to the doctor. Maybe I have a disability. But there is a lot to be said about honesty, openness, empathy, compassion, intelligence, work ethic, and resilience.

I will also add that I have had to work in my 28 years of living. Many labor intensive, dangerous, and customer facing jobs. I’ve even had jobs where I’ve performed minor surgical procedures. My epilepsy did not get in the way. It was certainly something I was concerned about and ready to ask for help for, but I did not need to.

Thank you again!

That's a reassuring answer, was not what I was envisioning based upon your initial posts. Best of luck.