Medical Who should I let know about illness during residency?

[MusicDOc124]

Hello,
I am currently in the middle of residency, and have been dealing with a physical illness for 5-6 years that isn't life-threatening, but does often impact my life and impair my ability to function.
I was able to complete medical school without any significant issues, and during my med school rotations I talked with several of my attendings beforehand to make them aware of my situation so that any odd behavior from me wouldn't be misinterpreted as laziness/rudeness, ineptitude, etc. and so I could make time for doctors' appointments as needed. I have been able to get through almost half of residency thus far without any significant issues either, but it has really been a tremendous struggle and I haven't yet disclosed my health problems to either my program director or any of my attendings, because I hoped I could get by without doing so, and I really didn't want to deal with any "stigma" or be looked at or evaluated differently. However, during some busier rotations recently it has been harder for me to keep up and some attendings noticed that I am falling behind - my specialty mostly does not involve direct patient care so this is more in terms of me appearing to be behind on my diagnostic knowledge (because my illness sometimes gets in the way of being able to adequately prepare my cases, etc. in the time given). I otherwise always fulfill my responsibilities diligently, so these issues are never a danger to patient care. I have considered talking to an attending or the PD about my situation, but I don't really know how to bring it up at this point so far into residency, and it's also a bit personal and I don't know to what degree I want all of my attendings (and possibly peers because we also work with fellows who evaluate us, and many of our fellows are former residents) to know about my personal health - and I don't want to seem like I'm conveniently making excuses at this point, although I'm hopeful it won't be viewed that way because I've always been professional and genuinely love my specialty, and making a fake excuse this dramatic would be a bit ridiculous. I'm usually able to keep up decently on most rotations, but on the busier ones where I'm pretty much living at the hospital I may struggle - and I also haven't been able to schedule as many doctors' appointments. I would appreciate any input on how to navigate this situation: whether it's worth disclosing at all, how to bring it up and how much to actually disclose (should I just tell the PD and see what they suggest? should all of my attendings be made aware or just some? should they know my actual condition or just only know that I have a problem?), or if I should just finish the rest of residency by trying to survive as I have been - I don't want to be viewed or evaluated differently, or for this to affect any future career opportunities. I definitely didn't disclose anything while interviewing for residency because I didn't want it to impact my chances of matching, so I'm grateful to have made it this far without any big problems, but I'm not sure where to go from here now. Thank you so much!

I would disclose. You make it a point to say that it will not endanger patient care, yet you mention falling behind and that evaluators may be concerned regarding diagnostic knowledge. If you're not able to prepare things in time, or adequately take time to read/go over/view what you must because an increased patient load means less time available, even as an attending in the future - I would say it has the potential. Be careful of this. A way of being careful is ensuring that who you are working with knows and supports you.

I would let your PD know, and see what they suggest. Beyond that, I'd let your evaluators know, be it a fellow or an attending on whatever given rotation you are on. This will hopefully prevent a negative evaluation for something regarding the condition. Depending on the field and your supervisors at any given time, it may also lead to more efficient teaching for you, or more time, as able, to prepare what you need to actually give you a proper evaluation of your fund of knowledge/skill/etc.

With all that said, this is based on the assumption you are at a good program in terms of resident support rather than a malignant program that would throw you under the bus, which seem to exist in some places/fields. You make no mention of this type of environment which is what directed my comment/suggestion.

It seems you have documentation since you said doctors appointments during med school. Is this a difficult to control condition? If so, I would say to ensure you are continuing with whatever follow up/PT, etc is required or recommend as much as possible, and demonstrate that you are doing what you need to do to stay as well as possible to the PD.

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[Mr.Smile12]

Agreeing with @MusicDOc124: You should let your supervisor or PD know. Is this illness such that you need a break or some sort of accommodations? You need to let your PD know or they will misconstrue your illness as something else that could be grounds for discipline or dismissal. Your patients are your chief concern, and any compromise to the quality of their care is going to affect the way you are assessed.

 

[MusicDOc124]

Thank you both for the feedback! I'll let my PD know and see what they suggest. I'd say my program is pretty supportive so I'm lucky in that regard.
It is a bit difficult to control but I am on medication and doing my best to stay well, and I do have documentation. In terms of accommodations, I may just need some extra time sometimes (which can be difficult when I'm already cutting so close to breaking duty hours). I'm comfortable with telling my PD all the details, but do you think everyone else I'm working with needs to know the whole story? It's tough to balance personal confidentiality and privacy with explaining myself - I'd prefer to be more vague with everyone else, but maybe they deserve to know more too.

I'm personally more of an open book and prefer those who matter, need to know, would be required to know, etc.. to all know. Because if something hits me out of nowhere, or I needed a surgery suddenly, or even as simple as I'm late because my BS delayed me, then coming out of the blue years later with "I have xyz" will get you funny looks and a bowl full of doubt.

Mind you, we are different people (obviously), and to a great extent this is a personal decision. If it were me, my friends within the program would know, the PD would know, and whoever my supervising physicians were for any given rotation would know.

 

[NotAProgDirector]

You should absolutely let your PD know. One critical issue in situations like this: you cannot use an undisclosed disability accommodation to "explain" poor performance. It is your responsibility to get the accommodation before there's a problem.

You usually would not let your supervisors know. Your PD (perhaps along with HR) will come up with some sort of an accommodation plan. This could include more time to attend appointments, for example. Supervisors will only need to be told that you have an appointment and will be excused for some period of time.

If you're having trouble getting all of your work done inside duty hour limits, that can be a problem. "less work" is usually not a reasonable accommodation -- although perhaps shorter bursts of more intensive work might be reasonable.