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Author Topic: An annoying disability issue for work at home (Getting a doctor's note)  (Read 3525 times)

nenjin

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Re: An annoying disability issue for work at home (Getting a doctor's note)
« Reply #15 on: September 18, 2023, 06:54:07 pm »

Thank you. I wasn't sure why he wanted to see me on video verses talk to me on the phone for this, given that it isn't like he's going to be able to see the nerves inside me on a regular camera. I also was not going to bring this up for fear he may decide I'm right and then insist I see him in person... 5 or 6 or however many months later. I appreciate it.

Doctors can tell a lot about you just by looking at you. For example, if you were needing a pain medication prescription and they (for some reason) decided to do tele-health, they'd want to see you to see if you look like a strung out drug addict looking for a fix. If you get on camera and your eyes are bloodshot, you got bags underneath them, you're disheveled, you're emaciated, your teeth are a mess and your living space in the background is a Stage IV disaster....they might think twice about prescribing you narcotics. Sometimes it's easier to get someone to show you who they actually are by allowing them to do so from the comfort of their own home.

And before you take that and get super paranoid about how you appear on camera....I can almost guarantee the reason they want to do tele-health is that it's MUCH more convenient for everyone.

So this is going to go one of two ways: 1) either it's telehealth because it's more convenient just to tell you no over the internet or 2) it's a fact-finding meeting that so far does not require you to physically be present to prove your disability to them. Which can be good! It might mean they're more likely to give you your doctor's note rather than making you PROVE you're facing chronic pain and a disability. Part of the battle might just be showing up.

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ChairmanPoo

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Re: An annoying disability issue for work at home (Getting a doctor's note)
« Reply #16 on: September 19, 2023, 06:17:05 am »



Hang on a second, you're a physician right? I imagine you have a million things to do and your time is very valuable.
I understand that the world simply does not have enough doctors. It's a hard job and I don't want to make it harder.

May I please ask for some tips to make things easier on my physician? or physicians in general? (Different in US, but...).
I may be very frustrated with the whole process, but I am just smart enough to know the doctor is not to blame. I also just work sort of adjacent to healthcare in offices and don't know medicine really.
I figured out doctors have a special way of looking at things and I don't want to be a pain for him, especially if he is being nice enough to work me into his (who are we kidding, probably overbooked) schedule.

I'm actually surprised that they are giving you so much trouble. I've gotten plenty of requests from patients for certs & letters for various aid programs and usually if its not crazy I obligue. One patient was under some financial duress at one point and I even made a letter saying that stress was counterproductive to their condition and they should be given leeway (I didnt think itd work but for me its literally a short dictation). Hypothetically speaking if that person had asked for me for a letter for their employer to justify WFH I'd have done it too.

Then again I'm told I'm far more approachable than the average consultant in the country where I work.

I honestly think that in part is some weird cultural barrier. I get the impression that in the anglosphere there's more emphasis, almost an  obsession with "not letting X take advantage [of us, or of the system]". I think it very often ends up  generating situations where the innocent pay for the sins of the guilty, so to speak. I think culturally back home there's more a trend to work around difficult people. Both approaches have their pros and cons. But I digress.

I'd go from less to more. Ie: I presume your GP knows about your chronic conditions. There should be a mandate to make a report explaining how they limit your activities. From there I'd try to make it specifically about WFH.
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femmelf

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Re: An annoying disability issue for work at home (Getting a doctor's note)
« Reply #17 on: October 01, 2023, 12:22:12 am »

First of all thank you Doc. I truly do appreciate the perspective.

From what I've been told outside of work from others, the ADA protects me as long as I can prove I have a disability and I don't ask for too much.

My boss supports me, but he is saying higher ups in HQ will oppose me like they oppose everyone else. Just anyone and everyone. Boss is saying it would be best if the doctor's note said something about it being bad for my health to drive for more than an hour.... Well, I don't go anywhere and stay home except food, work and the occasional drive but yeah. My doctor has said he will put whatever in the note. I already have a general one, but basically some jerk up top is going to nitpick anything and everything.

For real, being in pain is quite distracting, being at home lessens that drastically. Traveling increases it as it is a mobility issue. I am slowly getting in medical records and think I actually have a good shot when I have things like this quoted from the hospital system I went to after the first was less than great. Basically from 2018,

"Pt is here for a second opinion regarding chronic postop pain. Started to have pain a day or so after surgery and the pain never resolved. States now has constant 3/10 to 4/10 pain and pain that radiates to and down R lower extremity with weakness. Very protective of area; fears falls. Ambulates with cane or walker (mostly cane) after PT. Activity, weight bearing, and supine position on R side exacerbates pain. Scar well healed no wound dishesience.

A/P If she fails to improve w pain injections she may need exploration w neurectomies and surgical revision. Referral to pain management. Referral to radiology for imaging CT w contrast dye RLE, RLQ abdominal, and pevlic. Discussed possible opioid option. Pt declines: family history of substance abuse and side post surgical effects of narcotic medication."

I don't understand all of it but I get a fair deal of it and I think I have a shot. I don't see how they can deny me when I have medical records confirming the existence of things going back to 2018, even if the original hospital system is being stupid and not wanting to give me records or saying it's been too long for them to retain them.

Thank you for your advice.
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Truean

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Re: An annoying disability issue for work at home (Getting a doctor's note)
« Reply #18 on: October 01, 2023, 01:43:47 am »

Not legal advice. No one here is a client. If you take legal advice off the internet, then you are stupid. One size does not fit all. Contact a lawyer licensed in your state/country if you have legal issues. Please No quoting. Thank you. This is based entirely off the information that has been supplied here by others and should not be relied upon by anyone for anything.

1.) I recommend you delete that section of medical record you posted. While it does not appear to contain any sensitive information, you never know.

2.) ADA is complicated. You can be referred to a licensed attorney who practices in your location: Be disabled, describe disability, impact of disability on job, proposed reasonable accommodation. Cannot be an "undue hardship," on the company ($ or operational changes). Those are basics but it is not all cut and dry like that at all.

3.) Having done several med mal cases, and worked for several healthcare concerns, here are some of the abbreviations that might be giving you issues:
Pt: Patient
PT: Physical Therapy (Not to be confused with Pt, lowercase).
R: Right side (but you probably knew that).
Supine (laying down on your back)
A/P: Assessment and Plan (What the physician thinks and what they might consider doing about it.
Neurectomy: A surgical removal or destruction of a nerve.
RLE: Right Lower Extremity (Right Leg).
RLQ: Right Lower Quadrant (The lower right side of the abdomen)

4.) Records Problems: "even if the original hospital system is being stupid and not wanting to give me records or saying it's been too long for them to retain them."

While I have the utmost respect for physicians, nurses, technicians, CNAs (Certified Nursing Aides), and most everyone else in the healthcare field, unfortunately there exist stupid, overpaid (making easily 6 or 7 figures) healthcare administrators who do not understand HIPAA, and refuse to listen to reason. These are overwhelmingly NOT physicians, but rather have an MBA/MPA for what should have been a law degree, but is no longer commonly the case.... Many of these people exist for no other reason than to boss around actual doctors and maximize profits at your expense. Several fail to understand that HIPAA stands for Health Insurance Portability and Accountability Act (of 1996), and the accountability is theirs to demonstrate not to demand.... I've seen them try to hide medical records in cases where surgical instruments have been left inside people. Patients have certain (although not absolute) rights to their medical records in many circumstances. https://www.law.cornell.edu/cfr/text/45/164.524 While I cannot represent you, let me tell you, hospital administrators hate it when a judge rules they have to pay the attorneys' fees for being stupid and explaining this to their board of directors is simply not fun for them.

This is another reason you can be referred to an attorney for, and thankfully now that the government shutdown has been averted, the good people at US HHS OCR (United States Department of Health and Human Services Office of Civil Rights) may factor in....

https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html

If the original hospital refuses to see reason,

https://www.hhs.gov/hipaa/filing-a-complaint/complaint-process/index.html?language=es

Bottom line, there are ways to get your medical records and an appropriate referral to the right attorney can result in this. Said referral can be through PM as your location information even at the state level should always remain private for your benefit. Suffice it to say I once had a hospital deny me a copy of my medical records (and they would not even give me them if I paid them a fee of any amount). In the event the hospital stupidly destroyed your records too soon and or improperly against the required records retention policy, then that would explain to future decision makers why you could not get records was not your fault.

5.) I always recommend taking the polite, professional route. Never lead with the links above, or impolite force of any kind. Rather these are nuclear options of last resort. As you may know, everyone has a boss somehow or another, and you don't know if the person telling you "no," is only following orders ... and might even prefer to assist you. It seems your immediate supervisor ("boss") is on your side. This is good and tactically advantageous to know someone higher up is the problem. Your boss also told you what to ask the physician to write in a note (about car rides being a problem). Hopefully the physician can be asked to accommodate this to appease the higher up. The physician's duty is to the accuracy of the medical truth to assist the patient. However, many doctors are intelligent and respond well to a polite request if appropriate. I am glad your physician has told you they will write whatever is needed.

If you have a good professional relationship with your boss you might consider asking him or her for advice (assuming they can give it to you, possibly without notifying the higher up person/getting in trouble).

The question is how does this end, and how does it end well? What is the person in HQ looking for? What is that person's reservation to granting what you are asking (costing money? changing business practice? fear of someone abusing the system (possibly after some jerk did so in the past and ruined it for the rest of us)?, fear other employees would also demand the same and they couldn't provide it? avoiding the wrath of an owner/investor in the business?, triggering some sort of regulation? tax issues (where you and other employees work physically may have tax implications, especially at the city/county level, and state level if more than one is involved)? It may or may not be a legit issue, and someone may or may not be handling it correctly/well. I bet there's more information that you aren't being told as to why they are holding this up if your injury is "open and obvious" as you use an assistive device to ambulate.

Not legal advice. No one here is a client. If you take legal advice off the internet, then you are stupid. One size does not fit all. Contact a lawyer licensed in your state/country if you have legal issues. Please No quoting. Thank you. This is based entirely off the information that has been supplied here by others and should not be relied upon by anyone for anything.
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