QD104 - You Are So Not Disabled Save
QD Clinic - Lessons from the clinic
Grappling with Disability Letter Requests
Features Dr. Jack Cush
Transcription
Hey. This is QD clinic. I'm Jack Cush with RheumNow. This QD clinic is called, you are so not disabled. QD clinic is brought to you by RheumNow's coverage of ACR twenty twenty.
You give us two hours, we'll give you the meeting. You are so not disabled is kinda what a lot of people think when patients start asking for that disability letter. Could you please do this letter for me and whatever? And, you know, it doesn't really matter who the patient is or what the diagnosis is. We're like, oh my God, really?
I don't wanna do this. Didn't go to medical school nor rheumatology fellowship, or any of my career has been spent doing disability letters. It's not what I do. It's not what I should have to do. It's sort of like, like you can say yes or no, this person is smart enough to move ahead or this yes or no, this person is disabled enough to get the letter.
It's, again, it's very, very difficult. This came up recently with a 50 year old gal who has lupus, and, you know, she's having trouble. The last six months have been really difficult on her, she probably had COVID before COVID was a thing and diagnosable, and now she's dealing with a lot of skin disease, loss of hair, you know, more rash, more arthritis, arthralgia more than arthritis, cognitive problems, and she's got new renal insufficiency, and she's got a really important job that she just can't function in, and should she be disabled? So, again, the question of disability sort of depends on who it is and what they you know, and do they deserve it? That's what part you don't want to do.
You don't want to get into do they deserve it? Everybody deserves it. Everybody deserves it, and and and everybody deserves your support and instruction. It is far easier to say, no, I'm not writing that letter, and I want you to continue to work, because that's easier on you, is it not? But you're not living in their shoes.
You don't really know what they're going through. I've kind of had a change of heart on this in the last year or two, especially during COVID when we started getting all these letters, requests for, you do you write a letter saying the patient has an autoimmune disease and is at risk and they shouldn't go back to work or school? What I've said is, it's my job to support the patient, especially during times like this, when there's so much uncertainty and so much worry, do the right thing, write the letter, support the patient. It is part of managing a disaster, doing what you can. Patients who are asking for disability are kind of in a disastrous situation.
You know, and I get it that you don't want to do it, I mean, I have patients who want me to write for a wheelchair or an electric scooter for them, and I say no, because if I put you in that wheelchair or electric scooter, you're gonna get disabled. You're gonna get weaker. Weak people do less. If you do less, you get weaker. If you get weaker, you're in a wheelchair for the rest of your life.
I want them to be strong. I want them to force themselves to walk with a walker and to go to physical therapy and be all that they can be. But in some people, this does ultimately get down to being, doing the disability letter. So let's talk about the hard part. The hard part is number one, writing the letter.
I'd rather just shoot myself than have to write one of these disability letters. But you know what? You can fix all that by just writing a good template and then filling in the blanks on each patient. If you've got a good template to write a disability letter where you're putting in there the things that are most important that are justifiable by their disease, then they get this ability with your testimony. Do you have to actually say a certain thing?
They're missing one and a half eyeballs and a left tibia? No. It's not a formula like that. The formula is what the doctor says. If you can make a case for it, being the authority that you are.
So have a good template that you can rely on. It makes your life easier. How do I know what to write? Second thing, I mean, I don't know what to put in there. Start with the patient.
Why do you need disability? What is it that you can't do in your job that we can't fix? And if you're convinced that they've tried, and they've especially taken your advice, and done things that they really should do, on the side of the patient when it's a toss-up. It's the right and kind thing to do. Again, ask them, what is it that you want me to do?
And then you can declare that activity, that task that they can't do, and how it's backed up, and infringed upon by their disease. So, again, it depends if they're stuffing envelopes, anybody can stuff envelopes, but what if you got worsening scleroderma, you got digital ulcers and you're missing a few fingers? Not so easy. What if you work at the checkout stand and you've got PMR? Not so easy.
What if you're a police officer and there's a lot of desk work and that actually is what kills them? So again, you have to sort of, be permissive in what the patient says, is disabling them. You have to be along on the ride. Is it doing the right thing? You know, again, we can easily just continue to think like, You are so not disabled, and I am so not writing this letter.
But that's not the right thing to do. Do the right thing. And lastly, I ain't getting paid for this. Well, you can get paid for this. When I ran my own clinic, it was $50 for me to fill out any of such forms.
Cash, pay write the check, it's not going be paid by paid for by insurance. It's infringing upon my time, I should get paid for it because I got to look stuff up. Even if I got a template, I gotta look stuff up. It takes time. In my institution, they don't charge for it, but someone else is actually gonna do a lot of the work for me.
You can actually get paid for this by scheduling a visit. Make this a 99214 visit, do you know, check a few things, squeeze a few joints, but spend most of your time filling out this form to the patient's satisfaction. And, of course, always keep copies of everything you do, whether it's an FMLA paperwork or a disability paper. Again, disability, some people need it, and they need you to get it. Do the right thing.
Hey. Let me tell you about two things we're doing cool in covering the ACR. One, rheumatology roundup, Artie Cavanaugh and I, Monday night, 7PM. That's gonna be the, November 13. And on Saturday night, midway through the meeting, we're gonna have a mid meeting sort of, wrap up, if you will, or, look in at the meeting and see what's been presented so far and what's coming up.
That's gonna be a Saturday night thing at 7PM. It'll be a Zoom meeting. Those of you who, are verified rheumatologists, you'll get an invite to me to attend both of those events. Those of you who are not, but follow us on RheumNow, you can actually watch both of those presentations where we're getting a lot of questions from people and field those. You can watch those on our YouTube channel or on our website where we're gonna livestream them from again, PM on Saturday night and on Monday night.
That's 7PM eastern time, 5PM pacific time. We think that's 8PM eastern time, 7PM central time. Hope I said that all that right. Tune in. Take care.
Bye.
You give us two hours, we'll give you the meeting. You are so not disabled is kinda what a lot of people think when patients start asking for that disability letter. Could you please do this letter for me and whatever? And, you know, it doesn't really matter who the patient is or what the diagnosis is. We're like, oh my God, really?
I don't wanna do this. Didn't go to medical school nor rheumatology fellowship, or any of my career has been spent doing disability letters. It's not what I do. It's not what I should have to do. It's sort of like, like you can say yes or no, this person is smart enough to move ahead or this yes or no, this person is disabled enough to get the letter.
It's, again, it's very, very difficult. This came up recently with a 50 year old gal who has lupus, and, you know, she's having trouble. The last six months have been really difficult on her, she probably had COVID before COVID was a thing and diagnosable, and now she's dealing with a lot of skin disease, loss of hair, you know, more rash, more arthritis, arthralgia more than arthritis, cognitive problems, and she's got new renal insufficiency, and she's got a really important job that she just can't function in, and should she be disabled? So, again, the question of disability sort of depends on who it is and what they you know, and do they deserve it? That's what part you don't want to do.
You don't want to get into do they deserve it? Everybody deserves it. Everybody deserves it, and and and everybody deserves your support and instruction. It is far easier to say, no, I'm not writing that letter, and I want you to continue to work, because that's easier on you, is it not? But you're not living in their shoes.
You don't really know what they're going through. I've kind of had a change of heart on this in the last year or two, especially during COVID when we started getting all these letters, requests for, you do you write a letter saying the patient has an autoimmune disease and is at risk and they shouldn't go back to work or school? What I've said is, it's my job to support the patient, especially during times like this, when there's so much uncertainty and so much worry, do the right thing, write the letter, support the patient. It is part of managing a disaster, doing what you can. Patients who are asking for disability are kind of in a disastrous situation.
You know, and I get it that you don't want to do it, I mean, I have patients who want me to write for a wheelchair or an electric scooter for them, and I say no, because if I put you in that wheelchair or electric scooter, you're gonna get disabled. You're gonna get weaker. Weak people do less. If you do less, you get weaker. If you get weaker, you're in a wheelchair for the rest of your life.
I want them to be strong. I want them to force themselves to walk with a walker and to go to physical therapy and be all that they can be. But in some people, this does ultimately get down to being, doing the disability letter. So let's talk about the hard part. The hard part is number one, writing the letter.
I'd rather just shoot myself than have to write one of these disability letters. But you know what? You can fix all that by just writing a good template and then filling in the blanks on each patient. If you've got a good template to write a disability letter where you're putting in there the things that are most important that are justifiable by their disease, then they get this ability with your testimony. Do you have to actually say a certain thing?
They're missing one and a half eyeballs and a left tibia? No. It's not a formula like that. The formula is what the doctor says. If you can make a case for it, being the authority that you are.
So have a good template that you can rely on. It makes your life easier. How do I know what to write? Second thing, I mean, I don't know what to put in there. Start with the patient.
Why do you need disability? What is it that you can't do in your job that we can't fix? And if you're convinced that they've tried, and they've especially taken your advice, and done things that they really should do, on the side of the patient when it's a toss-up. It's the right and kind thing to do. Again, ask them, what is it that you want me to do?
And then you can declare that activity, that task that they can't do, and how it's backed up, and infringed upon by their disease. So, again, it depends if they're stuffing envelopes, anybody can stuff envelopes, but what if you got worsening scleroderma, you got digital ulcers and you're missing a few fingers? Not so easy. What if you work at the checkout stand and you've got PMR? Not so easy.
What if you're a police officer and there's a lot of desk work and that actually is what kills them? So again, you have to sort of, be permissive in what the patient says, is disabling them. You have to be along on the ride. Is it doing the right thing? You know, again, we can easily just continue to think like, You are so not disabled, and I am so not writing this letter.
But that's not the right thing to do. Do the right thing. And lastly, I ain't getting paid for this. Well, you can get paid for this. When I ran my own clinic, it was $50 for me to fill out any of such forms.
Cash, pay write the check, it's not going be paid by paid for by insurance. It's infringing upon my time, I should get paid for it because I got to look stuff up. Even if I got a template, I gotta look stuff up. It takes time. In my institution, they don't charge for it, but someone else is actually gonna do a lot of the work for me.
You can actually get paid for this by scheduling a visit. Make this a 99214 visit, do you know, check a few things, squeeze a few joints, but spend most of your time filling out this form to the patient's satisfaction. And, of course, always keep copies of everything you do, whether it's an FMLA paperwork or a disability paper. Again, disability, some people need it, and they need you to get it. Do the right thing.
Hey. Let me tell you about two things we're doing cool in covering the ACR. One, rheumatology roundup, Artie Cavanaugh and I, Monday night, 7PM. That's gonna be the, November 13. And on Saturday night, midway through the meeting, we're gonna have a mid meeting sort of, wrap up, if you will, or, look in at the meeting and see what's been presented so far and what's coming up.
That's gonna be a Saturday night thing at 7PM. It'll be a Zoom meeting. Those of you who, are verified rheumatologists, you'll get an invite to me to attend both of those events. Those of you who are not, but follow us on RheumNow, you can actually watch both of those presentations where we're getting a lot of questions from people and field those. You can watch those on our YouTube channel or on our website where we're gonna livestream them from again, PM on Saturday night and on Monday night.
That's 7PM eastern time, 5PM pacific time. We think that's 8PM eastern time, 7PM central time. Hope I said that all that right. Tune in. Take care.
Bye.
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