Ugh, outpatient sounds just as horrible as it was in residency. Ultimately, what's good for the patient? I really like the idea of helping the patient self-advocate.
Some posters seem aware, and others do not, that the concept of "self advocating" when it comes to disability accommodations and employers/schools is COMPLETELY ridiculous.
The self advocating, is reaching out to ombudsman and the Title IX office, or HR, and then being given a form that you go to your doctor with and ask for help.
People seem to misunderstand that there is an ENTIRE medicolegal landscape that the patient MUST navigate. The patients don't make the rules. Physicians don't make the rules. The rules are made either by federal or state law, and workplace laws and employers. Employer policies may or may not actually follow the law, keep in mind.
Do no be naive to the extent that employers will resist even the most minor "hassle." Or that they can and will discriminate and even fire employees over this stuff, despite it being highly illegal, and the patient having little recourse. Having a signed form from a physician is often the only paper-thin defense the patient has from this kind of thing.
I've personally worked with more than one Title IX director and others involved in this system. The overarching theme is how unbelievably unaccommodating employers will be unless someone seen with authority sends in the right paperwork.
I have seen employers balk at patients with lower extremity injuries having a wheelchair or cane at work, even when the nature of the work made that entirely possible and not much of an issue otherwise! Even because, the employer was concerned what "people would think" to see the employee with one!
Is this discrimination with a capital D? Of course it is. But you would be completely shocked what employers will do or try to get away with.
Now, let's not say something like, "well if your employer is that bad, find another job."
And, you might say, if the employer is this awful, why would a form from a physician make any difference? Won't they just find another way to screw the patient?
Well, yes and no. Some employers if faced with paperwork, rather than just the typical bullying that might happen when there is no 3rd party (like a physician or lawyer), and it's just between the patient and their employer or HR, some of them will decide it isn't worth it and "give in" and stop hassling the patient.
Or, say they do go ahead and fire the patient anyway. Now, when the patient files for unemployment, the employer may not fight the claim and just let it go, because they don't want to get into the whole thing, not when the patient has some paperwork about disability on their side.
You know, some of the times when patients ask us to intervene on their behalf with a school or employer, you aren't always "enabling" dysfunctional behavior. You aren't always being asked to give an opinion that you can't reasonably give. You aren't doing something the patient can do themselves. Lawyers can't actually help a lot of these situations without a sympathetic physician, actually.
Keep in mind, the patient's insurance will often cover the visit to see you and ask your help. Help only you can give, a lawyer can't. But it won't cover a lawyer.
I know this is a little sideways from some of the examples given in this thread where it sounds like patients may want something unreasonable or counterproductive for them.
But we need to correct the notion that patients do not get backed into a corner where only a physician's letter can help them avoid unfair treatment, or help them maintain employment in a reasonable fashion, or allow them FMLA.
(Also not everyone qualifies for FMLA depending on the particulars of their job. And last I checked, the employee can be asked to get information corroborating the situation, like from a physician).
I can't for the life of me understand why physicians are under the impression that this is not something patients need help with, frequently not something the patient or their lawyer can do for them, or that it wouldn't be something that would be under a treating provider's job.
Use your best judgement, but don't assume it's someone else's job or the patient needs to see a damn forensic whatever or other special eval. Most of the time it isn't rocket science and people aren't asking for the moon. Be a god damn human being.