Personal story of a family physician
A family physician shared their story about the impact of severe migraines on their practice.
Their main accommodation is being able to work virtually when needed with flexible hours. They are able to self-accommodate in this way, since they have an independent practice providing care fee-for-service. Although no formal approval process was necessary, there were times when they did have to advocate for themselves within the clinic.
1. Can you describe your condition?
I experience migraines, which are more than just “headaches”. They include debilitating pain, dizziness, light headedness, mild cognitive slowing effects, sensitivity to light and sound and sleep disruption. Symptoms, especially fatigue, may last one to two days. Since migraines are also a risk for dementia later in life due to the chronic neuroinflammation, prevention is also important.
2. What sort of challenges did you face at work related to illness?
Prior to the pandemic, virtual care was not common. I came to work even if I had a migraine. If I missed work, I would lose income. Additionally, due to a shortage of family doctors, there was no coverage to care for patients.
Work also caused migraines (stress, computer work, fast pace, bright lights, noise and scents). Keeping on top of tasks was difficult, and I would work weekends to catch up.
Most migraines occur on workdays, so I am not able to work five days per week. Subsequently, I have a smaller roster of patients and earn a lower income.
3. What accommodations have been helpful to you?
Providing virtual care when needed with flexible hours and working part-time has been extremely helpful. These accommodations are aimed at both treating migraines and preventing them.
Virtual care especially helps on days when I have a migraine. It allows me to rest, practice self-care, and work in low light or use sunglasses. I use the telephone to minimize the bright lights from screens. I also decrease the volume on the telephone and can reduce other noise exposures.
Working virtually also allows me to start and end later if I wake up with a migraine. I am not limited by the usual office hours of the clinic.
Finally, virtual care allows me to avoid the commute to work, which can exacerbate symptoms. Most migraines develop in the late afternoon or evening. Walking or driving home with a migraine is difficult at night due to the brightness of lights and photophobia. The motion of public transit also makes migraines worse.
4. How did the COVID-19 pandemic impact your practice?
The pandemic is “over” for much of the population, but for those with medical conditions, it is not. We are still at high risk of complications.
People with migraines are likely more susceptible to long COVID, so I am very careful to wear an N95 mask at work. Wearing this mask does however cause TMJ pain and induce migraines.
I already suffer disability from migraines, and it makes me fearful of further disability from COVID-19. This fear of further disability or returning to disability once it has been overcome is common.
5. What do you wish you had known earlier in your illness journey?
At the beginning of my illness journey, I wish I knew that:
- It is important to ask for accommodations
- Virtual care is an option
- If I work while sick, my health will decline and my practice will not be sustainable
- The health-care system creates working conditions that can cause illness and burnout for doctors
- A physician with disabilities who works unsupported is at higher risk of burnout.
6. What would you say to other physicians who identify with your story?
You know what it is like to experience your illness. Even two people with the same condition have different lives, and there is nuance to what each person needs.
It is important to ask for what you need and advocate for your health. A healthier you will enable you to take better care of patients.
We are all one event or illness away from experiencing temporary or permanent disability. It is important to advocate and support each other to create a future where physicians of all abilities are included and can thrive. We need equity, diversity, inclusion and accessibility for physicians.
Legal disclaimer:
The OMA is providing this space for physicians to share their personal stories about their experiences with disability. The experiences and challenges faced by each individual with disabilities are unique. The stories presented here do not reflect the specific needs or experiences of everyone, and may not reflect the present state of commitments or policies at any facility. While we are providing this information to support inclusion of all physicians with disabilities, you should inquire about the policies specific to your facility and personal circumstances.