Reasonable accommodation not approved by my doctor. Suggestions?

February 17, 2025 10:04 AM

My job is requiring me to return to office full-time, 5x a week, from my current 100% remote status. I have Stage 4 cancer and asked my oncologist for a reasonable accommodation (RA) letter, but was told no. Suggestions on next steps?

I have Stage 4 cancer, undergoing treatments. While the treatments are keeping my cancer at bay so far, I was told initially that I am considered immunocompromised. I wouldn't mind going back in the office in a hybrid factor, as I don't mind going in a few days a week and being around coworkers. However, everyday seems like a lot, especially considering how fatigued I feel from time to time, and I'm concerned about being sickened easily.

I explained this to my oncologist in the hope of getting a RA letter, who denied the request, saying I wasn't immunocompromised enough to be considered for a hybrid RA, and she didn't want to get in trouble for writing a RA letter when she knew I was fine enough to travel, etc.

Thing is, I only traveled to visit my family on the other side of the country, and I got pneumonia last year during my treatments, as well as horribly sick a few times. I was under the impression that I was immunocompromised, and I was originally told my Stage 4 cancer was considered terminal (5-8 years lifespan with treatments expected) by the same oncologist.

I am mystified because I talked with my office's reasonable accommodations team, who agreed that Stage 4/terminal cancer was a valid reason to get a RA. My oncologist has always been supportive, so I'm a bit surprised by this.

Do you have any suggestions on best next steps? Another aspect is I'd be in an open space, not my own private cubicle, so I might be easily distracted and not be as productive. That's why I want a hybrid arrangement, so I can have a good balance (less transport, hence less chance of getting sick). I asked my supervisor about having my own office and they seemed unsure, because as everyone is returning, there really is no space. I doubt my oncologist would write a RA letter for that, as she seems to think I'm fine going back to office full time. (My supervisor is aware of my cancer. Not really much they can do — this is outside their control.)

I wish I had the opportunity to ask for another opinion/ask another doctor, but my insurance is a HMO so everything is centralized and linked—my chart has the oncologist notes saying 'no' to the RA, which all other doctors can easily view.

Thanks for any input you might be able to provide!

posted by anonymous to Human Relations (17 answers total)

I'm so sorry. This is so f****d up.

There is no way you should be needing to seek help about this position. I wish there was a way you could get another Oncologist to change that status. You really should not be returning to the office, especially now. Absolutely not.

I really hope someone else on here can provide you with a more direct solution.

I'm assuming you're USA based. So maybe the accomodations can be made by someone else at your employer (to be your status is a blatently obvious reason why you shouldn't be returning to the office)? Or perhaps you join a suitable Union and have them help protect your rights to carry on working from home? Or get a privately paid appointment with an out of insurance oncologist at least for a meeting and letter writing if that's at all possible?

I'm really really sorry. This should never have come to this.
posted by many-things at 10:13 AM on February 17 [2 favorites]

Can you ask your family doctor for the letter? I dont think you need to hide that the oncologist said no. Lead with what you said here: you are worried about exposure because you are immunocompromosed and you are tired. The oncologist said no, but you need the accommodation. Can they please provide the letter.

One thing I woukd say though is that you should be asking fir the accommodation of 100% remote. If you say "going in to the office is too dangerous for me" it doesn't make sense to then say "so I'll just go in two days a week." It makes it seem like you just don't want to RTO and are using the accommodation as your excuse.
posted by If only I had a penguin... at 10:14 AM on February 17 [38 favorites]

I also suggest asking your PCP. (I'm baffled at the oncologist's response.)
posted by BlahLaLa at 10:21 AM on February 17 [3 favorites]

I would try your pcp.

I’d also really think through your reasons. The way you’ve put it here is human and real but it sounds a bit like just bargaining. If you want hybrid your reason should be fatigue. If the issue is distraction I’m not sure how that works. And if your reason is immunocompromised then yeah, it doesn’t make sense to go in at all. I think fatigue would be a good one, and your oncologist didn’t say no on those terms.
posted by warriorqueen at 10:25 AM on February 17 [16 favorites]

If your HMO has an ombudsman file a formal complaint with them.

I think this is borderline malpractice and it shocks me, but the if the HMO is paid for by the employer, you can put it down to their desire to continue to be chosen as a provider by that employer, and your welfare is a secondary, if not tertiary concern.

And if I could I would get out of that HMO as soon as possible.
posted by jamjam at 10:50 AM on February 17 [8 favorites]

and she didn't want to get in trouble

Yes, it has come to this in the United States. "Going back to work" has become such a political signpost that people with complex needs like yours take the hit. It is outrageous.

I agree that you should ask your pcp -- or even a telehealth provider! It's possible that your employer just wants any doctor's signature to be able to help you out.
posted by ojocaliente at 11:01 AM on February 17 [2 favorites]

It has been my previous experience that a certain HMO (I'm presuming this is Kaiser) doesn't like to write reasonable accommodation letters and their doctors will refuse to do it. That was my experience, anyway. You can try other doctors like a PCP, but there was a whole lotta buck passing and hot potato going on when I was trying. They specifically did not want to make any kind of recommendation, at bare minimum they would just say some vague stuff in a letter that wasn't quite disclosing or recommending but indicated you were getting treatment. Also, even if you COULD get a letter from someone, the employer can just...not accommodate, if they don't wanna.

Unfortunately, I don't know enough about your employer to know if there's any options for when you can't get accommodation (there was in my case) or can't get anyone to commit to writing the letter someone else requires of you--and these days that stuff has probably been cut anyway.

I hate to say this, but mask up at work and bring your own portable HEPA filter might be the options under your control to get done.
posted by jenfullmoon at 11:17 AM on February 17 [1 favorite]

I suggest focusing on fatigue rather than immune concerns, as that makes more sense for only going into the office a few days per week but not five days per week.
posted by Winnie the Proust at 11:40 AM on February 17 [4 favorites]

I’m a transplant patient with similar concerns. I would pay out of pocket, if possible, for a second opinion.
posted by mochapickle at 12:00 PM on February 17 [6 favorites]

I think you should doctor shop for this, but on the basis of fatigue and the need for medical appointment flexibility.
posted by haptic_avenger at 12:03 PM on February 17 [5 favorites]

she didn't want to get in trouble for writing a RA letter when she knew I was fine enough to travel, etc.

It sounds like she was referring to one specific trip you took, right?

Even putting aside the fact that you got sick over the trip: Risk is a probability thing. Risk management is also a probability thing. Taking a trip exposes you to some set number of environments and people over some finite amount of time. You can take some measures to reduce your risk level in those specific environments and for that finite period of time. Whether you do or you don't, going on that trip is your conscious decision to risk your own health, in those specific environments, over that finite - and presumably not especially long - period of time. You got to make that conscious decision based on analysis of the probability of risk in those specific circumstances.

Having to go into work on a regular basis is also exposing yourself to risk. Except here the period of time is effectively infinite. This is not taking a risk over a period of a week or a month; it's taking a risk every weekday for months or years. You have no control over the environment. Even though you have the information that the workspace is a particularly high-risk environment.

You're coming to your doctor and saying "I was willing to risk my health and possibly life to see my family briefly during a terminal illness. I am not willing to risk my health and possibly life for the foreseeable future for work that I can do just as well from a safe environment." These are two different situations, two different levels of risk probability, two different time windows. That your doctor would think differently is insane.

I do agree with everyone saying you shouldn't go in with a compromising attitude on this. However, it is also true that the probability of infection for 2 days a week of exposure may be different than the probability of infection for 5 days a week, and that you may be willing to risk health/life given the lower probability but not given the higher one. The doctor should also be able to understand that (and then they should ask you "Would you really feel it was worth it if you did get super sick? For work?")

I'd try to get the approval from a different doctor, and if that doesn't work I'd go back to the oncologist and make her explain to you why those two things are somehow the same, when they're so clearly not. (You might also consult with a labor lawyer regarding your right to sue if you do, predictably, end up getting sick at work. And regarding your right to additional accommodations, such as your own office, a HEPA air purifier, permission to wear masks continuously (and a budget for buying high-quality masks), etc.

(All of this is not even looking into the fatigue angle, which I think is also important, and also something a healthy doctor may be likely to underestimate the costs of.)
posted by trig at 12:30 PM on February 17 [11 favorites]

I didn't get any text search hits on "train" or "turn" or "turn over" so here's my thought. When I was preparing for full retirement Fall of 2023 I worked fully from home but in addition to my normal tasks and attending Teams meetings, etc. I also began writing a fairly extensive explanation of my job, including special cases, research aids, known problems in certain systems, etc. On my last day they thanked me for doing that (but they may just have been being polite).

My point is, by making you RTO they may be reducing the amount of your knowledge that may be recorded/transferred. If nothing else, this dovetails with warriorqueen's suggestion that you carefully think through you reasons. On the other hand, your employer may just not be as kind as mine was (?).
posted by forthright at 1:31 PM on February 17

I don't know how things work in your particular state, but in some places, you can file an RA request with HR without a letter from a physician. I'd go this route, and would basically overwhelm them with evidence: detailed summaries and documentation about your treatment, illness, whatever you've got that you're OK sharing with them.

That's going to win you back some time when they have to review it all. They might just go ahead and approve the request in the meantime. I'd also use the intervening time to scope out a more amenable doctor. If they don't approve you, and what they need is a letter from your doctor, you'll have a better sense of what your options are with respect to your medical team.

(Frankly, I'd also go back to the original oncologist and request her to document her refusal of the RA request in writing, explaining her rationale. This may also be enough to make her reconsider.)
posted by yellowcandy at 2:15 PM on February 17 [7 favorites]

The oncologist has been extraordinarily unhelpful and that must be frustrating for you. Based on how you described the conversation, it's possible there's some confusion about why you were asking for this accommodation and that may be why they refused it.

There are a couple of valid reasons why you should be allowed to work from home, with different rationales and different outcomes:
1. because you are both immunocompromised and vulnerable, you should be able to work from home 100% or, at most, occasional trips to the office for eg large critical meetings, with suitable personal protection
2. because you suffer from fatigue exacerbated by longer days and travel stress, you should be able to work from home for a portion of the week.

These are two very different reasons, with necessarily different outcomes. You can't logically argue that you can go to the office a few days a week due to being immunocompromised because it weakens your key argument. Yes, I know that's an oversimplification and less exposure reduces risks etc. But this may be the way the oncologist is seeing it. They're saying you are fine to travel across the country, so your fatigue is obviously manageable. It's a shitty way for a health professional to act, but these are shitty times and they are likely influenced by the health insurer.

Before asking the oncologist to reconsider or asking another doctor, get clear in your head what you are asking for and why. In your case, my view is you should get to do whatever the fuck you want but, unfortunately, I'm not your doctor (or a doctor at all). I think, if you go in with a clear outcome you are seeking and a logical reason for that, you'll have better success.
posted by dg at 8:59 PM on February 17 [1 favorite]

What if you send your oncologist a letter clarifying your request and thoroughly documenting your concerns with a return to office.

Sometimes people change their minds when information is presented in a different format, or when they’ve had time to think.

You could post another question here to help you create a strong letter that both documents your circumstances and is also as persuasive as possible.
posted by bunderful at 6:26 AM on February 18 [1 favorite]

(It can also help to have a paper trail.)
posted by trig at 8:12 AM on February 18

Some doctors tend to just flatout ignore such requests. If your PCP ignores that, it may be time to request a different PCP. Or if who you requested it from is not accommodating, try your PCP, and so on. You just need a MD to sign off on that, and s/he can explain his/her reasoning on paper. Doesn't matter which one.
posted by kschang at 9:09 AM on February 19