The new accommodation battle: Working from home

When the federal government asked employees to return to the workplace, a new challenge quietly emerged in family medicine. Almost overnight, requests for work-from-home accommodation letters began to rise. They all look different, they all come with different stories, yet many lead to the same request: “Doctor, can you write me a letter so I can work from home?”I recently saw a patient who told me that by the end of every workday his back pain becomes unbearable. He explained that he wanted an accommodation allowing him to work from home because of this pain. I asked him how long he had been suffering from it. His answer was more than ten years.My next question was simple.“What did you do before COVID, when working from home did not exist?”His answer was honest.“I had no choice.”Now that working from home has become an option, he wanted to pursue it. I suggested something different. I offered to manage his pain. He immediately declined, saying he had tried everything and was not interested in pain medication. I then proposed a compromise. Let us try a different treatment for one month and reassess. Again, he refused. He did not want treatment. He wanted the accommodation.I declined to provide the letter. I advised him to discuss possible workplace accommodations directly with his employer. I also explained that if he had been repeatedly leaving work early because of pain, I would need objective information from his employer confirming this pattern before considering any medical recommendation. That information never arrived.Another patient had been under my care for more than 15 years. Two years ago, he requested a work-from-home accommodation because of depression. His depression was well controlled with medication, and I did not believe there was a medical justification for permanent remote work. I declined.A few weeks ago, he returned with a letter from another healthcare provider describing a different diagnosis, one that typically begins in childhood and one I had never observed throughout 15 years of caring for him. The provider asked me to support a work-from-home accommodation. Once again, I declined because I was not medically convinced that working from home was necessary or that it would improve his health outcome.Neither patient was pleased. Both left disappointed, and understandably so. No one likes to hear “no,” especially when they believe they have found the answer to their “problem.”This raises an important question. What exactly is the physician’s role?Our responsibility is not simply to support what patients want. Our responsibility is to determine whether a medical condition genuinely limits function and whether the requested accommodation is medically necessary. There is an important difference between a preference and a medical indication. Wanting to work from home is not, by itself, evidence that someone medically needs to work from home.As physicians, we also have an obligation to remain objective. If a treatment is available but the patient refuses it while requesting a specific workplace arrangement instead, it becomes much harder to conclude that the requested accommodation is the only reasonable medical option.I sometimes wonder whether other colleagues are experiencing the same growing pressure. It has certainly become one of the most frustrating administrative issues I have faced over the past several months. Increasingly, I find myself spending more time explaining why I cannot write these letters than actually discussing the patient’s medical condition, if any. Working from home can absolutely be an appropriate accommodation for some cases. There is no question about that. However, the decision should always be based on sound medical evidence, not on convenience, personal preference or simply because remote work became common during the pandemic.I believe that all employers, whether in the federal government or the private sector, should cease treating working from home as the default accommodation. In my opinion, remote work should be reserved for situations where there is clear medical evidence that it is necessary and where it is expected to improve the patient’s health or functional outcome. If the patient is not satisfied with their doctor's decision then requiring an assessment by a second independent physician is an option before permanent work-from-home accommodations are approved for disability-related reasons.Otherwise, we risk transforming physicians from medical professionals into gatekeepers for workplace negotiations—a role we were never meant to play. Dr. Jabir Jassam is a family physician in Ottawa. He’s also an author and creator and runs the InsideTheMind.ca website.

The new accommodation battle: Working from home

Register for free access or login.

Related Topics