Reasonable accommodations are adjustments in the workplace that help employees work or continue to work, and they may take a variety of shapes and forms. This specific phrase is a legal term that is used in the ADA as well as in various state fair employment laws and the Federal Rehabilitation Act. However, not all patients will have access to the legal protections that these laws provide. Nevertheless, even if your patient isn’t entitled to an accommodation under a federal or state law, they may still benefit from discussing these suggestions with their employer as potential job modifications. Often employers are willing to support workers during treatment, even if they are not legally obliged to do so; especially if the employee approaches the conversation with useful information and a solid plan.

MODIFYING A SCHEDULE. To start you’ll want to help your patients get a general idea of how their treatment is likely to affect their work.

• Suggest they first identify specific hours and/or days of the week they feel best, versus when they experience the most fatigue.
• Discuss the types of medication being prescribed — and the possible side effects. Explore whether some medications might be taken at night to offset uncomfortable side effects or lowered cognition/energy levels.
• Alert patients about which days are typically the most difficult following treatments, so this information can be factored into their plan.

Patients who are able to adjust their schedule to better balance their job and treatment (or ease the re-entry to work later on) may want to consider one of the following:

Telecommuting. Working from home, part- or full-time, can help eliminate a draining commute or enable patients to lie down when necessary. The key to successful telecommuting is to create a clearly defined agreement with the employer that establishes:

• Which hours the patient will work
• How the patient will be reachable (via phone or email)
• How he/she will indicate being away from their desk (e.g., via auto replies on instant messaging, voicemail and/or email)
• Any equipment needs (a phone, computer, printer, access to servers, etc.).

Flexible hours. Patients may want to explore the possibility of creating a flexible schedule, whereby they continue to work full-time, but vary the start and end times of their workday. Alternatively, a flexible schedule might entail:

• Taking time out during the workday to go to appointments, and then making up that time by working later that day or later in the week.
• Scheduling additional breaks throughout the day to allow for rest.
• Temporarily reducing a work schedule from full-time to part-time.

MODIFYING A WORK SPACE. Your patients’ work environments should be as comfortable as possible. Encourage them to think creatively about ways they can adjust their work space to help them be more productive. This can include simple things such as setting up their work area so they don’t have to expend unnecessary energy. For instance, if your patient sits at a desk, he/she may consider putting his/her phone, files, printer, etc., within easy reach, or requesting a special chair that will be more comfortable. Another example of a modification might be providing a stool to a cashier who typically stands behind a register all day, or reassigning a security guard to cover an area that is located closer to a restroom.

It may be necessary for a patient to provide his/her manager with a medical certification form when requesting a reasonable accommodation of any kind. It is likely that they will ask you, or another member of their healthcare team to complete this medical certification form. You should make sure that you know what your patient has disclosed about their diagnosis at work, to ensure that you share only as much information as is necessary for them to get the accommodation. In most instances sharing an exact diagnosis is not required.

Reasonable accommodations/job modifications will depend on the nature of the disability and the job. If your patient is unsure which adjustments may work for his/her situation, contact the Job Accommodation Network (JAN), a program of the U.S. Department of Labor (www.askJAN.org). JAN offers a Searchable Online Accommodation Resource (SOAR) system that allows people to explore various accommodation options for different types of medical conditions in particular workplace settings.