Introduction

Like most of you, I spend more than a few hours a week on Family Medical Leave Act (FMLA) paperwork, disability paperwork, doctor’s notes for accommodations, and the rest. The bane of primary care. A huge chunk of my time that residency did not prepare me for at all. I’ve been stumbling through the process for decades now, and have never come across a formal educational resource to help.

But I’ve come up with some tips — mostly about setting boundaries — with which I have achieved a degree of Zen. Much of it comes from the realization that our powers as physicians are quite limited. We can’t compel employers or patients to heed our advice. We don’t have to convince the government to award someone disability. And we don’t have to do the lawyer’s work for them.

I do not want someone to take early retirement over these headaches, so I am going to share what I’ve learned, and I hope you will share with me.

A caveat before we start. This is practical advice, not legal advice, and it reflects how things work in North Carolina. Federal rules change — the emotional support animal section below is a good example of a rule that reversed completely in 2025–2026 — so check the primary sources I’ve linked before you rely on any of it. When a question is genuinely legal rather than medical, send it to your own risk management or legal department.