I'm quitting residency - any legal/logistical issues I need to worry about?

[anonymous-resident]

Hi everyone -

I'm an intern, and I'm going to be quitting residency as soon as possible. (It's for personal reasons that unfortunately aren't going to change, I've thought it through, I know I can't come back to medicine, I know it might burn bridges, and I'm lucky to have a very safe and stable back-up option to earn a living - just trying to get ahead of the comments telling me to tough it out and finish the year, that's unfortunately not an option.)

Are there any legal issues I need to be aware of with this process? Is there a minimum amount of notice I'm supposed to give? I can't seem to find anything about it in our residency contract. Other than telling my program director/etc that I'm resigning, is there any sort of official process for this? I've reached out to HR and GME at my institution, and haven't heard back yet, so would love any info or advice y'all could offer.

🙏

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[DrMetal]

Hi everyone -

I'm an intern, and I'm going to be quitting residency as soon as possible. (It's for personal reasons that unfortunately aren't going to change, I've thought it through, I know I can't come back to medicine, I know it might burn bridges, and I'm lucky to have a very safe and stable back-up option to earn a living - just trying to get ahead of the comments telling me to tough it out and finish the year, that's unfortunately not an option.)

Are there any legal issues I need to be aware of with this process? Is there a minimum amount of notice I'm supposed to give? I can't seem to find anything about it in our residency contract. Other than telling my program director/etc that I'm resigning, is there any sort of official process for this? I've reached out to HR and GME at my institution, and haven't heard back yet, so would love any info or advice y'all could offer.

🙏

No, there shouldn't be, unless you've created legal/logistical issues.

If you're leaving purely on your own accord, there shouldn't be any issues. Don't steal any office stationery.

 

[Smurfette]

There is almost certainly a minimum notice expectation, so see what GME office tells you.
Expect your program to scramble a bit if you give notice, so expect a bit of frustration on their end and possibly some upset co-interns if they are pulled to other rotations or have vacation days changed to accommodate your leaving. Just keep your head down until you're done.
I don't think there's any other legal requirements since you don't work independently.

 

[DrMetal]

so expect a bit of frustration on their end and possibly some upset co-interns if they are pulled to other rotations or have vacation days changed to accommodate your leaving.

The OP likely regards these concerns is the same way I regard fibromyalgia as a real disease entity.

My question is, what's the current state of medical school admissions, when we admit and graduate such students, only to find out that they want nothing to do with medicine. What the hell are we doing wrong?

 

[shaggybill]

My question is, what's the current state of medical school admissions, when we admit and graduate such students, only to find out that they want nothing to do with medicine. What the hell are we doing wrong?

I was in OPs shoes at one point. I worked in the hospital closely with physicians for 5 years before getting into medical school. I wanted to be a doctor all the way up until I didn't anymore in residency. Luckily it wasn't too late for me to come back later.

OP, I likely have felt your pain. I don't have any legal advice but feel free to shoot me a PM if you ever want to chat about what's going on.

 

[NotAProgDirector]

Even if your contract states what the notice period should be, giving them less notice is basically unenforceable. You didn't get any signing bonus to pay back, nor is there much they can do if you no longer plan to work in medicine.

It does pay to be reasonable and professional about it. Future employers, even if non medical, may want to contact your prior employers. Would be best to have nothing concerning reported when they inquire. If your contract doesn't state a notice period, then 3-4 weeks is very reasonable. Leaving in a professional manner leave open the door to return - not likely to that program, but a reference that states you did good work, left because of unfortunate circumstances, and that should be considered for a position again in the future when issues resolve could be incredibly helpful.

Make sure you've considered health insurance. When our residents graduate we cover their health insurance for an extra 4-8 weeks to bridge them to their next position. If you quit, expect nothing. You can always COBRA but that can be very expensive. if you're married, you can usually get on your spouse's insurance (as losing your job counts as a "life event").

They will want all their stuff back. if you have materials stored on a computer, email, etc, make sure you have everything you need. Do not take any information that's not yours -- i.e. no patient info, etc. There is some chance (very small) that when you announce your plan to resign, they may decide to pay your salary until your quit date but inactivate you immediately. Hence, make sure you've got everything you want/need before you announce. (This is very unlikely for an intern/resident).

Your request must be in writing. Email = writing.

You've already mentioned that you're quitting and the decision is made. Other options might be a leave of absence, including 6 months and restarting next year. As you mentioned, this may be irreversible. There are lots of fields in medicine, if the one you're in isn't a good fit. And if there's something outside of medicine that's pressuring this change, you can (perhaps) address that and then continue on your journey..

Best of luck, whatever you decide.

 

[dozitgetchahi]

The OP likely regards these concerns is the same way I regard fibromyalgia as a real disease entity.

My question is, what's the current state of medical school admissions, when we admit and graduate such students, only to find out that they want nothing to do with medicine. What the hell are we doing wrong?

Fully agree. If this person indeed is in the category you describe, then I don’t understand it at all. I can understand people burning out of medicine in the real world after putting up with the realities of it for a while - but to bail out 6 months into intern year because you don’t like it seems impulsive and poorly thought out.

Reading OP’s post again, however, I’m not sure that’s it. “Personal reason” can mean a lot of things, and I’ve heard of people bailing out of medical training to go take care of sick relatives, moving because the spouse got a really great job, etc. I don’t understand this any more than I understand the first category. You incur all this debt and take all this time out of your life to train as a doctor…only to just bail out? Hard to wrap my head around it.

 

[DrMetal]

I was in OPs shoes at one point. I worked in the hospital closely with physicians for 5 years before getting into medical school. I wanted to be a doctor all the way up until I didn't anymore in residency.

What made you want to quit in residency? It's a peculiar thing: You never really know what it's like to do a job, until you have it and are doing it. No matter how much you shadow and do research, you never really know it until you're in the thick of it.

Problem with medicine is, you're not in the thick of it (and doing it by yourself) for some 10-15 years. By then it's too late. You're gonna walk away, and do what?

By contrast, it takes 2 years to get an MBA, and they go company hopping throughout their careers.

 

[dozitgetchahi]

What made you want to quit in residency? It's a peculiar thing: You never really know what it's like to do a job, until you have it and are doing it. No matter how much you shadow and do research, you never really know it until you're in the thick of it.

Problem with medicine is, you're not in the thick of it (and doing it by yourself) for some 10-15 years. By then it's too late. You're gonna walk away, and do what?

By contrast, it takes 2 years to get an MBA, and they go company hopping throughout their careers.

Also, I personally think that nobody can really make a good judgment call on whether they like medicine or not based on how they feel about it during residency.

Why? Because residency, in a word, sucks ass. It’s overwhelming, exhausting, annoying, sometimes almost humiliating. You’re expected to eat **** with a smile, and much of the **** you’re eating is things that real world doctors never deal with.

That said, while I agree that you never really know what something is like until you do it…you certainly do get some pretty strong clues during medical school, no? If you hate seeing patients and/or doing the myriad of other things doctors do, it seems to me you would have been aware of this by the time you got halfway through 3rd year…

 

[hallowmann]

Hi everyone -

I'm an intern, and I'm going to be quitting residency as soon as possible. (It's for personal reasons that unfortunately aren't going to change, I've thought it through, I know I can't come back to medicine, I know it might burn bridges, and I'm lucky to have a very safe and stable back-up option to earn a living - just trying to get ahead of the comments telling me to tough it out and finish the year, that's unfortunately not an option.)

Are there any legal issues I need to be aware of with this process? Is there a minimum amount of notice I'm supposed to give? I can't seem to find anything about it in our residency contract. Other than telling my program director/etc that I'm resigning, is there any sort of official process for this? I've reached out to HR and GME at my institution, and haven't heard back yet, so would love any info or advice y'all could offer.

🙏

Any chance you could request a LOA and come back in 6-12 mos? Everyone is human and personal stuff comes up, but if you want to stay in medicine there may be options. Now if you want to leave medicine indefinitely, then by all means, do so, and I don't mean to talk you out of it.

I would wait to hear back from GME/HR regarding procedure, but would also be telling your PD the plan rather than having them find out from GME. People like notice if possible, but if not, you do you.

 

[Obnoxious Dad]

The OP likely regards these concerns is the same way I regard fibromyalgia as a real disease entity.

My question is, what's the current state of medical school admissions, when we admit and graduate such students, only to find out that they want nothing to do with medicine. What the hell are we doing wrong?

I'm not a physician. My kid is. Here are my two cents. You end up with people quitting because medical school admissions officers don't normalize undergraduate transcripts to account for the varying difficulty of undergraduate colleges and majors. Hard workers who overcame challenges aren't valued. Furthermore, admissions officers actually believe the nonsense they read in personal statements and hear in medical school interviews. Instead, they should try to divine who worked the hardest as undergraduates by accounting for varying admissions standards, grade inflation and the varying difficulty of majors.

 

[NITRAS]

Hi everyone -

I'm an intern, and I'm going to be quitting residency as soon as possible. (It's for personal reasons that unfortunately aren't going to change, I've thought it through, I know I can't come back to medicine, I know it might burn bridges, and I'm lucky to have a very safe and stable back-up option to earn a living - just trying to get ahead of the comments telling me to tough it out and finish the year, that's unfortunately not an option.)

Are there any legal issues I need to be aware of with this process? Is there a minimum amount of notice I'm supposed to give? I can't seem to find anything about it in our residency contract. Other than telling my program director/etc that I'm resigning, is there any sort of official process for this? I've reached out to HR and GME at my institution, and haven't heard back yet, so would love any info or advice y'all could offer.

🙏

Student loans.

You can tell yourself that you will go to income base repayment, never pay your interest and it will be forgiven in 10, 20, 25 years. . . But it will always be monkey on your back unti you pay it off or get forgiven, and six figures in student loans is no joke. I have no idea what “safe and stable” but it is usually means low paying.

I hope your situation gets better. It sounds like it sucks.

 

[dozitgetchahi]

Any chance you could request a LOA and come back in 6-12 mos? Everyone is human and personal stuff comes up, but if you want to stay in medicine there may be options. Now if you want to leave medicine indefinitely, then by all means, do so, and I don't mean to talk you out of it.

I would wait to hear back from GME/HR regarding procedure, but would also be telling your PD the plan rather than having them find out from GME. People like notice if possible, but if not, you do you.

I agree. The OP’s statement doesn’t sound like someone who doesn’t like medicine - it sounds like some sort of issue came up.

If OP does indeed want to stay in medicine, they should be aware that many programs will actually work with you on this. Hell, there was someone in my residency program who went through a BMT during his residency…he graduated 6 months late, but he got through.

 

[dozitgetchahi]

I'm not a physician. My kid is. Here are my two cents. You end up with people quitting because medical school admissions officers don't normalize undergraduate transcripts to account for the varying difficulty of undergraduate colleges and majors. Hard workers who overcame challenges aren't valued. Furthermore, admissions officers actually believe the nonsense they read in personal statements and hear in medical school interviews. Instead, they should try to divine who worked the hardest as undergraduates by accounting for varying admissions standards, grade inflation and the varying difficulty of majors.

Not sure I agree.

The recipe for success in medicine isn’t just hard work. There are a lot of kids who get into medical school because, for instance, their parents basically demanded they go - they’re smart and hard working, they got the right grades and scores, but they actually don’t want to be there. These are some of the people who quit.

 

[cincincyreds]

Hi everyone -

I'm an intern, and I'm going to be quitting residency as soon as possible. (It's for personal reasons that unfortunately aren't going to change, I've thought it through, I know I can't come back to medicine, I know it might burn bridges, and I'm lucky to have a very safe and stable back-up option to earn a living - just trying to get ahead of the comments telling me to tough it out and finish the year, that's unfortunately not an option.)

Are there any legal issues I need to be aware of with this process? Is there a minimum amount of notice I'm supposed to give? I can't seem to find anything about it in our residency contract. Other than telling my program director/etc that I'm resigning, is there any sort of official process for this? I've reached out to HR and GME at my institution, and haven't heard back yet, so would love any info or advice y'all could offer.

🙏

I would recommend arranging a meeting with your residency director to discuss all of your concerns. They can direct you to doing the right thing.

 

[Margo]

The OP likely regards these concerns is the same way I regard fibromyalgia as a real disease entity.

My question is, what's the current state of medical school admissions, when we admit and graduate such students, only to find out that they want nothing to do with medicine. What the hell are we doing wrong?

Dr. Metal,
I was one such student, about a decade ago. Similar to OP, I've made a decision to leave 6 months into my intern year. Unlike OP, I deliberately stayed with the program for the remaining 6 months, so not to burden my intern colleagues. I knew there was no coming back. Forward 11 years, I have never regretted my decision. I am MD PhD and my clinical background has definitely been as asset throught my research career that followed. My research is translational - I am involved in drug development and validation, which I hope one day will be available to patients. Please do not generalize us as people who "want nothing to do with medicine."

 

[AlbinoHawk DO]

I'm not a physician. My kid is. Here are my two cents. You end up with people quitting because medical school admissions officers don't normalize undergraduate transcripts to account for the varying difficulty of undergraduate colleges and majors. Hard workers who overcame challenges aren't valued. Furthermore, admissions officers actually believe the nonsense they read in personal statements and hear in medical school interviews. Instead, they should try to divine who worked the hardest as undergraduates by accounting for varying admissions standards, grade inflation and the varying difficulty of majors.

Then you end up with everyone trying to major in rocket science and you get no diversity of thought in medicine. The way you try to normalize this is by having a cumulative and a science GPA. If you have high cGPA but low sGPA, it is self-evident why. Similarly, the MCAT is a way to normalize everyone. The other problem with your idea is that you can't account for individual professors. There will be students hunting for easy professors and other similar strategies. In the end, you would create more problems than you purport to want to fix

 

[AlbinoHawk DO]

The OP likely regards these concerns is the same way I regard fibromyalgia as a real disease entity.

My question is, what's the current state of medical school admissions, when we admit and graduate such students, only to find out that they want nothing to do with medicine. What the hell are we doing wrong?

There's an abusive culture and there's also just life. The idea that you'll make sure everyone ends up being a practicing clinician is unattainable. Fact is the majority of people that enter medicine, do in fact end up being practicing physicians. This is as good as it gets

 

[Iamnew2]

Hi everyone -

I'm an intern, and I'm going to be quitting residency as soon as possible. (It's for personal reasons that unfortunately aren't going to change, I've thought it through, I know I can't come back to medicine, I know it might burn bridges, and I'm lucky to have a very safe and stable back-up option to earn a living - just trying to get ahead of the comments telling me to tough it out and finish the year, that's unfortunately not an option.)

Are there any legal issues I need to be aware of with this process? Is there a minimum amount of notice I'm supposed to give? I can't seem to find anything about it in our residency contract. Other than telling my program director/etc that I'm resigning, is there any sort of official process for this? I've reached out to HR and GME at my institution, and haven't heard back yet, so would love any info or advice y'all could offer.

🙏

We can't know any "legal" issues per se as we don't have your contract. However typically there is some sort of notice period although as APD said, it's likely unenforceable if you truly are leaving medicine. You said you didn't want someone to talk to you about burning bridges, not coming back to medicine, etc. however if you post a question you should be able and willing to listen to feedback you are given. So as someone else said, make sure you truly don't want to be in medicine. medicine sadly is not a super forgiving industry and if you leave you likely will not be coming back if you significantly burn your bridges. do you have a plan for your future? loans? job? etc? I'd plan that out if I were you. also I frequently get messages about people wanting to change residencies, quitting, etc. and frequently it's in the first year -I'd guess that many if not most of us hated the beginnings of our residency and how overwhelming it was. for me , if it wasn't for my family/mom/husband, etc I'd probably would have quit 100 times but glad I stuck it out. residency blows - that's the truth and dont let anyone else tell you otherwise. but it blows for just about everyone (the only exception might be derm, not sure). don't throw out all that work and effort because you are feeling in the dumps. know that just about all of us felt like crap at one point and felt stupid, incompetent, and like we couldn't make it. make sure that if you are leaving it's for the right reasons. and even if you do feel you are doing the right thing, I'd give it a little more time. it's not like you have a fabulous offer waiting for you at this time (if I'm wrong, my apologies).

 

[dozitgetchahi]

Dr. Metal,
I was one such student, about a decade ago. Similar to OP, I've made a decision to leave 6 months into my intern year. Unlike OP, I deliberately stayed with the program for the remaining 6 months, so not to burden my intern colleagues. I knew there was no coming back. Forward 11 years, I have never regretted my decision. I am MD PhD and my clinical background has definitely been as asset throught my research career that followed. My research is translational - I am involved in drug development and validation, which I hope one day will be available to patients. Please do not generalize us as people who "want nothing to do with medicine."

It’s nice that this turned out well for you. However, I suspect that even you know that folks who have this degree of success after leaving medicine are a distinct minority. A lot of folks are going to struggle to pay off their loans after leaving medicine, unless they have a big time job lined up elsewhere somehow. That’s why we’re on the OP to make sure he really wants to do this before he makes a decision that may be impossible to reverse.

 

[Margo]

It’s nice that this turned out well for you. However, I suspect that even you know that folks who have this degree of success after leaving medicine are a distinct minority. A lot of folks are going to struggle to pay off their loans after leaving medicine, unless they have a big time job lined up elsewhere somehow. That’s why we’re on the OP to make sure he really wants to do this before he makes a decision that may be impossible to reverse.

Thank you for your comments! For a bit of a perspective, I did not have a "big time job" right away Following internship, I was a postdoctoral fellow at a university for 4 years, then 2 more years as a scientist at the same place. Then I transitioned to biotech. My medical school loan is still there, though I've made much progress to cut it down, especially during the Covid years. It does not stop me from living the life I enjoy, however.

Yes, I agree with you that the decision to leave residency may be irreversible, thus anyone contemplating to do so should explore all options carefully.

 

[ObsequiousAplomb]

The OP likely regards these concerns is the same way I regard fibromyalgia as a real disease entity.

My question is, what's the current state of medical school admissions, when we admit and graduate such students, only to find out that they want nothing to do with medicine. What the hell are we doing wrong?

Why don't you regard fibromyalgia as a real disease entity? Is it for scientific reasons or emotional, non-logical reasons?

 

[DrMetal]

Why don't you regard fibromyalgia as a real disease entity? Is it for scientific reasons or emotional, non-logical reasons?

Fibromyalgia, chronic fatigue syndrome, IBS, and all of these other syndromes that don't seem to have a pathophysiological basis, are mostly a manifestation of untreated mental health issues (anxiety, depression, severe stress). Your brain is the greatest generator of symptoms.

Unfortunately, we as physicians dont like to explain this to our patients. We're scared of how they may react, when they're told 'it's all in their head". So instead, we've created these fake diagnosis, to make the patient (and us) feel better, they can wear the diagnosis like some weird badge of honor on their chest.

Amazingly enough, if you are one of the rare physicians that can convince your patient that the source of the problems are mental health related, and then treat those mental health conditions, much of these symptoms go away.

 

[IonClaws]

What made you want to quit in residency? It's a peculiar thing: You never really know what it's like to do a job, until you have it and are doing it. No matter how much you shadow and do research, you never really know it until you're in the thick of it.

Problem with medicine is, you're not in the thick of it (and doing it by yourself) for some 10-15 years. By then it's too late. You're gonna walk away, and do what?

By contrast, it takes 2 years to get an MBA, and they go company hopping throughout their careers.

Definitely a big problem in medical training. Even more so for the ones who can't cut it in residency rather than those who quit voluntarily.

 

[ObsequiousAplomb]

Fibromyalgia, chronic fatigue syndrome, IBS, and all of these other syndromes that don't seem to have a pathophysiological basis, are mostly a manifestation of untreated mental health issues (anxiety, depression, severe stress). Your brain is the greatest generator of symptoms.

Unfortunately, we as physicians dont like to explain this to our patients. We're scared of how they may react, when they're told 'it's all in their head". So instead, we've created these fake diagnosis, to make the patient (and us) feel better, they can wear the diagnosis like some weird badge of honor on their chest.

Amazingly enough, if you are one of the rare physicians that can convince your patient that the source of the problems are mental health related, and then treat those mental health conditions, much of these symptoms go away.

That's kind of the point. As a psychiatrist I treat all of those conditions, so I'm confused as to why one would say they're not diagnostic entities.

 

[DrMetal]

That's kind of the point. As a psychiatrist I treat all of those conditions, so I'm confused as to why one would say they're not diagnostic entities.

The diagnosis is GAD, or MDD, or Adjustment Disorder, etc.

The symptoms (diffuse muscle pains, aches, 'irritable' bowel, etc) are manifestations of the mental health diagnosis. It's important to NOT call the symptoms a diagnosis (or make up a 'syndrome), because then we end up treating the wrong thing (treating the muscle pains with relaxants, opioids, etc).

Treat the true diagnosis (GAD, MDD), and you make headway. [none of this is easy. I falter at this myself. It's very hard to convince patients (and your medical director) of this.]

 

[sirspamalot]

Its not me, its you?

Reverse Seinfeld Procedure ..engage.

 

[lal4life]

The diagnosis is GAD, or MDD, or Adjustment Disorder, etc.

The symptoms (diffuse muscle pains, aches, 'irritable' bowel, etc) are manifestations of the mental health diagnosis. It's important to NOT call the symptoms a diagnosis (or make up a 'syndrome), because then we end up treating the wrong thing (treating the muscle pains with relaxants, opioids, etc).

Treat the true diagnosis (GAD, MDD), and you make headway. [none of this is easy. I falter at this myself. It's very hard to convince patients (and your medical director) of this.]

I think the issue is that a lot of the patients that experience these issues is that they don’t have the mental fortitude because of the underlying psychological factors to understand the connection correctly or to cope well when described that the symptoms are mostly psychological. I always explain when treating these conditions that if we ignore the mental health aspect of all involved we’re really only treating symptoms and not the underlying cause, and ignoring half of entities (treating physical, ignoring mental).

The issue I have with the above thought process is it’s not the approach our patients need and leave a vulnerable population with a mistrust of the medical professionals. Also, I think it’s wrong to say that there are not real syndromes that connect the brain to the above symptoms. Fibromyalgia is very clearly a diffuse pain manifestation of underlying mental health dysfunction. Same with IBS and the gut. I think it’s more appropriate to say that we don’t have the tools yet to identify the clear connection between the two and may not in our lifetime. So we’re left with treating what we know.

If a patient hears me say “it’s all in your head”, they lose confidence in me. If they hear “it’s not unreasonable to say there’s a connection between mental and physical health” or a variation, they’re much more receptive. Unless we’ve experienced debilitating mental health, we won’t fully understand where they’re coming from.

 

[DrMetal]

I think the issue is that a lot of the patients that experience these issues is that they don’t have the mental fortitude because of the underlying psychological factors to understand the connection correctly or to cope well when described that the symptoms are mostly psychological. I always explain when treating these conditions that if we ignore the mental health aspect of all involved we’re really only treating symptoms and not the underlying cause, and ignoring half of entities (treating physical, ignoring mental).

Yep, pretty much . . .

Also, I think it’s wrong to say that there are not real syndromes that connect the brain to the above symptoms. Fibromyalgia is very clearly a diffuse pain manifestation of underlying mental health dysfunction.

Yes, and if you say that it is clearly a manifestation of mental health dysfunction, you're correct. Problem is, many providers don't make that admission, and they treat fibromyalgia (lump in there IBS, CFS, etc) as unique disease entities, like HCV, or cancer. They miss the mental health piece, and then they're surprised when the fibromyalgia doesn't go away despite the narcotics, muscle relaxants, physical therapy, etc.

These things are not their own disease entities, and we never should've named them. We don't need to do more 'research' on them, we already have the tools, we know what it is, we're just too scared to call it properly.

Instead of fibromyalgia, it should be "Diffuse myalgia secondary to General Anxiety Disorder".

Want proof of what I'm saying? Treat the GAD (or get it treated by someone else) and see what happens.

 

[J ROD]

Just give them the damn Xanax!

 

[Drjc1977]

Hi everyone -

I'm an intern, and I'm going to be quitting residency as soon as possible. (It's for personal reasons that unfortunately aren't going to change, I've thought it through, I know I can't come back to medicine, I know it might burn bridges, and I'm lucky to have a very safe and stable back-up option to earn a living - just trying to get ahead of the comments telling me to tough it out and finish the year, that's unfortunately not an option.)

Are there any legal issues I need to be aware of with this process? Is there a minimum amount of notice I'm supposed to give? I can't seem to find anything about it in our residency contract. Other than telling my program director/etc that I'm resigning, is there any sort of official process for this? I've reached out to HR and GME at my institution, and haven't heard back yet, so would love any info or advice y'all could offer.

🙏

If you have read and understand your contract and there are no penalties for dropping out, then it seems to be there will be no legal repercussions. However you may be blackballing yourself for future opportunities. What ever the reasons, you have to do what you have to do. On a personal note, I hope this is not an emotional decision made in order to be with a romantic interest. That being said, I wish you well.

 

[LeaveNoTrace]

I agree. The OP’s statement doesn’t sound like someone who doesn’t like medicine - it sounds like some sort of issue came up.

If OP does indeed want to stay in medicine, they should be aware that many programs will actually work with you on this. Hell, there was someone in my residency program who went through a BMT during his residency…he graduated 6 months late, but he got through.

BMT?

 

[VA Hopeful Dr]

BMT?

Bone marrow transplant?

 

[Crayola227]

The diagnosis is GAD, or MDD, or Adjustment Disorder, etc.

The symptoms (diffuse muscle pains, aches, 'irritable' bowel, etc) are manifestations of the mental health diagnosis. It's important to NOT call the symptoms a diagnosis (or make up a 'syndrome), because then we end up treating the wrong thing (treating the muscle pains with relaxants, opioids, etc).

Treat the true diagnosis (GAD, MDD), and you make headway. [none of this is easy. I falter at this myself. It's very hard to convince patients (and your medical director) of this.]

Lmao so now you're telling the psychiatrist that CFS is a psych dx

 

[Crayola227]

I think the issue is that a lot of the patients that experience these issues is that they don’t have the mental fortitude because of the underlying psychological factors to understand the connection correctly or to cope well when described that the symptoms are mostly psychological. I always explain when treating these conditions that if we ignore the mental health aspect of all involved we’re really only treating symptoms and not the underlying cause, and ignoring half of entities (treating physical, ignoring mental).

The issue I have with the above thought process is it’s not the approach our patients need and leave a vulnerable population with a mistrust of the medical professionals. Also, I think it’s wrong to say that there are not real syndromes that connect the brain to the above symptoms. Fibromyalgia is very clearly a diffuse pain manifestation of underlying mental health dysfunction. Same with IBS and the gut. I think it’s more appropriate to say that we don’t have the tools yet to identify the clear connection between the two and may not in our lifetime. So we’re left with treating what we know.

If a patient hears me say “it’s all in your head”, they lose confidence in me. If they hear “it’s not unreasonable to say there’s a connection between mental and physical health” or a variation, they’re much more receptive. Unless we’ve experienced debilitating mental health, we won’t fully understand where they’re coming from.

So we're starting to have an understanding of IBS and CFS beyond what people here are saying. It's controversial to what extent MDD for example is related to neurotransmitters like serotonin levels in the brain for instance, but some evidence that some folks get tx responses from medications believed to have that mechanism of action. Interestingly we have seen improvement in IBS in folks treated for depression with these meds. But before you conclude that the IBS was a symptom of depression, it helps to understand that this effect was then seen in patients without depression who had IBS. This is less bizarre when you realize that the neurons and neurotransmitters signaling in the gut rivals the brain in some ways. Something similar has been seen with migraine medications, leading some to think of some types of gut issues as like "migraines" of the gut.

I didn't get to follow it up, but there was also a biomarker found for CFS that also suggests there is some pathophysiological basis.

Here's the thing. "It's all in your head" "it's emotional" docs have said to patients about a LOT of **** that later on we discovered oh wait, that did have your standard pathophysiology.

So for some of these conditions, you would think we could at least maintain the humility to say, we don't really know given how often this has happened in our history.

That isn't to say the best thing to do is to throw procedural or medicinal measures at these things. Certainly doing things we know makes people feel better like exercise, mental health techniques, etc can help anyone feel better.

As far as how to discuss these things with patients, functional disorders I think is the best formulation. Reassuring the patient that it is not "in their head" as in, under their conscious or voluntary control that they feel as they do. Perhaps medicine will shed more light on this. In the meantime, we do what we can do.

 

[Crayola227]

Biomarker for chronic fatigue syndrome identified

Stanford scientists devised a blood-based test that accurately identified people with chronic fatigue syndrome, a new study reports.

medicalgiving.stanford.edu

Shouldn't be surprised. The immune system, and neurological system, and gut are probably the last great mysteries. The first two particularly different to visualize their workings.

We know just how powerful the immune system is, as well as how complex the cells operate, yet much of it is a black box to us.

Perhaps others will be correct about fibromyalgia.

In any case, the thing about humility, functional disorders, frontiers of science, holistic treatment, it all means we can have an agnostic approach that supports these folks and their conditions, it doesn't depend on knowing.

 

[Crayola227]

The Brain-Gut Connection

A Johns Hopkins expert explains how what’s going on in your gut could be affecting your brain.

www.hopkinsmedicine.org

Neurotransmitter and Intestinal Interactions: Focus on the Microbiota-Gut-Brain Axis in Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder of unknown etiology. IBS is caused by a disruption in the gut-brain axis. Given the importance of the gut microbiota in maintaining local and systemic homeostasis of immunity, endocrine, ...

www.ncbi.nlm.nih.gov

Associations of neurotransmitters and the gut microbiome with emotional distress in mixed type of irritable bowel syndrome - Scientific Reports

Evidence highlights the comorbidity between emotional distress and irritable bowel syndrome (IBS) through the gut-brain axis. However, the underlying mechanism is largely unknown. Thus, the present study aimed to evaluate the associations among neurotransmitter levels and the gut microbiome...

www.nature.com

The suggestion is that there are biological factors in the gut, leading to the symptoms of IBS, and that this then affects mood, not the other way round ("what's in your head and "untreated feelings/MDD etc leads to IBS sx".

It's common when we are faced with suffering and the unknown to blame the patient somehow.

 

[LucidSplash]

@Crayola227 Just in case you didn’t notice, you are responding to posts that are over a year old. The thread was not quite necrobumped, but at least senior citizen bumped, by another person asking for a definition of an abbreviation.

 

[DrMetal]

Lmao so now you're telling the psychiatrist that CFS is a psych dx

It is. There's no such thing as CFS, IBS, Fibromyalgia, long COVID. These are all made up diagnoses or syndromes, that we made up b/c we don't want to admit (and we don't want to try to explain to our patients, fearing their wrath) that they are manifestations of acute on chronic mental health pathology, perhaps, or just a reaction to acute emotions in the absence of true psych pathology [addendum, edited].

Every morning when I wake up at 6:00 AM, I have lower back, shoulder and neck pain. Do I have fibromyalgia? No, my pain is a manifestation of stress, that I feel b/c I don't wanna go to work. Interestingly enough, when I wake up at 6:00 AM on a Sunday morning to go play golf, said pain is gone.

 

[twospadz]

Don't quit residency. I wanted to quit so bad too. Now that I'm an attending, it gets so much better. And i can make my schedule how I want while being compensated well. Fix your internal or external issues. Dont quit!!!!

 

[ObsequiousAplomb]

It is. There's no such thing as CFS, IBS, Fibromyalgia, long COVID. These are all made up diagnoses or syndromes, that we made up b/c we don't want to admit (and we don't want to try to explain to our patients, fearing their wrath) that they are manifestations of acute on chronic mental health pathology.

Every morning when I wake up at 6:00 AM, I have lower back, shoulder and neck pain. Do I have fibromyalgia? No, my pain is a manifestation of stress, that I feel b/c I don't wanna go to work. Interestingly enough, when I wake up at 6:00 AM on a Sunday morning to go play golf, said pain is gone.

You clearly so profoundly misunderstand the entire realm of psychiatry that you are telling two psychiatrists that they are incorrect about what makes something a psychiatric diagnosis. Diabetes is just as made up as these constructs. What are you on about?

 

[DrMetal]

You clearly so profoundly misunderstand the entire realm of psychiatry that you are telling two psychiatrists that they are incorrect about what makes something a psychiatric diagnosis.

Your point is taken. I don't mean to say specifically there's a psych diagnosis there, maybe I used the wrong vernacular. What I meant to say is that most of those things are a reaction to some mental state (acute stress, anxiety, etc), and all of this can certainly occur in the absence of any real psych diagnosis. Read John Sarno, he explains it better.

My muscle pains in the morning are a reaction to stress and acute anxiety about the upcoming day. I don't have GAD.

Now, when the leprechaun shows up and tells me to burn it all down, then it's game on!