Accepted- Not sure how to handle setting up mental health team for fall

[12345anonymous]

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Now that I'm starting to make all the arrangements for moving to med school and getting life set up in a new city, I'm not sure how to approach getting myself set up with a new psychiatrist/mental health team. I was diagnosed with borderline personality disorder 5 years ago. I have been in therapy since that time, I take medication, I've attended a few therapy groups, and I've been very successful at learning to manage my illness and my life. I made it through school and got into med school while handling it, so I'm confident that I have the skills to handle this next (albeit challenging) chapter.

One of the things that I've learned is what I need to have in place to be successful and that primarily includes a psychiatrist set up BEFORE I find myself starting to have difficulty, and also so that I don't have any interruption in my medication. This is where my difficulty lies. I'm worried about trying to set this up before I get to school, or even at the very beginning of school because I'm afraid they'll kick me out. If I just waltz into the med school counselling office on the first day and explain my situation and ask for a referral, I'm sure the next day I'll find myself in the Dean's office and they'll be telling me they are concerned that I can't handle this and that I'm no longer welcome as part of their class. Ditto for if I called now to try to talk to someone about setting things up.

Has anyone else ever dealt with something like this before? I know the website of the school says that they have services if you're in crisis and need help, but I really would rather go BEFORE I'm in crisis. Will they kick me out for that? Any thoughts on how I should proceed? Should I talk to the disability office in addition to the counselling office? Any advice is very much appreciated.

 

[mrh125]

Now that I'm starting to make all the arrangements for moving to med school and getting life set up in a new city, I'm not sure how to approach getting myself set up with a new psychiatrist/mental health team. I was diagnosed with borderline personality disorder 5 years ago. I have been in therapy since that time, I take medication, I've attended a few therapy groups, and I've been very successful at learning to manage my illness and my life. I made it through school and got into med school while handling it, so I'm confident that I have the skills to handle this next (albeit challenging) chapter.

One of the things that I've learned is what I need to have in place to be successful and that primarily includes a psychiatrist set up BEFORE I find myself starting to have difficulty, and also so that I don't have any interruption in my medication. This is where my difficulty lies. I'm worried about trying to set this up before I get to school, or even at the very beginning of school because I'm afraid they'll kick me out. If I just waltz into the med school counselling office on the first day and explain my situation and ask for a referral, I'm sure the next day I'll find myself in the Dean's office and they'll be telling me they are concerned that I can't handle this and that I'm no longer welcome as part of their class. Ditto for if I called now to try to talk to someone about setting things up.

Has anyone else ever dealt with something like this before? I know the website of the school says that they have services if you're in crisis and need help, but I really would rather go BEFORE I'm in crisis. Will they kick me out for that? Any thoughts on how I should proceed? Should I talk to the disability office in addition to the counselling office? Any advice is very much appreciated.

As someone else w/ a psychiatrist who will need to do something similar in a year my one tip is to get your psychiatrist to work with you to make sure you find a good doctor in your new area, send the necessary files, and communicate with your new doc. Switching psychiatrists can be complicated at times and if your doctor is really helpful and caring he should be able to help ease your transition. The last thing you need is a bad or incompetent psychiatrist at the start of your journey into medical school. Bring it up with your current doc sooner than later. Doing the whole counseling office routine with no support system set up can really take a toll on you emotionally too.

 

[Ismet]

All schools are required by the LCME to provide confidential mental health services to students. You will not be kicked out for wanting to meet with a psychologist or psychiatrist.

 

[snowflakes]

Can you find a psychiatrist outside of your school's hospital system, even if it means travelling more to appointments?

 

[Plecopotamus]

Now that I'm starting to make all the arrangements for moving to med school and getting life set up in a new city, I'm not sure how to approach getting myself set up with a new psychiatrist/mental health team. I was diagnosed with borderline personality disorder 5 years ago. I have been in therapy since that time, I take medication, I've attended a few therapy groups, and I've been very successful at learning to manage my illness and my life. I made it through school and got into med school while handling it, so I'm confident that I have the skills to handle this next (albeit challenging) chapter.

One of the things that I've learned is what I need to have in place to be successful and that primarily includes a psychiatrist set up BEFORE I find myself starting to have difficulty, and also so that I don't have any interruption in my medication. This is where my difficulty lies. I'm worried about trying to set this up before I get to school, or even at the very beginning of school because I'm afraid they'll kick me out. If I just waltz into the med school counselling office on the first day and explain my situation and ask for a referral, I'm sure the next day I'll find myself in the Dean's office and they'll be telling me they are concerned that I can't handle this and that I'm no longer welcome as part of their class. Ditto for if I called now to try to talk to someone about setting things up.

Has anyone else ever dealt with something like this before? I know the website of the school says that they have services if you're in crisis and need help, but I really would rather go BEFORE I'm in crisis. Will they kick me out for that? Any thoughts on how I should proceed? Should I talk to the disability office in addition to the counselling office? Any advice is very much appreciated.

A psychiatrist and psychologist will be available to you through the health coverage you will receive through your school.
Services through this psychiatrist/psychologist will be confidential and you will not be kicked out for disclosing this to your psychiatrist. You will not be the first med student either of these professionals will have encountered with a personality disorder.

Be prepared that there will be some negative talk (informed and uninformed) about BPD over the course of your education -- if that is something you anticipate will make you upset, you might want to develop a plan for how to handle those situations, as basic psych is integrated into the curriculum pretty early at some schools.

 

[hmockingbird]

I had to do this but with other doctors for physical illness.

First of all I think you are wise to want to get on top of this before a problem starts. Not only for your health/prevention, but it can take a long time just to even get an appointment with a new primary care doctor, so you might be facing a delay before you can start and the earlier you try to work this out the better. I would ask your psychiatrist if he/she knows anyone in the area, or if his/her colleagues do. If not, still talk to them about handling the transition and maybe having them talk to your new doctor once you have that set up. I didn't find any leads with people back home knowing doctors at med school, so I asked our clinical medicine director at med school for a recommendation for PCPs who were experienced with "complicated cases", but I am not sure if you would feel comfortable asking someone for a psychiatrist recommendation. If not, I'm sure you have had experience finding a psychiatrist before and know what you are looking for if you end up just trying out some random people 🙂

If your insurance now covers your psych visits and you can keep it, KEEP IT. I have found school insurance (in both college and med school) tends to be good for people who don't have a lot of medical problems, but not for someone who needs anything more involved and I would think the same goes for mental health as well as physical illness. E.g. they might provide the most coverage for the student health clinics, but those are kind-of crap if you have anything more serious than strep throat. Usually, they will have info about the plan on their website, or you could email them for more info, if you wanted to see what is covered.

Finally, I know some of my classmates who have taken advantage of the school's free confidential mental health services, and while that might be an option for you (maybe especially while you are trying to find a new psychiatrist?), if you have something ongoing you might want to look into getting your own doctor outside of that (i.e. at a hospital or private practice in the area) just because I know a lot of them have only been seeing residents and/or support groups. In other words, it seems more set up for people who just need temporary counseling, not ongoing psychiatric care.

ETA: Your doctor might agree to stay on as your doctor until you are set up with a new one so you can keep getting your prescriptions.

 

[darkjedi]

Be prepared that there will be some negative talk (informed and uninformed) about BPD over the course of your education -- if that is something you anticipate will make you upset, you might want to develop a plan for how to handle those situations, as basic psych is integrated into the curriculum pretty early at some schools.

This is unfortunately very true, especially once you are on your psych rotation. There will be many med students, residents and even attendings burnt out treating patients with Axis II disorders since the ones they generally see are the most serious, treatment resistant cases that get admitted to inpatient. Most health staff will be professional, but just keep aware and be prepared for the fact that there may be some who are less so.

 

[QuinnTheEskimo]

Now that I'm starting to make all the arrangements for moving to med school and getting life set up in a new city, I'm not sure how to approach getting myself set up with a new psychiatrist/mental health team. I was diagnosed with borderline personality disorder 5 years ago. I have been in therapy since that time, I take medication, I've attended a few therapy groups, and I've been very successful at learning to manage my illness and my life. I made it through school and got into med school while handling it, so I'm confident that I have the skills to handle this next (albeit challenging) chapter.

One of the things that I've learned is what I need to have in place to be successful and that primarily includes a psychiatrist set up BEFORE I find myself starting to have difficulty, and also so that I don't have any interruption in my medication. This is where my difficulty lies. I'm worried about trying to set this up before I get to school, or even at the very beginning of school because I'm afraid they'll kick me out. If I just waltz into the med school counselling office on the first day and explain my situation and ask for a referral, I'm sure the next day I'll find myself in the Dean's office and they'll be telling me they are concerned that I can't handle this and that I'm no longer welcome as part of their class. Ditto for if I called now to try to talk to someone about setting things up.

Has anyone else ever dealt with something like this before? I know the website of the school says that they have services if you're in crisis and need help, but I really would rather go BEFORE I'm in crisis. Will they kick me out for that? Any thoughts on how I should proceed? Should I talk to the disability office in addition to the counselling office? Any advice is very much appreciated.

This is an interesting question. I might be in the minority here, but I would strongly suggest finding a doctor unconnected to your school. Don't go to the student health center. Yeah, I know they tell you it's technically confidential, but these things have a way of revealing themselves...I have heard some horror stories to that effect.

The thing is, doctors who work in hospitals only see the extremes of mental illness. They hear "borderline personality disorder" and they think of the patient who lit themselves on fire in order to piss off her boyfriend. Meanwhile, half of the US population would probably be diagnosed with a personality disorder if they felt compelled to go to a psychiatrist. Get my drift? You want to keep these things as private as possible because there is still a huge stigma, fair or not, attached to these diagnoses.

 

[12345anonymous]

This is all really good advice. Thank's for your thoughts everyone. You've given me a lot to mull over - do I go through the school or find treatment privately, how to consider insurance, finding someone who will be experienced in what I need (not just a support group through the counselling center), etc. - and also the reassurance that my instinct to start setting things up now is right and that I can't get kicked out. Thank you!

I also appreciate the point to be prepared for how people perceive and react to mental health problems and personality disorders, and to be aware of comments that will be made as I go through med school. Those are very insightful thoughts. I never expected them to bother me because I've been aware for a long time about the most extreme examples of BPD and how difficult of a case they can be for mental health professionals. However, I've also never heard the full extent of what burnt out psych attendings and residents say. It might be really hard when I'm in rounds talking about someone who sounds a lot like me, and the team is being brutally honest, or even just brutal. So I appreciate your comments because it's better to be prepared to steel myself against these things than go to pieces over them.

Thanks again for your thoughts. Hopefully I'll get things set up well and, instead of getting in the way, my experiences will just help me ace my psych rotation. 🙂

 

[NickNaylor]

This is an interesting question. I might be in the minority here, but I would strongly suggest finding a doctor unconnected to your school. Don't go to the student health center. Yeah, I know they tell you it's technically confidential, but these things have a way of revealing themselves...I have heard some horror stories to that effect.

The thing is, doctors who work in hospitals only see the extremes of mental illness. They hear "borderline personality disorder" and they think of the patient who lit themselves on fire in order to piss off her boyfriend. Meanwhile, half of the US population would probably be diagnosed with a personality disorder if they felt compelled to go to a psychiatrist. Get my drift? You want to keep these things as private as possible because there is still a huge stigma, fair or not, attached to these diagnoses.

Agreed that this is critical. Take every promise of privacy with a huge grain of salt (even though it's the law). Our institution recently praised itself for instituting a "break the glass" program with respect to the medical records of employees and students which consists of a pop-up box warning you this record is "protected" and requiring you to choose a reason for accessing this record. Whether you think that will actually protect you from anything... I'll leave that up to you.

In our case, psych records actually don't show up in the medical record at all - for you or any patient - so it's impossible for staff to see them unless they're in psychiatry. I don't know how widespread that kind of scheme is, but this is definitely something to be aware of. If you value you your privacy highly, I would make it a point to avoid using your school's services. Call me paranoid, but I simply don't trust them. I would also avoid disclosing any sort of drug use to the physicians at your student health center unless absolutely necessary in an emergency situation for similar reasons. The last thing you want is documented drug use floating around in a medical record potentially accessible by attendings and members of your school's administration.

 

[12345anonymous]

Agreed that this is critical. Take every promise of privacy with a huge grain of salt (even though it's the law)... If you value you your privacy highly, I would make it a point to avoid using your school's services. Call me paranoid, but I simply don't trust them.

Do you (and others who have mentioned this eg @QuinnTheEskimo ) suggest this in order to protect my personal privacy because it's just my own business? Or do you suggest it to protect my privacy because if my school finds out about it there could be "trouble" for me - despite the fact that this is "not allowed"? If it's the latter, what kind of "trouble" might I face? Would the school confront me about my ability to be successful? General harassment/discrimination from faculty who might make assumptions about me? I really have no idea in what way this might play out, and I admit this is one of my primary concerns.

I would also avoid disclosing any sort of drug use to the physicians at your student health center unless absolutely necessary in an emergency situation for similar reasons. The last thing you want is documented drug use floating around in a medical record potentially accessible by attendings and members of your school's administration.

By "drug use" do you mean the medication I'm on? Really? Would they not allow me to be a med student or a doctor (eventually) because I have to take meds? Or do you mean recreational drug use? (Of which I have none.) If it is the medication to which you are referring, again, could you give me some kind of idea of what sort of consequences you're envisioning? Or just that, administrators don't need to know these things; they just need to know that I'm that delightful student who stopped by the other day?

Finally, the med school I'm going to is affiliated with a major university. I'm assuming the medical records for the university student health (ie where an undergrad would go) is still going to be accessible by people throughout the university and/or hospital system? This is to what you are referring when you say "Don't use the student health center", yes?

I know that's a lot of questions. I really appreciate all of your insight. Thanks a lot.

 

[NickNaylor]

Do you (and others who have mentioned this eg @QuinnTheEskimo ) suggest this in order to protect my personal privacy because it's just my own business? Or do you suggest it to protect my privacy because if my school finds out about it there could be "trouble" for me - despite the fact that this is "not allowed"? If it's the latter, what kind of "trouble" might I face? Would the school confront me about my ability to be successful? General harassment/discrimination from faculty who might make assumptions about me? I really have no idea in what way this might play out, and I admit this is one of my primary concerns.

By "drug use" do you mean the medication I'm on? Really? Would they not allow me to be a med student or a doctor (eventually) because I have to take meds? Or do you mean recreational drug use? (Of which I have none.) If it is the medication to which you are referring, again, could you give me some kind of idea of what sort of consequences you're envisioning? Or just that, administrators don't need to know these things; they just need to know that I'm that delightful student who stopped by the other day?

Finally, the med school I'm going to is affiliated with a major university. I'm assuming the medical records for the university student health (ie where an undergrad would go) is still going to be accessible by people throughout the university and/or hospital system? This is to what you are referring when you say "Don't use the student health center", yes?

I know that's a lot of questions. I really appreciate all of your insight. Thanks a lot.

Apologies, I should've been more clear. As far as seeing an outside physician, I only recommend that insofar as you will remove the risk of your records being accessible by people that, in my view, have no business accessing them. Of course, they shouldn't do it in the first place, but that's not going to stop some snoopers and records access audits by nature only sample a small number of users. If you want to remove the risk that your health information be found out, then see someone outside of the university system. If you don't care or would be fine if some asshat went peeking around in your records, then by all means be seen at the university system. It's simply something to keep in mind. Despite what anyone says, mental health and psychiatry still carry a stigma within the medical community and neither are viewed all that positively. For a fine example, check out this thread in the allo forum: http://forums.studentdoctor.net/threads/psychiatry.1072681/. This is what some of your future colleagues think about it, and from personal experience these views are not unique nor particularly uncommon. While they are the minority, they form a not insignificant faction of the profession. Especially when you're talking about something like BPD, I would hate for someone with the mindset and hugely ignorant to find out that information about you. Again, I want to stress that this would be highly, highly unlikely, but it's something to be aware of.

Regarding the drug use, that was not directed at you and more a general comment given how relatively common drug use among people our age. Again, the motto is "better safe than sorry" for anyone concerned about these kinds of issues. But if it's not a concern for you personally, then ignore everything I said. There's absolutely no problem related to medications you might be taking - I don't think that's a problem you should be concerned about.

 

[QuinnTheEskimo]

Do you (and others who have mentioned this eg @QuinnTheEskimo ) suggest this in order to protect my personal privacy because it's just my own business? Or do you suggest it to protect my privacy because if my school finds out about it there could be "trouble" for me - despite the fact that this is "not allowed"? If it's the latter, what kind of "trouble" might I face? Would the school confront me about my ability to be successful? General harassment/discrimination from faculty who might make assumptions about me? I really have no idea in what way this might play out, and I admit this is one of my primary concerns.



By "drug use" do you mean the medication I'm on? Really? Would they not allow me to be a med student or a doctor (eventually) because I have to take meds? Or do you mean recreational drug use? (Of which I have none.) If it is the medication to which you are referring, again, could you give me some kind of idea of what sort of consequences you're envisioning? Or just that, administrators don't need to know these things; they just need to know that I'm that delightful student who stopped by the other day?

Finally, the med school I'm going to is affiliated with a major university. I'm assuming the medical records for the university student health (ie where an undergrad would go) is still going to be accessible by people throughout the university and/or hospital system? This is to what you are referring when you say "Don't use the student health center", yes?

I know that's a lot of questions. I really appreciate all of your insight. Thanks a lot.

Because once your info is in the university's medical records, all your colleagues/superiors potentially have access to that information. Even if they don't intend to snoop, sometimes this stuff is revealed unintentionally. Like Nick said, it might sound paranoid, but better safe than sorry.

I know of one case where a student had a history of mental issues, and it came back to bite them when the residency director somehow found out. If she had not used the school health services, no one would ever have found out about it.

In terms of what will happen if the information is released: It's not like if people find out, they will automatically dismiss you. But say you have an issue with a colleague down the road. Do you want the attendings to think to themselves, "of course this student has interpersonal problems, she has a personality disorder...maybe she doesn't really belong here..."

 

[mehc012]

The dean at my UG once told me, point blank, that he could look at my mental health records from Student Health. Now, he may well have been bluffing, as he had no medical background whatsoever and thus no leg to stand on, but I'm sure he knew someone who knew someone. And then they wondered why I never used their services again.

 

[Mornhavon]

.

 

[QuinnTheEskimo]

I can't be the only one here who has never used any kind of mental health service for fear of career consequences...

Career consequences? Who are you, Tony Soprano?

 

[ThisCouldBeYou]

My brother recently had to switch psychiatrists. He had aged out and he also wanted to find a doctor who was closer to him since he was able to drive himself. His psychiatrist gave him a list of recommended doctors, all about an hour away. I mention the distance to show that psychiatrists are familiar with each other even if they aren't in the same community. When he made the appointments, he was also able to check out which hospitals they were associated with as well as which insurance. Once he narrowed it down to 2-3, he met with each dr. to determine which one was he'd eventually see.

 

[WingedOx]

In our case, psych records actually don't show up in the medical record at all - for you or any patient - so it's impossible for staff to see them unless they're in psychiatry. I don't know how widespread that kind of scheme is, but this is definitely something to be aware of. If you value you your privacy highly, I would make it a point to avoid using your school's services. Call me paranoid, but I simply don't trust them. I would also avoid disclosing any sort of drug use to the physicians at your student health center unless absolutely necessary in an emergency situation for similar reasons. The last thing you want is documented drug use floating around in a medical record potentially accessible by attendings and members of your school's administration.

We had that in the past with our records, but it became a pain and somewhat of a safety issue when we'd look up a patient's record and changes to medications and rationale done by psych weren't available to us.

That said, don't underestimate the number of students who end up utilizing mental health services while at school. It'll be more way more common than you think. At this point, OP, you'd likely be protected by the Americans with Disabilities Act if the dean ever did such a thing to you as you described in your first post.

 

[Amygdarya]

That said, don't underestimate the number of students who end up utilizing mental health services while at school. It'll be more way more common than you think.

Yeah, I've heard that it's common knowledge that the number of student mental health visits at a certain high pressure medical school substantially increases as exams approach...
Also, a psychiatrist that works in several different capacities at a top US medical school (clinician at an affiliated hospital, professor, student mental health director) once told me that not only students, but a not insignificant number of residents, attendings, even deans (he didn't give any names or drop any hints for obvious reasons) use mental health services provided by the school/medical center. Take it for what it is.

Regarding a slightly different topis, it seems to be relatively common that in EMR psych notes are hidden from anyone outside of psychiatry, i.e. even scheduled psych visits are not visible. However, keep in mind that your (abbreviated) psych history may be included in notes for other specialties, especially in primary care notes. Psych medications will show up on medication lists, too (which makes sense medically).

 

[12345anonymous]

Thanks again, everyone. This is such good advice and I really appreciate it. I'm going to go the path for looking for a private psychiatrist who is not affiliated with my school. Though I do appreciate knowing that many students utilize psych services: it's good to know I'm not alone.