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

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.

 

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

 

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.

 

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.

 

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.

 

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.

 

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.

 

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..."

 

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.

 

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Career consequences? Who are you, Tony Soprano?

 

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.

 

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.

 

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).