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Curious, any of you pyschiatrists have current mental disorders

Discussion in 'Psychiatry' started by helpfuldoc2b, Apr 11, 2007.

  1. helpfuldoc2b

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    Curious, any of you pyschiatrists have current mental disorders. If so what are they and how do you feel/able to function with your work and studies tolerating the illness and the medication/side effects.
     
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  3. whopper

    whopper Former jolly good fellow
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    I don't have one (except maybe an occasional sx of an Axis II Cluster B-being sarcastic).

    However several people asked me if I have one while on the interview trail. Several program directors told me that several medstudents with an Axis I go into psyche because they feel some type of association and have a desire to want to treat themselves and understand their illness as best as they can.

    They told me the thing that made them ask was I took a year off during medschool and my grades before that year off were mostly Bs & Cs. After that year it was mostly As. Some of them speculatd that I had an Axis I, decompensated, then took meds to stabilize myself and that's why I was doing better.

    Nope...I took a year off because I wanted to date some women. Being in medschool, and not having had a date for 2 years was wearing on me. I wanted to live a "normal" life for awhile and see what I was missing out on.

    To my dismay, some of the programs that asked me asked as if accepting a doctor with an Axis I would be a horrible thing and they wanted to know if I had one upfront. One guy said it as if it were an interrogation and used some police "bad cop" methods on me which bugged the heck out of me.

    As far as I know, only 1 resident in my program had mental illness. She was booted out but no one held her Axis I mental illness against her. This person couldn't hack the job and (seriously) had every Cluster B disorder-(even antisocial personality disorder) in addition to her Axis I disorders. She couldn't do the job.
     
  4. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    r/o 305.90

    :D
     
  5. jjbmsiv

    jjbmsiv INTJ
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    Isn't this question a little too invasive? I mean, sure, if you feel this question is an invasion of privacy you aren't going to post, but, even still, I don't know how cool it is to be asking this.

    Of course, I could just be paranoid, or 300.02.
     
  6. MBK2003

    MBK2003 Senior Member
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    Not to completely hijack the thread, but brings to mind the question of if you could have any DSM-IV TR disorder, which would it be?

    For instance, I believe I often meet criteria for 292.9 and I feel that I am starting to meet criteria for 780.93. My husband would prefer if I had 302.4 of course ;)

    MBK2003
     
  7. atsai3

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    In the NCS-R, major depressive disorder was associated with 9 days of absence & 18 lost days of productivity annually. Bipolar disorder, 28 days of absence & 35 lost days of productivity. Because these values are averaged across a nationwide sample, one might expect the means to be even greater among employees experiencing above-average job-related stressors (i.e., residency training). A program director concerned about the potential productivity of his or her residents might rationally take these factors into account without subjecting particular applicants to moral judgments.

    -AT.
     
  8. Doc Samson

    Doc Samson gamma irradiated
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    Asking upfront about any diagnosis (psychiatric or medical) is a blatant match violation.
     
  9. Adam_K

    Adam_K Indentured
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    I'm not sure that it is a match violation, but it may be in violation of the Americans with Disabilities Act.

    ERAS does ask you about any "limiting aspects" when completing your CAF. State Medical boards may ask whether you have been treated for medical or psychiatric illnesses.
     
  10. strangeglove

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    They can ask about psychiatric and medical diagoses after you are matched. I'm not sure how they would use this information, though.
     
  11. whopper

    whopper Former jolly good fellow
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    I'm not surprised.

    However I found this distasteful and hypocritical because we're in the field where we're supposed to treat people with mental illness with respect. If we're not going to do this, we shouldn't be in the field. Also as mentioned, to discriminate against someone with mental illness is to my knowledge illegal.

    If program directors want to keep out people with mental illness who could do their jobs, then IMHO its not really their business.

    A comparison---people who smoke also aren't as productive because they are out due to illness more often then nonsmokers. I didn't get anyone asking me if I smoked. (which I don't)

    If people with mental illness can't do their jobs, then the people who wrote their letters of reccomendation, and their academic record should record this.
     
  12. toby jones

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    > I found this distasteful and hypocritical because we're in the field where we're supposed to treat people with mental illness with respect.

    Well... You are supposed to treat PATIENTS with mental illness with respect.

    The most judgemental things I've heard about people with mental illness...
    The most hurtful
    The most hateful
    The most disrespectful
    The most condemning
    Have been from mental health 'professionals'.

    Pick up an academic article. You don't read about PEOPLE with schizophrenia, you read about clients or patients or subjects. Part of the attempt to be 'neutral' but a consequence is that there is indeed a tendency to dehumanise.

    And that is just getting started. Read about how certain people (solely by virtue of having a dx label) have a brain 'disease' or 'malfunction'. have a chronic condition. are unable to hold down a job etc. are socially devient. are 'manipulative' or have an innate 'excess of agression'...

    Who is it that creates the stereotypes? Who is it that provides the categories with their associated stereotypes? Who is it that assumes that a client with disorder x behaves more or less according to the stereotype? Who is it that projects the stereotype into the future and judges it probable or improbable that the person will ever recover? What are the consequences of this on public perception? What are the consequences of this for people living / working / loving a person who they know has a mental disorder?

    I'm not surprised about the interview situation. Not surprised at all. Sad, sure. But really very unsurprised.
     
  13. toby jones

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    > major depressive disorder was associated with 9 days of absence & 18 lost days of productivity annually. Bipolar disorder, 28 days of absence & 35 lost days of productivity.

    But it isn't 'major depressive disorder' or 'bipolar disorder' being interviewed. It is a person who happened to meet criteria for one of those disorders at some point in their history. A person. Someone with their unique experiences and qualities and abilities. Someone whose experiences and qualities and abilities should be assessed rather than assumed on the basis of dx category surely.

    Or maybe we should look at stats on race and gender and income of parents and so forth as well?
     
  14. zen76

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    In my personal opinion, applicants should be judged on an individual basis. But before one goes on a tirade against the entire field, any research journal uses "patients" or "clients," ie. cancer patients, not "people with cancer." That's part of the medical model, and the distance can be helpful for patients as well as practitioners. Most of us who are going into or went into psychiatry had some early experience with mental illness, personally or with loved ones, that inspired us to work with this patient population.
    However, psychiatry is filled with the most chronic, debilitating illnesses in all of medicine. That requires a thick skin, and sometimes dark humor to get through the day. Practitioners are human too, not saints. So while I tried to bring unconditional positive regard to every patient I worked with as a med student, I was not feeling particularly warm and fuzzy to the crackhead, or person with an addiction to crack, who screamed at me that, "I'm going to kill every [email protected]#king cracker in here," when I couldn't get her some chocolate milk immediately in our CPEP after the local ER turfed her over to us. She was very pleasant a few minutes later when I brought her chocolate milk, but it takes stamina and fortitude to do clinical psychiatry, and before judging practitioners in an entire field, perhaps one should walk in our shoes, not just look down at a distance from a theoretical perspective.
    To the OP, I apologize for jacking the thread. I found some hang overs from an older generation of psychiatrists have a rather loose definition of "appropriate questions" during an interview, but in all fairness, this represents a small minority that hopefully will eventually retire and go away. But there are going to be jerks in every field, plenty of female classmates of mine going into surgery had at least one encounter on the interview trail of surgeons asking them flat out about having families or getting pregnant, this as evidence of a lack of true commitment to a surgical career.
    My two cents.
     
  15. toby jones

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    > But before one goes on a tirade against the entire field, any research journal uses "patients" or "clients," ie. cancer patients, not "people with cancer." That's part of the medical model, and the distance can be helpful for patients as well as practitioners.

    Yes. It is also common in psychology where it is customary to talk about research 'subjects' or 'participants' or 'normal controls' hence it isn't specific to the medical model. I understand that the purpose of this practice is to convey scientific neutrality or objectivity. That part of doing so involves distancing oneself and indeed regarding the participants as 'research subjects' rather than people. I also understand that it has a more practical purpose of distancing oneself from the people who present for treatment so that the practitioner can treat them on the basis of scientific rather than personal considerations. Also goes some way towards preventing burnout I would suppose. I am aware that there are rationales for doing so, but I am also concerned that this practice does indeed result in practitioners distancing themselves from clients and that viewing a person as a stereotype (which is indeed dehumanising) can result in harm with respect to confirmation bias and self fulfilling prophecy (which patients are often encouraged to internalise).

    > ...while I tried to bring unconditional positive regard to every patient I worked with as a med student...

    Sure. I guess I'm not thinking so much on the warm fuzzies as I'm thinking on the refraining from harm.

    > before judging practitioners in an entire field...

    I didn't mean to unfairly generalise to ALL psychiatrists. I just meant to say that I'm not surprised and I do feel sad about that. Similarly to how I feel sad about women getting a hard time about their pregnancy plans and the like. You are correct, there are assholes in every field and it is unfair to generalise from them to the whole field. I guess part of it comes back to the point that we do expect better of psychiatrists. Like how we expect that policemen conduct themselves within the law and we expect that clergy conduct themselves according to their role. In practice... I don't think people are overly surprised when we hear of another bad cop or another clergy who abused children. I'm similarly unsurprised when I hear of psychiatrists having a dim view of mental illness. I appreciate they aren't the majority... Though... Don't get me started on the harm that can result of telling a person that they have a chronic mental illness that is very unlikely to improve.
     
  16. silas2642

    silas2642 silas2642
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    But say hypothetically that an applicant did have an Axis I diagnosis that he did have to take a substantial amount of time off for-- how do you answer this on the interview trail without being discriminated against? Do you lie and say that it was due to a physical ailment, or do you tell the truth and accept the consequences?

    I had to take time off because of depression and I am terrified of the stigma and repurcussions that this is going to have on my future; I have no idea how I'm going to answer program directors when I'm sitting in front of them when they ask me about my time off even if I have a strong resume. I don't want to shoot myself in the foot, but at the same time, I don't feel comfortable about lying, however, it's none of their damn business.

    How common do you think it is that pds ask applicants if they have a psychiatric disorder and does this actually violate any rules? Am I going to end up in a less competitive program as a result of my illness?
     
  17. whopper

    whopper Former jolly good fellow
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    I can't honestly answer all your questions.

    To my knowledge a program cannot discriminate against someone because they have an illness so long as that illness will not affect their performance.

    http://www.drc-gb.org/employers_and_service_provider.aspx
    However despite this several corporate jobs do discriminate but do so under the table. For example if a male comes to a job interview with long hair, and the place doesn't like it, they can say he was rejected because of some problem that had nothing to do with his hair. Any excuse can be made and told but the real reason was the hair.

    IMHO, no one should be discriminated against so long as their illness/disability does not affect their job performance. IMHO, that can be properly judged based on the candidate's evaluations from their various rotations and academic performance. If they're alright, then there's not much reason to hold a patient's illness/disability against them.

    However that's just my opinion. The real world doesn't work that way.

    Mentioned this on the forum before. My program kicked out a resident last year who had an Axis I illness. Unfortunately for her, she also had EVERY Axis II Cluster B disorder as well (not joking) and lied, cheated, spread malicious rumors on top of doing a piss poor job at work (gave a pregnant patient a class D med without clearing it with the attending, was responsible for 3 patients coding in 1 month due to overmedication).

    Her axis I was not held against her at all. Her Axis II problems though strongly were. I didn't have much sympathy when she got kicked out because by that time she had made 2 false claims of rape, made sexual approaches to several patients, wore sexually provocative clothing (navel exposed at work due to some provacative clothing) caused several codes among several other problems.

    When I was asked, I said I didn't have an Axis I disorder--and that was honest. I don't. Like I said above, some of the programs dug into it in an unethical manner. Others didn't. IMHO, and I know this isn't right, you're going to have to anticipate that some of them will not be right minded about this issue and may ask, and may hold it against you. I know its wrong but I think it may happen to you if you took a year off. I took a year off and that's why they asked me if I had an Axis I.
     
  18. toby jones

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    If they ask about the time off I'd say that it was due to a health issue and (I'm hoping that you can be genuine in this) that you feel it is unlikely to recurr and / or have a detrimental impact on your ability to train / practice. If they ask you for more details I'd restate the above with a particular emphasis on the latter side of that.

    If you have some concerns yourself about whether it is likely to impact on your professional life I really would go see a councellor or something and work on believing that it won't! You would thus be telling them the truth (though perhaps not to the degree of specificity they would like). I'd say that they would be most concerned about whether it is likely to impact on your professional life and so if you can reassure them that it will not then they should leave the issue alone.

    Yeah it is the offical party line that you aren't allowed to discriminate on the basis of gender and mental illness and so forth. There have been some interesting experiments conducted that showed that people DO IN FACT do this, however, even if they are consciously attempting to guard against it. For that reason I really don't think that they need to know.

    It really could help to practice role playing that part of the interview. I would say that it could be tricky to appropriately juggle being truthful, not providing more information that you need to, while simultaneously addressing the question appropriately. It could be helpful to list some of the different ways in which they could ask the question and have responses prepared for the different phrasings so your response can come across with an appropriate tone, volume, and rate etc so they are less likely to find your response 'odd' or somehow inappropriate.

    I'd suggest a similar approach for handling all those inappropriate questions like when you are planning on having children and how you think you are going to find the locale and so forth. It is true that people really aren't meant to ask those kinds of questions... Sometimes I think that they ask about them precisely to assess how one can handle oneself, however... A bit of a shame to be sure, but handling it well should leave more of an impression than the people who didn't get the opportunity to show that they can infact handle themselves well in the face of inappropriate questions / remarks.
     
  19. Adam_K

    Adam_K Indentured
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    During my interviews this year, I was asked extensively about my short academic leave of absence (family issues causing me to take time off).

    While no one asked me directly about psychiatric or medical diagnoses, there were a couple of interviewers that asked questions designed to tease out underlying psychopathology by attempting to provoke a reaction.

    I didn't have a problem dealing with these, but decided to rank those programs down my list, as I thought this was unprofessional. After all, the programs have plenty of information to make a decision on me without having to resort to stress questions.
     
  20. whopper

    whopper Former jolly good fellow
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    Same thing happened here.

    At one place the interviewer went ballistic on me and said some very mean spirited things. I would love to mention the program but I don't want to add to the gossip wagon on a forum that is seen throughout the world.

    The guy said some real real mean things. I gave details about it in a previous post from way back. Things like loaded questions, calling me names, told me that he was going to report to the "committee" that he was going to say I was an irresponsible narcissistic what have you withing 10 minutes of the interview.

    He also interviewed me on the year I took off. He went through it like he was some type of bad cop without my lawyer present.

    You know what? I interviewed at 13 places. I didn't need to go to that place. I didn't even place that program on my Match list. I had a few places offer me a contract before I left, I had other places tell me I was going to be very high on their Match list. The program I got into ranked me #1 for their list.

    The program director of that program later told me that same day that their program strongly wanted me to be there. Perhaps the guy interviewing me told them I kept my cool and liked that. I don't know. In any case, though that type of mean spirited interview turns off candidates. It'd only work in a situation where a candidate had no where else to go--and then it'd be just bullying becuase the candidate has no choice but to take that abuse.

    Had the guy simply just told me after the interview that it was some type of test, that he needed to see my honest reactions, I would've been fine with it. The guy didn't--and I wasn't in a position where I had to take their abuse.

    For this reason, I tell people they're going to have to think about admitting their mental illness during an interview. I wish I could tell them to just be honest--but from what I've seen, it seems like it will be held against you. I also sometimes tell people this before their interview becuase often times it is just a test. If you get too stressed they're going to hold that against you too.
     
  21. chaos

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    I just wandered in from the psychology board and have been debating about posting on this topic...every time I mention it I somehow feel that people will assume I'm going into psychology to fulfill the ultimate cliche and heal myself, not others. I was diagnosed with paranoid schizophrenia two years ago and I've thought long and hard about whether it's ethical...or even possible...for me to pursue psychology as a profession. I want to do research, not practice, so there's less of an ethical consideration right there...but the fact is, I will be recieving clinical training in grad school no matter what, and although I feel I am stable now, who knows what could happen in the next five years?

    Based on whopper's post, I'm now very nervous about how to explain the two undergraduate semesters where I dropped out of every class. A total of five withdrawals on my transcript needs some kind of explanation. I plan to address this briefly in my SOP by saying I was ill and unable to complete those semesters...I didn't consider the possibility they'd be like 'uh, ill with what, exactly?'. I've had varying opinions on how much to disclose, if asked. People in the profession have told me 'admit nothing, deny nothing', and others have said I should disclose even if I'm not pressed about it.

    The fact is, it's a liability for a grad school to take someone like me on. I feel I should be up front with them, and if I thought they would simply perform an objective cost/benefit analysis of my qualificiations versus the fact that I may need to take some time off now and again, I'd gladly disclose my diagnosis. But psychologists, psychiatrists, have their own set of prejudices about mental illness, based not on ignorance, but on experience. I wish I could say this isn't fair- but I've seen for myself how mental illness can destroy the lives of even the most promising, industrious, intelligent people. I guess all we can do is try to be twice as productive while we're able and recognize if we're getting pushed close to the edge.
     
  22. whopper

    whopper Former jolly good fellow
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    I'll just throw in that some programs I do think will be understanding to applicants with mental illness. I think my own program would be--we've had a few with mental illness in the past and the program directors never held it against them.

    However this is not the case with all programs, and I nor anyone else can give you a list of which ones are understanding and which aren't.
     
  23. atsai3

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    Your approach seems like a reasonable one. As previous commenters have noted, for people who are going through the Match process, if some programs rub them the wrong way (eg., by asking questions in such a manner as to nibble around the edges of the DSM checkboxes) then they can decide for yourself as to whether those programs are being unprofessional -- and they can penalize those programs appropriately (ie., by docking them a few points on their rank lists) or even taking further action by reporting those programs to the NRMP.

    A few years ago, Elizabeth Baxter won some awards from NAMI and Lilly as a psychiatrist who overcame her own illness (schizoaffective disorder): "Psychosis Fails to Block Psychiatrist’s Career Path"; "Personal Accounts: The Turn of the Tide".

    Cheers,
    -AT.
     
  24. toby jones

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    I don't have a great deal to add to what I've already said except that I didn't mean to imply that one should report programs or rank them lower on the basis of their asking questions that go beyond what you are required to disclose.

    I'm not terribly sure how competitive it is to get into a program but in my field 260 applicants for 15 places is fairly common. It is often said that any of the applicants in the top 100 could go on to do good work but that they do need some way of sorting the top 15 from the top 100. Factors such as who the referees are and what institution a person comes from and area of interest thus come into play quite significantly. Basically, any perceived weakness is used to help sort those top 15 from the top 100. If there were interviews (which there aren't for admittance to a PhD program) I'm sure that all kinds of inappropriate questions may be asked to see how the person handles themselves.

    This is known to happen on the job market. There you could be looking at 260 applicants for one job. Questions like 'how do you think the location will suit you?' are asked to people who studied in Boston and applied to Arkansas (for example). IMHO what they are really checking is your ability to provide a diplomatic answer.

    How many people with schizophrenia manage to get an undergraduate degree? If you look at the statistics it is very unlikely. If you had have been diagnosed with schizophrenia before you enrolled in university what do you think your psychiatrist would have said about your prospects of getting an undergraduate degree? I'd imagine they wouldn't have thought that it was very likely that you would have been able to do it. Telling you this could well have made it so. Forget the statistics on schizophrenia relapse and the like you have distinguished yourself from the majority already. If you don't give this the best shot you have then won't you always wonder 'what could I have done with my life if I had have been dx'd with "brief psychotic episode" instead of "schizophrenia'.

    There is a middle ground between refusing to answer the question and answering the question to a high degree of specificity. 'I had a health problem' is true though admittedly not highly specific. If they push you you can repeat this more firmly. They will most probably want to know whether you think the health issue is likely to affect your future study. Here... What we come to believe depends quite significantly on what information we surround ourself with. There is a lot of stuff on how much better outcomes are when people have meaningful employment. There is a lot of stuff on how diagnoses of schizophrenia (for example) are inflated because of the health insurance system in the US. There is a lot of stuff on people who have recovered and gone on to do amazing things. There is also a lot of stuff on how all the 'normal' people in the world may acquire mental disorders or babies or ill physical health which requires them to take time off.
     
  25. Adam_K

    Adam_K Indentured
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    If programs treat an applicant unprofessionally during the interview by asking stress questions, it leaves me wondering as to how they'll treat me if I match to their program.
     
  26. musm2008

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    Are there any governing bodies that actually REQUIRE reporting psych diagnosis/treatment- ie. medical boards, insurance, etc. If so, how does it affect licensure or premiums? Would there be any diagnoses that are major red flags?
     
  27. Adam_K

    Adam_K Indentured
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    Medical boards may, and of the handful of licensing applications I've seen, all required disclosure (I was checking licensing requirements for IMGs and just thought that the question was an interesting one).

    If you wish to know for a specific state, find the link for that state's medical/osteopathic board on the FSMB website. Then, find and download a license application to find the specific language.
     
  28. musm2008

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    I'm curious about what they actually DO with that information. For example, if someone was a schizophrenic or had bipolar or something, would that make it more difficult to get a license? I don't know enough about all this, but it's weird that this isn't considered a privacy violation.
     
  29. toby jones

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    > of the handful of licensing applications I've seen, all required disclosure

    How did they phrase the question?

    E.g., 'do you know of any current reason...'

    'Do you currently have a mental health disorder...'

    'Do you have a past history of anything that might impact on...'

    'Do you have a past history'

    ?
     
  30. Adam_K

    Adam_K Indentured
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    Here's a couple examples.

    Have you been diagnosed with an emotional, mental or behavioral disorder which impairs your ability to practice medicine safely? (California)

    During the past 10 years, have you voluntarily entered or been involuntarily admitted to an institution or health care facility for treatment of a mental or emotional disorder or condition?

    During the last ten years have you been diagnosed with or treated for bipolar disorder, schizophrenia or any psychotic condition? (Nebraska)

    Have you EVER suffered from any physical, psychiatric, or addictive disorder that would impair or require limitations on your functioning as a physician, or that resulted in the inability to practice medicine for more than 30 days? (Maine)

    Have you within the past five years been advised by your treating physician that you have a mental, physical, or emotional condition, which, if untreated, would be likely to impair your ability to practice medicine with reasonable skill and safety? If you answer this question 'yes", please answer the following:
    Y N 4a. With regard to any condition referenced above, are you being treated so that such
    impairment is avoided?
    Y N 4b. With regard to any condition referenced above, are you in compliance with the
    recommended treatment?
    Y N 4c. With regard to any condition referenced above, has your treating physician advised you
    that you are able to practice medicine with reasonable skill and safety?
    4d. Please explain._______________________________________________________
    4e. Identify your treating physician (Minnesota)
     
  31. Adam_K

    Adam_K Indentured
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    I'm not a lawyer, so take this with a big grain of salt, but I suspect that the licensing laws enacted by the state legislatures specifically allow for this. As to whether this is in conflict with the Americans with Disabilities Act, that's a good question.

    As far as the options available to the medical board, there are plenty. They could either deny the application or grant a license with specific restrictions.
     

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