Dealing with Major Depression - How to Proceed?

[tofu dredge]

I am a 1st year medical student at a MD school. I believe that I am suffering from major depressive disorder (I have all but two of the SIGECAPS criteria for the past month or so), and it is making my life miserable. I feel tired all the time despite sleeping close to 12 hours a day, and it is almost impossible for me to concentrate on schoolwork despite spending 10+ hours a day studying.

I am doing poorly in my classes as a result of my depression, but I am afraid to go to a school psychiatrist and get a diagnosis so I can start getting treatment. I've heard that mental illness (especially depression) is looked down upon by medical school faculty and administrators, and I don't want to have a diagnosis on my medical record - for fear of being kicked out of school and future ramifications. I've heard that admitting to having depression makes it difficult to get licensed in certain states.

However, I can't continue to go like this since my depression is having a severe impact on my ability to study and pass exams. I want to get better so I can get back in the game, but I don't want anyone at my school to know that I have depression. So what should I do?

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[TBV]

Go see someone, they don't have to be associated with your school if you're not comfortable with that. But see a psychiatrist and do it sooner rather than later.

 

[OnePunchBiopsy]

If you would like to go see someone about it, honestly, getting in with a psychiatrist can take months.

Go see a primary care doc, or go see a psychologist. You will get in sooner, and they should be able to give you the help you need.

 

[tofu dredge]

If you would like to go see someone about it, honestly, getting in with a psychiatrist can take months.

Go see a primary care doc, or go see a psychologist. You will get in sooner, and they should be able to give you the help you need.

Thanks. But can a primary care doctor or psychologist adequately address my symptoms? I just want to get better as soon as possible so I can be more productive with my studying (right now, I am not retaining any information, and I can't concentrate longer than 20-30 minutes without taking a big break), and I figured that a psychiatrist can diagnose me the fastest and prescribe antidepressants.

 

[InsideTheBoards]

Thanks. But can a primary care doctor or psychologist adequately address my symptoms? I just want to get better as soon as possible so I can be more productive with my studying (right now, I am not retaining any information, and I can't concentrate longer than 20-30 minutes without taking a big break), and I figured that a psychiatrist can diagnose me the fastest and prescribe antidepressants.

I know some people who can give some great advice on this and can offer some perspective as well. Email me directly @ [email protected] (and I'll give you my personal contact via) or DM me at facebook.com/insidetheboards or Twitter @boardsinsider. - Patrick

 

[Crayola227]

http://forums.studentdoctor.net/threads/how-should-i-proceed.1162787/#post-16954878
scroll up a bit to find my post on self care

http://forums.studentdoctor.net/threads/resident-friend-joked-about-suicide.1116935/#post-16240366
tips on confidentiality in seeking help for mental illness

http://forums.studentdoctor.net/thr...ability-accommodations.1179885/#post-17333196
tips on getting a disability accommodated

http://forums.studentdoctor.net/threads/alcoholics-anonymous-in-residency.1138505/#post-16691390
on substance abuse and treatment

You absolutely can seek care for depression and not have it be an issue for licensing, but there's some considerations to take.

**One, you want to seek help NOW before it affects your performance any more than it already has. If you pose an immediate danger to yourself or others, you need to take an immediate leave. It is OK to simply state that you need the leave for personal medical reasons at this point to your Dean if that is the path you must go down. Don't let work give you enough rope to hang yourself with (meaning you are impaired in some sense, go because it's "expected of you" and you fear consquences of not going, only to go perform badly and then bring about even worse consequences). On the other hand, if you can continue without having any break in training, without putting yourself or others in danger, and passing, that is better. If you are at risk of failure you need to act fast or consider a leave. It's easier usually easier to hit the pause button in education than the replay button. If you go down the immediate leave for depression pathway, then you need to follow the advice in the post about disability accomodations and consider an attorney. Whether or not you take a leave, I urge you to work with a med provider and the disability office to set up ongoing mental health care, or at least to help you carve out the time for it for 3rd and 4th year.

**Feeling acutely suicidal? The right answer is to tell you to go to the ED. The career smart answer is to google anonymous suicide helpline and call that number blocking your phone number (google there's usually a code to put in on most movile carriers). Also career smart is to avoid inpt treatment if you can. Before people get upset that I say this, it's just a sad reality that what is best for your medical career vs your health are frequently at odds. Which you should maximize? Hard to say as neither are independent of the other.

**Secrecy is key. My school was very good about having really confidential access to healthcare. It's true you don't want your PCP visit re: your depression in the same EHR as where you work. See above post on tips for finding help outside your system.

**An easy place to start might be your school's ombudsman or Student Health Center after you check confidentiality policies and the EHR system in place. Or call your insurance and find out where you can seek care that is outside your system.

**Many states, if you have never received inpatient treatment or interrupted training or had other reportable consequences of depression affecting your work, you will not have to get into the sort of details for licensing that truly make your life harder. It really depends on the wording of the application and the state.

**Again, the right thing to tell you is absolute honesty with your medical providers. That said, the worst thing to have on record about you is not depression, it's other things that make us question *judgement* in a physician. The biggies are drug abuse, psychosis, and self-harm (cutting, suicidality). Try searching my post history "substance abuse" and see what advice that gives you if it applies to you. If there is any way for you to avoid self harm without creating a paper trail about it that is ideal. Phone a helpline, a trusted friend or loved one. For those two you may have enough insight to be able to address with the help of a medical provider without having to create too much paper trail. However, for psychosis since that is a loss of touch with reality to some degree or another, there is too much risk that insight is affected so that is one that I urge you to be completely honest with anyone about.

I want to reiterate that your immediate safety is more important than any job or diploma. Also, that you CAN seek treatment and not have this be any more than a minor inconvenience from a career standpoint. Thousands of physicians are seeing psychiatrists, going to counseling, and taking psych meds on a daily basis. However, mishandled it can be very stigmatizing and damaging. The key is to be smart and secret, not to ignore the issue.

 

[Crayola227]

Thanks. But can a primary care doctor or psychologist adequately address my symptoms? I just want to get better as soon as possible so I can be more productive with my studying (right now, I am not retaining any information, and I can't concentrate longer than 20-30 minutes without taking a big break), and I figured that a psychiatrist can diagnose me the fastest and prescribe antidepressants.

uncomplicated run of the mill depression absolutely can be adequately diagnosed and treatment initiated by a primary care provider, whether that's a doctor or an NP even

what I should, say, is that a PCP absolutely can handle initial assessment and planning and in most cases begin therapy, and can always provide referral to emergent services or counseling as needed

so to answer your question, actually, it is the PCP who can get you whatever help you actually need the fastest

often the bigger hurdle is working with insurance for counseling
or if a trip to the psychiatrist is recommended by your PCP, then it's often an issue of coverage & availabilty

don't worry about a psychiatrist for now, go see a PCP

 

[NontradCA]

SDN is not the place for medical advice, and the people giving it to you here shouldn't be.

 

[Crayola227]

I reread my posts and feel comfortable that the content was more about how to seek help for depression within the context of a medical career, and wasn't so much about any diagnosis the OP may or may not have

the closest I came to medical advice was the the link I provided on self care, which can be seen as simply providing my opinions/facts on self care in general, and telling the OP to see their PCP or go to the ED if in immediate danger

career advice and providing basic medical information not aimed at treating a specific individual is allowable under the TOS
and when people seek medical advice on these boards telling them to speak to their PCP or if in more immediate danger to go to an ED I've frequently seen, in fact, I'm not sure that a doctor should say *less* than that to anyone seeking medical help

 

[GaiusOctavius]

Why exactly is secrecy so important? Isn't your EHR confidential?

http://forums.studentdoctor.net/threads/how-should-i-proceed.1162787/#post-16954878
scroll up a bit to find my post on self care

http://forums.studentdoctor.net/threads/resident-friend-joked-about-suicide.1116935/#post-16240366
tips on confidentiality in seeking help for mental illness

http://forums.studentdoctor.net/thr...ability-accommodations.1179885/#post-17333196
tips on getting a disability accommodated

http://forums.studentdoctor.net/threads/alcoholics-anonymous-in-residency.1138505/#post-16691390
on substance abuse and treatment

You absolutely can seek care for depression and not have it be an issue for licensing, but there's some considerations to take.

**One, you want to seek help NOW before it affects your performance any more than it already has. If you pose an immediate danger to yourself or others, you need to take an immediate leave. It is OK to simply state that you need the leave for personal medical reasons at this point to your Dean if that is the path you must go down. Don't let work give you enough rope to hang yourself with (meaning you are impaired in some sense, go because it's "expected of you" and you fear consquences of not going, only to go perform badly and then bring about even worse consequences). On the other hand, if you can continue without having any break in training, without putting yourself or others in danger, and passing, that is better. If you are at risk of failure you need to act fast or consider a leave. It's easier usually easier to hit the pause button in education than the replay button. If you go down the immediate leave for depression pathway, then you need to follow the advice in the post about disability accomodations and consider an attorney. Whether or not you take a leave, I urge you to work with a med provider and the disability office to set up ongoing mental health care, or at least to help you carve out the time for it for 3rd and 4th year.

**Feeling acutely suicidal? The right answer is to tell you to go to the ED. The career smart answer is to google anonymous suicide helpline and call that number blocking your phone number (google there's usually a code to put in on most movile carriers). Also career smart is to avoid inpt treatment if you can. Before people get upset that I say this, it's just a sad reality that what is best for your medical career vs your health are frequently at odds. Which you should maximize? Hard to say as neither are independent of the other.

**Secrecy is key. My school was very good about having really confidential access to healthcare. It's true you don't want your PCP visit re: your depression in the same EHR as where you work. See above post on tips for finding help outside your system.

**An easy place to start might be your school's ombudsman or Student Health Center after you check confidentiality policies and the EHR system in place. Or call your insurance and find out where you can seek care that is outside your system.

**Many states, if you have never received inpatient treatment or interrupted training or had other reportable consequences of depression affecting your work, you will not have to get into the sort of details for licensing that truly make your life harder. It really depends on the wording of the application and the state.

**Again, the right thing to tell you is absolute honesty with your medical providers. That said, the worst thing to have on record about you is not depression, it's other things that make us question *judgement* in a physician. The biggies are drug abuse, psychosis, and self-harm (cutting, suicidality). Try searching my post history "substance abuse" and see what advice that gives you if it applies to you. If there is any way for you to avoid self harm without creating a paper trail about it that is ideal. Phone a helpline, a trusted friend or loved one. For those two you may have enough insight to be able to address with the help of a medical provider without having to create too much paper trail. However, for psychosis since that is a loss of touch with reality to some degree or another, there is too much risk that insight is affected so that is one that I urge you to be completely honest with anyone about.

I want to reiterate that your immediate safety is more important than any job or diploma. Also, that you CAN seek treatment and not have this be any more than a minor inconvenience from a career standpoint. Thousands of physicians are seeing psychiatrists, going to counseling, and taking psych meds on a daily basis. However, mishandled it can be very stigmatizing and damaging. The key is to be smart and secret, not to ignore the issue.

 

[Oblique]

SDN is not the place for medical advice, and the people giving it to you here shouldn't be.

They are not giving medical advice. They are just giving the OP tips on seeking help, which is appropriate.

 

[Goro]

Don't be a non-compliant patient. You're going to see tons of these in your career.

Get help NOW. Your school should have a counseling center.

Med schools have the philosophy that once we admit you, we do everything in our power to get you to graduation (unless you're dishonest or have a pattern of unprofessional behavior).

Take a LOA, go and heal, and come back stronger.

I can't sugar coat this. You're sick and you need help. If you had hematuria, would you just ignore it? Your medical career is on the line here, and doing nothing = no MD.

Get help NOW.
Get help NOW.
Get help NOW.
Get help NOW!

I am doing poorly in my classes as a result of my depression, but I am afraid to go to a school psychiatrist and get a diagnosis so I can start getting treatment. I've heard that mental illness (especially depression) is looked down upon by medical school faculty and administrators, and I don't want to have a diagnosis on my medical record - for fear of being kicked out of school and future ramifications. I've heard that admitting to having depression makes it difficult to get licensed in certain states.

However, I can't continue to go like this since my depression is having a severe impact on my ability to study and pass exams. I want to get better so I can get back in the game, but I don't want anyone at my school to know that I have depression. So what should I do?

 

[Bancrofti]

Your school should have some type of psychologist that's always available for whom you can get appointments relatively quickly. Make an appointment tomorrow morning for whenever you can get in soonest. You'll need to talk about what's going on with you, especially if you think you know what the inciting cause of your depression is.

You can see your PCP and they can recognize you have depression and start you on the appropriate treatment. However, they aren't as well versed on advising coping skills and helping you determine what the cause of your mood is, so you still need to see a psychologist or psychiatrist as soon as you can, and preferably for multiple sessions.

 

[NotAProgDirector]

I'm going to agree with everyone else here. And I'm possibly your future employer.

Forget about whether residency programs or licensing boards "look down" on leaves for mental illness. All of us "look down" on doing poorly, which is what is going to happen to you shortly if you don't get help. Get help. Take an LOA if necessary.

 

[zeppelinpage4]

I am a 1st year medical student at a MD school. I believe that I am suffering from major depressive disorder (I have all but two of the SIGECAPS criteria for the past month or so), and it is making my life miserable. I feel tired all the time despite sleeping close to 12 hours a day, and it is almost impossible for me to concentrate on schoolwork despite spending 10+ hours a day studying.

I am doing poorly in my classes as a result of my depression, but I am afraid to go to a school psychiatrist and get a diagnosis so I can start getting treatment. I've heard that mental illness (especially depression) is looked down upon by medical school faculty and administrators, and I don't want to have a diagnosis on my medical record - for fear of being kicked out of school and future ramifications. I've heard that admitting to having depression makes it difficult to get licensed in certain states.

However, I can't continue to go like this since my depression is having a severe impact on my ability to study and pass exams. I want to get better so I can get back in the game, but I don't want anyone at my school to know that I have depression. So what should I do?

Please get help ASAP. I suffer from mental illness, I had some of the same concerns you did and decided not to seek help. But my mental health got worse until I began failing exams, and then I had to explain it to my administrion.
To my surprise when I told my deans, everyone was supportive. My deans supported me, and I got professional help. I've done much better in school since. I wish I sought help sooner, before I failed my exams, but I'm glad I finally got it, before any further damage was done. This issue is more common than you would think, and most likely your administration is familiar with helping students who deal with it.
And personally, I think a good student with dx of mental illness > a poor student hiding their mental illness.

Also at my school, the CAPS office is separate from the administration, so we can seek help without the admins being notified. Look to see if you may have a service like that too.

Feel free to PM me if you need, wishing you all the best.

 

[Crayola227]

Why exactly is secrecy so important? Isn't your EHR confidential?

Secrecy is important because there is still huge stigma associated with mental illness in healthcare. Many peers, attendings, and the school itself can be quite sympathetic. However, residency is cutthroat. It is difficult, competitive, and there is a TON at stake not just for the applicant but the program as well.

It is no exaggeration to say that residency programs, if not outright overtly but subconsciously, may very well pass up on an applicant if they knew ahead of time they suffered from any sort of mental illness. Honestly, the last thing they want to deal with is a potential "problem" resident or any sort of issue that might affect productivity or performance.

Academic medicine is a much smaller world than most realize. Doctors love to gossip as much as any human. If they are not your treating provider, they are not bound by HIPAA in discussing colleagues' health.

Yes, the EHR is confidential. However, think about this. What is really stopping the guy/gal in your class that hates you / obsessed with you / even just a busy body curious about you from clicking on your chart and reading it? The fact they could be caught and get in trouble? Think this through a little more. How would that happen?

The EHR records all the instances of chart access, but who is going to police or enforce those policies about unauthorized access? Most institutions will tell you there is too much going on for every chart access to be scrutinized to assess if _____ who accessed _____'s chart really had business doing so. What most places do is *random* monitoring, meaning that the access history of a small number of charts is looked at to check for odd patterns of access, or a small number of employees are selected at random and their access history looked at. Potentially this is done not randomly for the charts of very famous people or VIPs to the hospital.

The other way that EHR access is addressed is if a particular patient brings a complaint. The threshold for what sort of complaint will trigger an investigation can vary. An attorney threatening to sue for HIPAA more likely to get someone to really look. Perhaps saying "did anyone who wasn't supposed to access my chart?" might not glean much action. If there is someone in particular that you suspect accessed your chart without your permission that is much easier to track. But you would have to have suspicion to name someone in that case. Either way, you will be asked why you wanting to know before they are going to look.

Say they do pull up the list of all those who "broke the glass" of your chart and see that on that list is a classmate who did not have business in your chart otherwise (it's an investigation because everyone on that list they will have to cross reference clinic schedules and contact to suss out if they had business in your chart). Say no attorney is involved and you have not threatened to sue. Some institutions the EHR only tracks who accessed what chart, but does not specify to where they navigated. Other systems are more sophisticated. In any case, just clicking into many charts you can see a problem list. Depending on what personal history the person accessing has with you, and what their professional track record is, your institution's culture, and how much noise you are making (attorney or no), could they potentially pass off a lie about making a mistake and stumbling into your chart on accident? Maybe. Maybe not.

However, catching whoever cat-of-bagged your personal medical issues to the rest of the med school class-->admin-->residency programs does not undo any damage that may have come from it. Keep in mind as I said it is essentially just *fear* of the above that keeps people out of charts they're not supposed to be in in the first place. Unlikely to be caught vs dire consequences for being caught frequently is not enough to deter behavior or unauthorized access.

I can think of a number of ways for a colleague to have business being in your chart without being your provider that *could* happen, and heck, even if you're just on the clinic schedule for depression could the wrong person look over at someone else's computer and catch your name there?

Even if none of the above happened, if you get your care at your institution, than some people who work at your institution automatically have business being in your chart at least in the process of providing direct care. Say they only tell one friend about you, and the friend tells 2 people and then chain reaction. How to catch them for gossiping to a colleague about you? Only if someone came forward that they heard it from that one individual (in the course of even one office visit there are enough employees accessing your chart to make it nearly impossible to say the leak is one given individual without someone fingering them).

I got a lot of my care for issues not related to mental health at my institution. My mental illness was listed on my problem list, but no psych notes were in the computer for anyone feeling curious to read.

The world, especially the electronic world, is a lot smaller than you might think.

 

[Crayola227]

All that said, while I would want to keep all my mental health stuff as secret as possible in a healthcare work environment, merely having a diagnosis or treatment of depression or anxiety will not cause significant difficulties down the road with licensing or credentialing.

What you want to do is be proactive so that you don't have failures due to them. It's ideal if they don't cause you an LOA but you have to balance that with what you actually need and whether or not continuing without one is going to be counterproductive. Having any disciplinary actions against you for performance due to depression/anxiety doesn't do you any favors either. Lastly, substance use issues, self harm, or inpatient treatment changes the picture and having to checkbox that yes on paperwork can cause major problems.

Some state licensing will ask to review your psych notes!! Like I said in reviewing those notes, they are looking to assess how much your mental illness has affected insight, and the last 3 things I mention, substance use, self harm, or inpatient treatment, plus non-compliance, and psychosis are the sort of things that make them nervous.

If I were worried about my depression affecting my career longterm, I would seek treatment ASAP, to make sure one never got so bad off they were psychotic, harming oneself, or had a substance use issue secondary to it. The only issue that raises is that whoever you see you will then need to be compliant with.

If you are depressed, please refrain from self harm, like cutting or hitting yourself, on principle, but also so that you can honestly answer any health care provider no and can have an accurate chart and an honest relationship with your providers.

There was someone I knew who was quite depressed, and they called a helpline and were able to refrain from hurting themselves via cutting that way, because they were still cognizant of career considerations. They *really* wanted to keep their medical history clean that way so they were able to avoid self harm with that strategy.

They were suicidal, and had a relative come stay with them so they could avoid needing to go to ED or to be admitted inpatient. This worked for them because they knew as long as this loved one was around they would not attempt/complete a suicide, and it would allow them not to need to go to the ED or be admitted, going to the ED can create the sort of paper trail they wanted to avoid for licensing, and having received inpatient treatment is the sort of thing that often shows up as a questions for licensing apps and credentialing. This strategy isn't going to be safe or work for everyone, it depends on the person. Plenty of people live with an SO and still attempt.

It's OK to discuss suicidality and any plans you may have with your provider, having that in the notes will not hurt your career either. In discussing your plan I recommend you be honest, but from a career standpoint I would not mention anything illegal. If your plan is to OD on opiate medication, that's fine to mention, but if they're not from past prescriptions of yours I wouldn't mention that you bought them from a friend or anything like that. Disclaimer here is that I am not championing ideal medical treatment of depression, but just practically talking about issues that come up for depressed people and how that jives in with the fact that YES, some STATE MEDICAL BOARDS WILL DEMAND TO READ ALL OF YOUR PSYCH NOTES. So planning to OD on your legal prescription medication, or a *plan* to take your dad's meds from the medicine cabinet, all reads differently than saying your opiate stash you have *already* you bought from the street.

 

[Natu_]

You need to find your inner zen, sit down and meditate. Visualize what you need to do, think about how you can address your situation. Question yourself why you're depressed in the first place. Do you feel like you're overwhelmed? Do you feel like you're alone? Do you feel like you're stuck and theres nothing you can do about it? You need to really sit down and think about this stuff. I suggest taking a hot bath or a hot shower and thinking about these things. It's important that your mental health and emotions are in tact during medical school otherwise you're going to be screwed. Are you taking any medications that are making you depressed?

If you're out of shape as in not healthy maybe you should start taking care of your body more. If you're sleeping 12 hours a day and you have no energy then maybe its your diet. If you're skinny that doesn't mean you're necessarily healthy either. Look for healthy foods that can help with depression, etc. There's gotta be a way to treat this yourself. http://www.webmd.com/depression/guide/diet-recovery

I don't necessarily pity people who're depressed I can understand why some people get "kind of depressed" but when they let their emotions control them that makes them vulnerable and weak. If you're depressed because you're going to be paying off loans after medical school yeah I could see that... You might want to find a hobby that you enjoy during medical school. Maybe you're bored half to death or can't concentrate because you feel like you have to study 24/7.

 

[Crayola227]

There's gotta be a way to treat this yourself. http://www.webmd.com/depression/guide/diet-recovery

I don't necessarily pity people who're depressed I can understand why some people get "kind of depressed" but when they let their emotions control them that makes them vulnerable and weak. If you're depressed because you're going to be paying off loans after medical school yeah I could see that...

NO. NO. NO.

Not good advice, not evidence based, does not fit in with our current data on how best to treat depression. Depression can be life threatening if not treated appropriately.

Lastly, just because a diagnosis affects your emotions or your mood does not make it totally under your mind's control. Examples include Parkinson's or major depression.

Think of the somatic symptoms associated with depression - changes in appetite, sleep, psychomotor speed. Sure sleep, like breathing, can be affected by things under your conscious control. However, it's *not* entirely under conscious control. There's some common sense evidence for that right there. We're talking about a disease with concrete somatic effects.

Depression is not always a reaction to things like high debt. Oftentimes life events can trigger depression, but that doesn't always account for its start, and often life events cannot account for its continuance.

 

[Natu_]

It can be life threatening for sure, I knew a guy through some friends who blew his own head off with a shotgun. I didn't know him that well; He literally just graduated high school at the time. People assumed it was because he was sent back home from the military could have been more than just that though. (Think he had an injury?) But he seemed pretty down about it apparently. That's a bit extreme right there.

But he/she will need to figure out if its that serious. I knew people who were depressed cause they couldn't find a job for a while but they got over it. Sometimes we can figure things out ourselves and sometimes we can't. So if he/she is 100% sure its that bad to the point where they know that the depression will never go away then yeah you should go talk to a PCP. I guess since they're posting on the forums it might be pretty bad self-unfixable depression that needs to be treated properly.

 

[wholeheartedly]

It can be life threatening for sure, I knew a guy through some friends who blew his own head off with a shotgun. I didn't know him that well; He literally just graduated high school at the time. People assumed it was because he was sent back home from the military could have been more than just that though. (Think he had an injury?) But he seemed pretty down about it apparently. That's a bit extreme right there.

But he/she will need to figure out if its that serious. I knew people who were depressed cause they couldn't find a job for a while but they got over it. Sometimes we can figure things out ourselves and sometimes we can't. So if he/she is 100% sure its that bad to the point where they know that the depression will never go away then yeah you should go talk to a PCP. I guess since they're posting on the forums it might be pretty bad self-unfixable depression that needs to be treated properly.

People saying they feel depressed and actually being clinically depressed are two very very different things. I think this is where you might be getting confused.

 

[Stagg737]

I am doing poorly in my classes as a result of my depression, but I am afraid to go to a school psychiatrist and get a diagnosis so I can start getting treatment. I've heard that mental illness (especially depression) is looked down upon by medical school faculty and administrators, and I don't want to have a diagnosis on my medical record - for fear of being kicked out of school and future ramifications. I've heard that admitting to having depression makes it difficult to get licensed in certain states.

It sounds like you've gotten pretty unanimous advice to get help now, but if you need more motivation think of it this way. What is going to look worse to your future residency prospects and employers: Seeing that you had an issue with depression, got help, and have it under control or seeing that you had an issue with depression, tried to hide it/didn't get help, and ended up failing classes and potentially having to remediate a year (or worse, getting kicked out of school)?

You recognize you have a problem, it's only getting worse, and you're worried about failing exams. It's time to get help and work on the issue before something happens that really will hurt your career. Do some places/people still have a stigma against people who've had a mental issue? Yes, but it's far more common in med school than most people realize, and you're better off nipping it in the bud than letting it potentially snowball out of control.

 

[bumblebee611]

@Crayola227,

What do you recommend for keeping things quiet if you've already been treated (a few years ago, including therapy/psych notes) at the institution where you will be attending medical school?

 

[sloop]

Yes, the EHR is confidential. However, think about this. What is really stopping the guy/gal in your class that hates you / obsessed with you / even just a busy body curious about you from clicking on your chart and reading it? The fact they could be caught and get in trouble? Think this through a little more. How would that happen?

The EHR records all the instances of chart access, but who is going to police or enforce those policies about unauthorized access? Most institutions will tell you there is too much going on for every chart access to be scrutinized to assess if _____ who accessed _____'s chart really had business doing so. What most places do is *random* monitoring, meaning that the access history of a small number of charts is looked at to check for odd patterns of access, or a small number of employees are selected at random and their access history looked at. Potentially this is done not randomly for the charts of very famous people or VIPs to the hospital.

What's to stop them? Expulsion from medical school, a $250,000 fine, a criminal conviction and 10 years in prison.

Am I saying that it could never happen? No. However, someone doing this is making a potentially career ending and life-changing decision for very little gain. Even if you're talking about someone with a real incentive (a program director, for instance), the person still has very little personally at stake. So maybe you do poorly, get fired, and the other residents have to take extra call. Maybe it creates scheduling issues with work hour restrictions. Whatever. And to effectively screen this way would mean that he or she would be habitually doing this to all similar people, making him likely to get caught. People don't take these sorts of risk for that marginal a gain. I'm sure it has happened, but I'd be shocked if it wasn't totally anomalous.

I also think you totally underestimate how closely hospitals monitor EMR use (especially use of psychiatric records).

 

[sloop]

It can be life threatening for sure, I knew a guy through some friends who blew his own head off with a shotgun. I didn't know him that well; He literally just graduated high school at the time. People assumed it was because he was sent back home from the military could have been more than just that though. (Think he had an injury?) But he seemed pretty down about it apparently. That's a bit extreme right there.

But he/she will need to figure out if its that serious. I knew people who were depressed cause they couldn't find a job for a while but they got over it. Sometimes we can figure things out ourselves and sometimes we can't. So if he/she is 100% sure its that bad to the point where they know that the depression will never go away then yeah you should go talk to a PCP. I guess since they're posting on the forums it might be pretty bad self-unfixable depression that needs to be treated properly.

Dude, what?

OP doesn't need to fix this on his own. He has access to people who can help him with this. I'm unsure why you are suggesting he not go to a doctor.

I'm sure there are some (small number of) people with venous ulcers who could passably heal themselves with good wound dressing, elevation, etc. That doesn't mean they shouldn't see their vascular surgeon.

OP, go see your PCP or a psychiatrist. Don't listen to this dude who is telling you to try to treat yourself.

 

[Zebra Hunter]

Secrecy is important because there is still huge stigma associated with mental illness in healthcare. Many peers, attendings, and the school itself can be quite sympathetic. However, residency is cutthroat. It is difficult, competitive, and there is a TON at stake not just for the applicant but the program as well.

It is no exaggeration to say that residency programs, if not outright overtly but subconsciously, may very well pass up on an applicant if they knew ahead of time they suffered from any sort of mental illness. Honestly, the last thing they want to deal with is a potential "problem" resident or any sort of issue that might affect productivity or performance.

Academic medicine is a much smaller world than most realize. Doctors love to gossip as much as any human. If they are not your treating provider, they are not bound by HIPAA in discussing colleagues' health.

Yes, the EHR is confidential. However, think about this. What is really stopping the guy/gal in your class that hates you / obsessed with you / even just a busy body curious about you from clicking on your chart and reading it? The fact they could be caught and get in trouble? Think this through a little more. How would that happen?

The EHR records all the instances of chart access, but who is going to police or enforce those policies about unauthorized access? Most institutions will tell you there is too much going on for every chart access to be scrutinized to assess if _____ who accessed _____'s chart really had business doing so. What most places do is *random* monitoring, meaning that the access history of a small number of charts is looked at to check for odd patterns of access, or a small number of employees are selected at random and their access history looked at. Potentially this is done not randomly for the charts of very famous people or VIPs to the hospital.

The other way that EHR access is addressed is if a particular patient brings a complaint. The threshold for what sort of complaint will trigger an investigation can vary. An attorney threatening to sue for HIPAA more likely to get someone to really look. Perhaps saying "did anyone who wasn't supposed to access my chart?" might not glean much action. If there is someone in particular that you suspect accessed your chart without your permission that is much easier to track. But you would have to have suspicion to name someone in that case. Either way, you will be asked why you wanting to know before they are going to look.

Say they do pull up the list of all those who "broke the glass" of your chart and see that on that list is a classmate who did not have business in your chart otherwise (it's an investigation because everyone on that list they will have to cross reference clinic schedules and contact to suss out if they had business in your chart). Say no attorney is involved and you have not threatened to sue. Some institutions the EHR only tracks who accessed what chart, but does not specify to where they navigated. Other systems are more sophisticated. In any case, just clicking into many charts you can see a problem list. Depending on what personal history the person accessing has with you, and what their professional track record is, your institution's culture, and how much noise you are making (attorney or no), could they potentially pass off a lie about making a mistake and stumbling into your chart on accident? Maybe. Maybe not.

However, catching whoever cat-of-bagged your personal medical issues to the rest of the med school class-->admin-->residency programs does not undo any damage that may have come from it. Keep in mind as I said it is essentially just *fear* of the above that keeps people out of charts they're not supposed to be in in the first place. Unlikely to be caught vs dire consequences for being caught frequently is not enough to deter behavior or unauthorized access.

I can think of a number of ways for a colleague to have business being in your chart without being your provider that *could* happen, and heck, even if you're just on the clinic schedule for depression could the wrong person look over at someone else's computer and catch your name there?

Even if none of the above happened, if you get your care at your institution, than some people who work at your institution automatically have business being in your chart at least in the process of providing direct care. Say they only tell one friend about you, and the friend tells 2 people and then chain reaction. How to catch them for gossiping to a colleague about you? Only if someone came forward that they heard it from that one individual (in the course of even one office visit there are enough employees accessing your chart to make it nearly impossible to say the leak is one given individual without someone fingering them).

I got a lot of my care for issues not related to mental health at my institution. My mental illness was listed on my problem list, but no psych notes were in the computer for anyone feeling curious to read.

The world, especially the electronic world, is a lot smaller than you might think.

I get that you're trying to help, but it is info like this that makes people like OP think they should not seek a psychiatric evaluation and perpetuates this idea that there is a stigma towards mental health in medicine. Your colleagues are not going to be trying to look up one another to see if by some off chance they can find that you were diagnosed with depression. Most people don't give 2 s**ts that you are seeing a psychiatrist to manage your depression. Barring significant impairment of your duties as a physician, you don't have much to worry about from a licensing perspective.

 

[Crayola227]

I get that you're trying to help, but it is info like this that makes people like OP think they should not seek a psychiatric evaluation and perpetuates this idea that there is a stigma towards mental health in medicine. Your colleagues are not going to be trying to look up one another to see if by some off chance they can find that you were diagnosed with depression. Most people don't give 2 s**ts that you are seeing a psychiatrist to manage your depression. Barring significant impairment of your duties as a physician, you don't have much to worry about from a licensing perspective.

There is real stigma out there. There are real consequences. I'm not advocating not getting treatment. I do advocate getting discreet treatment and carefully considering any work-related person's knowing of this about you. I advocate confidentiality, privacy, and strategies to keep this from affecting your work, whether that's preventing this from affecting your performance OR affecting how people see you.

Plenty of horror stories out there. Google Dr. Pamela Wible and if you read her medscape articles, check out the comments section.

I'm talking about being a student that is depressed and this somehow becoming common knowledge about you pre-match. There are plenty of programs that would just pass on you before the match. There are programs that might put you under the microscope if they found out after the fact. Ditto for medical licensing boards.

 

[Crayola227]

@Crayola227,

What do you recommend for keeping things quiet if you've already been treated (a few years ago, including therapy/psych notes) at the institution where you will be attending medical school?

A couple of strategies, if the diagnoses are no longer "active problems" you can ask that they be removed from your active problem list. If you have moved care over from this institution to another provider you can ask the new provider to request that this be done. If the conditions are controlled/resolved the argument that it is appropriate to only list it in past medical history is a valid one especially if it's being made by someone who had taken over your care and it's not just you. Even if you still take meds if your condition is controlled the argument can be made it does not belong in the active problems list. It's not really up to a provider to leave things off your Past Medical History, however, the active problem list is up for judgement. My opinion is because to me there is a difference between having a past medical history note of anxiety/depression vs having it on your active problem list.

I would ask the institution if there are extra safeguards in place for psych records, some places there will be an extra "break the glass" type step for psych notes. Some places might be able to archive those notes so that they don't appear in the EHR, or don't appear outside of the psych services' access.

You can contact the records department and see what safeguards are in place for employees/students for confidentiality.

 

[pre med 2014]

Lol at the comments about classmates/coworkers being able to see your records on EPIC, for one that is is probably illegal and even if they did come across it and then telling other classmates about it would demonstrate a severe lack of judgement considering it is probably a crime and at the least would get you into heaps of trouble with admin. Can you imagine another student telling you they saw another students records and telling you the details about it?

I'd see the person snooping around someone else's records and being stupid enough to tell others they were doing it in a much worse light than that other someone being treated for depression

Edit: not that I would see someone in any bad light for treatment of depression


Sent from my iPhone using SDN mobile

 

[Natu_]

Dude, what?

OP doesn't need to fix this on his own. He has access to people who can help him with this. I'm unsure why you are suggesting he not go to a doctor.

I'm sure there are some (small number of) people with venous ulcers who could passably heal themselves with good wound dressing, elevation, etc. That doesn't mean they shouldn't see their vascular surgeon.

OP, go see your PCP or a psychiatrist. Don't listen to this dude who is telling you to try to treat yourself.

Dude take a chill pill maybe you need to go see a doctor...
(Maybe a Psychiatrist.. You sound like you're about to explode. I'd like to know what kind of testosterone supplements you're taking? You must have had a pretty good leg day, or a solid deadlift.)

Anyways all I was saying was he/she needs to figure out if they're just seriously "depressed" or if they have actual depression. And you said I didn't suggest for him to go see a doctor yes I did because I clearly said this. "So if he/she is 100% sure its that bad to the point where they know that the depression will never go away then yeah you should go talk to a PCP." Meaning if he/she knows for a fact they have legitimate depression then they should go to a PCP. But they probably do as I said if they're posting on the forums. I did not say that he/she shouldn't go see a PCP. I was saying he/she can probably figure out for him/herself if its just a phase in his/her life or something serious. We don't know anything about this persons life but he/she knows if they've been depressed for a while to know if something is clearly wrong. Therefore if he/she knows its serious then yes they should definitely go to the PCP. You can go to the PCP even if you know you don't have legitimate depression. The choice is his or hers to make at this point.

Should they go to the PCP regardless? Yes