getting your license when you're a little crazy

[gringolet]

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So I'm a nontraditional premed student looking to apply to med school soon. (please don't eat me! I swear this is a relevant question!)

I've read the license application for nearly all the states. A lot of them ask about one's own mental faculties, etc. I have bipolar disorder. I have had it for 10 years. I've been stable for a long time. I take lithium and risperdone.

I'm interested in a bunch of specialties (psych, ER, anesthesia) but I thought maybe this group might be uniquely qualified to answer, either due to their own experience or having had patients or friends who have found themselves in this bind. I don't know if I'll have to lie. Please don't think of my question as premature--it seems silly to me to apply to medical school, get in, complete training, and find myself unable to get a license to practice if I can't answer the questions "appropriately." (whether that means honestly or not I have no idea)

I've been hospitalized for mania and mixed episodes both years ago. Some of the states ask if I've ever been treated, others ask in the last few years, others refer to the time I've been in medical school or residency. My home state (which I'll decline to mention specifically) is particularly explicit, stating that they want to know if I've been hospitalized or if I currently take medication for mental illness. Does anyone have any experience with how to answer the questions on the license application?

 

[Faebinder]

Before you ask about what medical specialties you should go into, finish med school first or get near the end at least. By then you might change your mind or be set on something. You are jumping too many steps ahead.

 

[OldPsychDoc]

So I'm a nontraditional premed student looking to apply to med school soon. (please don't eat me! I swear this is a relevant question!)

I've read the license application for nearly all the states. A lot of them ask about one's own mental faculties, etc. I have bipolar disorder. I have had it for 10 years. I've been stable for a long time. I take lithium and risperdone.

I'm interested in a bunch of specialties (psych, ER, anesthesia) but I thought maybe this group might be uniquely qualified to answer, either due to their own experience or having had patients or friends who have found themselves in this bind. I don't know if I'll have to lie. Please don't think of my question as premature--it seems silly to me to apply to medical school, get in, complete training, and find myself unable to get a license to practice if I can't answer the questions "appropriately." (whether that means honestly or not I have no idea)

I've been hospitalized for mania and mixed episodes both years ago. Some of the states ask if I've ever been treated, others ask in the last few years, others refer to the time I've been in medical school or residency. My home state (which I'll decline to mention specifically) is particularly explicit, stating that they want to know if I've been hospitalized or if I currently take medication for mental illness. Does anyone have any experience with how to answer the questions on the license application?

You TELL THE TRUTH, and be prepared for the follow up questions about your treatment compliacnce and stability. Not telling the truth (i.e. lying about your condition) WILL preclude you from getting a license!
You can still get your license--but they are looking for signs of impairment. Look into the Health Professionals Service Program for your state--most states have these as "support for regulated health care professionals whose ability to practice with reasonable skill and safety (the key phrase)may be impaired due to illness".

 

[fotolilith]

You TELL THE TRUTH, and be prepared for the follow up questions about your treatment compliacnce and stability. Not telling the truth (i.e. lying about your condition) WILL preclude you from getting a license!
You can still get your license--but they are looking for signs of impairment. Look into the Health Professionals Service Program for your state--most states have these as "support for regulated health care professionals whose ability to practice with reasonable skill and safety (the key phrase)may be impaired due to illness".

This is true, although remember there's still a stigma against mental illness and please don't "cross any boundaries while telling the truth." What I mean is that, be prepared to give evidence of how you've overcome this obstacle without sounding too crazy yourself. ;-) And be prepared to jump through several hoops if others doubt your competency. One of my friends ran into a lot of bureaucracy when she admitted on her medical license application that she'd been treated for a mental illness before. It took a lot of time and a lawyer to get her case heard.

On the second point about crossing boundaries, I'll leave you with this anecdote: from one of my interviews, there was another interviewee who just kinda made people uncomfortable. When she talked about why she was going into psych, she started talking about her own personal problems, as well as bashing her ex husband. Well, I was not surprised that this was her second round of interviews (the first time she went unmatched and was told she "needed more clinical experience," which I think was a pretty suspect answer. I really just think she makes people around her uncomfortable). I really don't think she got that she makes people so uncomfortable, which is a shame.

It's great to learn from your mistakes and become a stronger person, but your interviews may not be the time to air dirty laundry. You can say that you "know people who have been treated for mental illness, and you want to help people like that" and of course you should tell the truth if outright asked. But don't volunteer too many personal details at the start, because that can make your interviewers uncomfortable. We all know "it takes an apache to catch an apache" (meaning psychiatrists are crazy), but you want to present yourself as a little more together during your interviews and in your personal statement.

There's a fine line between allowing yourself to show some humility/ vulnerability in order to convey your passion for this career, but don't unload everything on an unsuspecting interviewer.

And yes, get through undergrad and med school first. It's a good thing you started treatment before med school - I know 2 people who had psychotic breaks while in school, and another med student who killed himself. Med school is tough, and it takes a lot of commitment to your treatment, as well as understanding yourself, in order to succeed there with a mental illness. Of course, it's not impossible.

 

[fotolilith]

So I'm a nontraditional premed student looking to apply to med school soon. (please don't eat me! I swear this is a if I can't answer the questions "appropriately." (whether that means honestly or not I have no idea)

I've been hospitalized for mania and mixed episodes both years ago. Some of the states ask if I've ever been treated, others ask in the last few years, others refer to the time I've been in medical school or residency. My home state (which I'll decline to mention specifically) is particularly explicit, stating that they want to know if I've been hospitalized or if I currently take medication for mental illness. Does anyone have any experience with how to answer the questions on the license application?

And I apologize for not answering this specifically, but I thought you should know that a friend of mine was penalized for answering this truthfully. She said she'd been hospitalized, and thus she had to go for a formal eval from a forensic psych "expert."

She didn't know that it was a ruse to make herself into a scapegoat for the state medical board's drive to make it *appear* as if they are doing something about impaired doctors. Another one of her classmates got his case all settled by just hiring a lawyer, and my friend eventually got it cleared up (6 months later, and she had to reapply for residency because her program didn't save her spot while she was dealing with the medical board). Although, if she had lied on her application, she might have gotten into official trouble (she wasn't in trouble for her admission, it's just that she had to wait several months to hear from the medical board. There was a suspicion that the state medical board just wanted her to be so fed up that she quit before they needed to officially give her a license).

So, moral of the story - tell the truth (with minimum details), then if you're harassed by the state medical board, hire a lawyer ASAP. The lawyer will be cheaper and do things fast than trying to take care of it yourself. Sorry, but it's part of the bias against mental illness than even medical boards have.

 

[OldPsychDoc]

Your points are valid on one level, but i would reiterate that the original question was "what to say on the license application", not "how much to put forth in the personal statement and interviews".
My rule of thumb is if you're unstable enough that something comes through in interviews, you're probably not stable enough to practice. Putting a good spin on a bad year in undergrad or needing to take a year off in med school is very different than lying on a legal document (your state license application) about a history of treatment for mental illness or chemical dependency.

This is true, although remember there's still a stigma against mental illness and please don't "cross any boundaries while telling the truth." What I mean is that, be prepared to give evidence of how you've overcome this obstacle without sounding too crazy yourself. ;-) And be prepared to jump through several hoops if others doubt your competency. One of my friends ran into a lot of bureaucracy when she admitted on her medical license application that she'd been treated for a mental illness before. It took a lot of time and a lawyer to get her case heard.

On the second point about crossing boundaries, I'll leave you with this anecdote: from one of my interviews, there was another interviewee who just kinda made people uncomfortable. When she talked about why she was going into psych, she started talking about her own personal problems, as well as bashing her ex husband. Well, I was not surprised that this was her second round of interviews (the first time she went unmatched and was told she "needed more clinical experience," which I think was a pretty suspect answer. I really just think she makes people around her uncomfortable). I really don't think she got that she makes people so uncomfortable, which is a shame.

It's great to learn from your mistakes and become a stronger person, but your interviews may not be the time to air dirty laundry. You can say that you "know people who have been treated for mental illness, and you want to help people like that" and of course you should tell the truth if outright asked. But don't volunteer too many personal details at the start, because that can make your interviewers uncomfortable. We all know "it takes an apache to catch an apache" (meaning psychiatrists are crazy), but you want to present yourself as a little more together during your interviews and in your personal statement.

There's a fine line between allowing yourself to show some humility/ vulnerability in order to convey your passion for this career, but don't unload everything on an unsuspecting interviewer.

And yes, get through undergrad and med school first. It's a good thing you started treatment before med school - I know 2 people who had psychotic breaks while in school, and another med student who killed himself. Med school is tough, and it takes a lot of commitment to your treatment, as well as understanding yourself, in order to succeed there with a mental illness. Of course, it's not impossible.

 

[fotolilith]

Your points are valid on one level, but i would reiterate that the original question was "what to say on the license application", not "how much to put forth in the personal statement and interviews".
My rule of thumb is if you're unstable enough that something comes through in interviews, you're probably not stable enough to practice. Putting a good spin on a bad year in undergrad or needing to take a year off in med school is very different than lying on a legal document (your state license application) about a history of treatment for mental illness or chemical dependency.

Yeah, I went back to answered the OP more specifically. However, I decided to leave up my original answer because he or she may not get to the point of applying for a license if they don't use some prudence in their interviews/ PS. 🙂

 

[nancysinatra]

I beg to differ with those who make this situation sound like it's a straighforward case of tell-the-truth or don't-tell-the-truth. Here are a few (granted obscure) examples of cases where it could be a gray area:

(and a note: this topic has come up before, and just reminded me of these questions I had--it's not this specific post that made me think of this, so I'm sorry if this seems way off topic)

But anyway:

What if the person has lyme disease? That COULD have psychiatric manifestations. Imagine the poor soul who's staring at the licensing form, who's already in lyme limbo, and now is wondering what to put down. They're probably TOTALLY fine mentally and ought to be entitled to privacy, but what would they DO in this situation? It's always POSSIBLE they'll have a psychiatric problem. Worse yet, your syphillitic person. They COULD become psychotic, just like someone with confirmed bipolar disorder. Do they owe it to the medical board to inform them of their syphillis?

Now, personally, I took asthma medications for awhile and they made me anxious! Ok, do I need to comment on THAT? What I'm trying to say is that how you define "mental" or "illness" really affects how you would answer that question. I know the wording on these questions is probably done in such a way as to make it somewhat specific. After all, they don't want people writing in saying, "I had a mental status change once when I underwent anesthesia. Please monitor me throughout my career!" But what I'm saying is that legal questions, like medical exams, have their sensitivity and specificity problems. They are not perfect either. Some people will get unfairly trapped! Others will fall through the cracks.

Seriously, these are loophole type questions, and I'm probably the only one who cares about such oddities, but where do I go to answer them? It seems like psychiatry is full of these weird ethical/practical situations.

And what about all the people who have been MISDIAGNOSED with a psychiatric illness? Would a person need to list each misdiagnosis on the license form? What if they went to three psychiatrists and got three different diagnoses? What if the diagnosis was made in childhood and never revisited? This seems a situation where being "honest" runs into the realm of being ridiculous. It also sounds like some of the medical boards will hound anyone they can catch, so it is important to be judicious!

My larger question in that respect is, how do misdiagnosed mental illnesses formally get expunged from a person's medical record? Is "misdiagnosis" ever officially recognized in the way that, say, a "mistaken charge" would be officially wiped off my Visa card? This is important, seeing as a person can be required to report material from their medical record for such purposes as licensure or other things.

I think I know what I would do in the OPs situation. I'd be honest, but I would FLOOD the form with useless information. I would include every tiny bit of information from my medical past, particularly psychological details from the distant past, such as learning disabilities. Details from vision exams, color vision exams, etc. The readers of the form would then get so bored, they would overlook the pertinent current information.

 

[nancysinatra]

Ok, so a person with lyme disease or syphillis would probably not be filling out a medical license application, now that I think about it. More likely they'd be in the hospital, or at the pharmacy, getting antibiotics.

This, among other reasons, is why I am not going into internal medicine. 😀

 

[OldPsychDoc]

When it comes to licensing, the bottom line is always: "Is your cognitive, communicative, or physical capability to engage in the practice of medicine or surgery with reasonable skill and safety impaired or limited in any way?" (Note this may be due to lupus, Lyme, Alzheimers, cardiovascular disease...whatever) and "Does your use of alcohol or chemical substance(s), including prescription medications, in any way impair or limit your ability to practice medicine with reasonable skill and safety?"

If your answer is in any way "Yes", then be prepared to justify what you are doing about it. Different states may have slightly different definitions of impairment and may want more or fewer specifics about how your limitations or impairments are being dealt with and/or monitored.

 

[nancysinatra]

I guess what I am getting at, in my roundabout way, is that this word "reasonable" seems VERY open to interpretation. When people are given the chance to interpret a word, they will do so in ways that vary across a spectrum ranging from honest-to-a-fault (i.e. ridiculous) to dishonest (i.e. lying).

From what I've seen during medical school, this trait applies to medical students no less than it applies to the general public. Therefore, why should it not apply to doctors filling out medical license applications? So then, to me it seems like the purpose of the forms would be better achieved if they consisted of checklists asking about certain disorders, which are not open to interpretation.

Another problem here is that you have state medical boards which may have to look busy, apparently. Those people whose "interpretation" leads them to be "honest to a fault" could be easy prey for a state medical board that may have missed an obvious case in a prior year. Wheras people whose "interpretation" lies on the other end of the spectrum get off scott free. Ironically, those people are probably not the ones you want practicing medicine.

I understand that these OUGHT to be issues of honesty and integrity. But as long as there are people who are on far ends of the curve as far as how they intepret questions about "reasonable" (and just in four years of medical school I can say I've seen it all!) AND as long as state medical boards are not ALSO held to equally high standards as far as fairness and compassion in their own conduct (and there was an article in a midwestern magazine a few years ago about this very issue), well, I mean, what's the use of using words like "reasonable?"

 

[Goran]

Would you have to disclose taking SSRI's for anxiety or depression?

Also, do these questions get asked on residency applications?

 

[OldPsychDoc]

Would you have to disclose taking SSRI's for anxiety or depression?

I repeat--if you can answer "NO" to the question, "Is your cognitive, communicative, or physical capability to engage in the practice of medicine or surgery with reasonable skill and safety impaired or limited in any way?", there is no reason to have to disclose your med list.

Also, do these questions get asked on residency applications?

No.

 

[gringolet]

Ok, thanks for everyone's input. I'm a non-traditional student, FWIW. My BA says I have some withdrawals for 'crazy' semesters but I'm framing that as "being diagnosed with an medical illness that has been managed."

I have heard mostly that I should not disclose because the state boards can prevent you from practicing. I'll bring the question up with my psychiatrist too. If I were to answer olddoc's question, the answer would be no, but this is not the question they ask on my home state's license application. They ask something like "Have you been treated for or are you currently in treatment for any type of mental illness?" Which to me seems like none of their business. I realize they're trying to weed out people who have no business practicing medicine, but I'm a high-functioning person! Even my bad days are better than some people's good days--which is kind of mind-boggling to me. In any case, thanks for the insight. I guess I'll just have to see how everything goes.