How bad is a medical leave of absence for a psychosis?

[spoonuser]

I searched and couldn't find a thread addressing this topic: medical leave of absence due to having a psychosis. I was a first year medical student in the second semester, generally passing everything, when I had an acute psychosis. I ended up in the hospital for a few weeks and was put on a leave of absence by the school. I missed too much to make up so if I return to school I will be joining the next class of medical students and repeating the entire first year. How bad is this going to affect me for residency applications? I am afraid that it will be a major red flag and I won't be able to match due to me not being able to explain this leave in an acceptable way. For example I can't prove that I will never have another psychosis during residency. I would like to just say that I had a medical leave of absence because I got sick without saying specifically what it was but I don't think that's acceptable.

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[Goro]

Might be more of a problem for licensing.

 

[mrbreakfast]

Agree that residency is probably going to be less of an issue than licensing will. You need to talk to someone in your program about the specifics of your case in detail, because may well already be barred from practicing medicine in some states, and the remainder of states will need a strong argument to convince them it won't happen again.

It sucks, but you need realistic now, because you can't hide or minimize this, and unfortunately in some places, even one time is once too many.

 

[Redpancreas]

OP this is a sad case.

1.) I suggest asking your psychiatrist what your best path forward is. Develop a close relationship with them to advocate for you in the future. Try to establish some continuity. They can be someone who can put pen to paper on your behalf and mention your compliance with medications, etc. This will be important when it comes to medical licensing. If the medical board does an investigation, they may talk to your psychiatrist. You will likely hire a lawyer. I think you’ll win the day ultimately with your compliance and if you are resilient in the face of this challenge.

2.) Medical education and practice is stressful. There is a chance this could happen again. In a way, see life’s mercy in this in that you learnt this prior to picking a specialty. You learnt you will not handle sleepless nights and stress well. Tailor your specialty choice to these limitations. I recommend primary care internal medicine tracks, family medicine, radiology, pathology, and a few others I’m missing.

3.) In terms of residency programs, get a lawyer to confirm this if need be, but I don’t see any need for you to expand on the psychosis aspect on residency applications. Keep it strictly confidential and say it was a medical issue which is under control with treatment. Will some read through the lines and figure you may have some form of mental illness? Yes. But people see all sorts of flavors of people who have had a setback and you will be assessed on your response to that setback more so than the setback.

 

[spoonuser]

Thanks for the replies, I didn't realize the licensing was going to be an issue too. I guess it is what it is. Maybe I should do something else other than go back to medical school.

 

[ACSurgeon]

Thanks for the replies, I didn't realize the licensing was going to be an issue too. I guess it is what it is. Maybe I should do something else other than go back to medical school.

I would choose something less stressful. Your health is way to important. Medicine is way to harsh of a career and the constant stress isn’t worth it. Best of luck OP

 

[Redpancreas]

Thanks for the replies, I didn't realize the licensing was going to be an issue too. I guess it is what it is. Maybe I should do something else other than go back to medical school.

OP I made the last post with the assumption you were hellbent on practicing. If you can tolerate changing fields, then absolutely do it and don't look back!

 

[texan2016]

State licensing boards have 3 tiers regarding mental health histories:
1. Some states will ask about "current issues" that could affect medical care. In which case if adequately treated and it won't affect you, you can legally say no (although since this is an internet forum i would double check with a lawyer).
2. Some states ask about medical issues for the past 5 years
3. Some states ask about all previous medical issues

you can download their applications online usually and see which states you would want to avoid in the future. Not to say that the state will reject you if you do have that history, but it may just be easier to avoid certain more strict states.

The idea behind making state applications more lenient is about student safety. They want students to get the help they need without feeling like it will affect their future career.

 

[Lem0nz]

Thanks for the replies, I didn't realize the licensing was going to be an issue too. I guess it is what it is. Maybe I should do something else other than go back to medical school.

I think you should talk to the support staff at your school before you decide anything. As the previous poster has pointed out this is not necessarily a death sentence but it needs to be navigated by experienced advisors (your school). If a raging alcoholic can recover and practice medicine, this doesn’t seem impossible. You’d need a psychiatrist, some compliance (you should have and want those things anyway), and to set realistic goals.

I would genuinely be interested to hear what they tell you if you’d be willing to share too, as would others who may advise future students. This is just a very unusual occurrence. Please don’t feel obligated though, and no matter what you do, good luck friend.

 

[watchfulwaiting1957]

I searched and couldn't find a thread addressing this topic: medical leave of absence due to having a psychosis. I was a first year medical student in the second semester, generally passing everything, when I had an acute psychosis. I ended up in the hospital for a few weeks and was put on a leave of absence by the school. I missed too much to make up so if I return to school I will be joining the next class of medical students and repeating the entire first year. How bad is this going to affect me for residency applications? I am afraid that it will be a major red flag and I won't be able to match due to me not being able to explain this leave in an acceptable way. For example I can't prove that I will never have another psychosis during residency. I would like to just say that I had a medical leave of absence because I got sick without saying specifically what it was but I don't think that's acceptable.

"I am afraid that it will be a major red flag" I don't think it will be a major red flag, in fact I am pretty sure you will have little problem getting residency and licensed (assuming everything else is in good shape). You are not the only or first person to have mental health problems in medical school! Unfortunately they are not uncommon in the medical profession. I think you should be open and honest with the licensing committee while still trying to reframe the situation in a neutral light.

One needs to be mentally stable before they can consider helping others in the community with their health related issues.

 

[DJKitty]

I think it also depends on what type of psychosis you experienced. If this was substance-induced, brief psychotic episode or major depressive disorder with psychotic features that have a considerably better prognosis, then it may be easier. If this was due to diagnoses with worse prognoses such as schizophrenia, schizoaffective disorder, or bipolar disorder with psychotic features, you may have more difficulty.

Also, unfortunately, state boards can ask any type of question that they want about mental health and often time they are not in line with the Americans with Disabilities Act. I recommend that anyone interested read Jones JTR, North CS, Vogel-Scibilia S, et al. Medical licensure questions about mental illness and compliance with the Americans with Disabilities Act. JAAPL. December 2018; 46(4):458-471.
DOI: https://doi.org/10.29158/JAAPL.003789-18

 

[Detailsmatter]

Agree with others who have said to speak with your school. While maybe not discussed on these forums, you are definitely not the first medical student to have their first psychosis in med school and probably not even at your own school. Hopefully your school will be able to give some guidance on past students either at your own school or other schools (im sure admin talk about these issues amongst themselves) that have been through this and how licensing/residency ended up shaking out for them. I'm sorry youre going through this and I hope it all ends up working out

 

[sloop]

I do think I that it might be better to simply say that you had to take a leave of absence to address a medical problem that is now resolved.

While not to say that some state medical boards won’t give you trouble, I don’t think that I you should be disqualified from practice in many (if any) states. A resolved acute psychotic episode does not necessarily indicate that one has schizophrenia or another chronic psychiatric disorder.

The risk of recurrence of a psychotic episode beyond 36 months for an individual with a brief psychotic episode is between 0.3 to 0.54 depending on the specifics of the presentation [1]. In order to bar you from the practice of medicine, I would think there would have to be a good case that the disorder in question negatively impacts your ability to safely practice medicine. I think that this argument would be pretty specious for a discrete episode that has now resolved when half of patients will not have a future episode.

Source:

1. Fusar-Poli, P., Cappucciati, M., Bonoldi, I., Hui, L. M., Rutigliano, G., Stahl, D. R., Borgwardt, S., Politi, P., Mishara, A. L., Lawrie, S. M., Carpenter, W. T., Jr, & McGuire, P. K. (2016). Prognosis of Brief Psychotic Episodes: A Meta-analysis. JAMA psychiatry, 73(3), 211–220.

 

[calvinhobbes]

I would not worry about this until much later when you’re applying for a state license, otherwise you’re going to stress yourself out now. It’s nobody’s business why you took a medical leave / leave of absence. If you weren’t violent against anyone and are healthy now, just worry about finishing medical school and staying healthy. Your school also isn’t allowed to tell residency programs why you took a medical leave of absence, unless you want them to. Speak with your Dean and who writes the MSPE to double check. You’re def not the first, and not the last, to take a leave of absence for a “psych” issue — and it’s nobody’s beeswax what exactly happened. Clearly, if you’re able to come back, you’re in gooding standing with your school, so you’ll be okay “student affairs” wise. Just make to see your therapist/psychiatrist regularly to prove to the school (if they ask, which they will!) that you are in treatment. It will help you, and also help them (reassure them) that you’re doing well.

 

[Splenda88]

If OP psych condition is under control, I dont think he/she will have an issue to be licensed. I would advise OP to explore specialties that are not too stressful if he/she decides to move forward.