How important is a psychological evaluation for appeal?

[Smiths11]

I failed too many courses, was dismissed, sent in an appeal letter, and am facing the appeal committee in a hearing to (hopefully) reverse the decision for dismissal. The reason I failed, and gave to them, was because I was depressed for a significant part of the semester due to a personal reason. I have heard from people that I should visit a psychologist and have them write a letter for me, indicating my current condition and if necessary, a treatment plan, to show the committee. I have an appointment for tomorrow actually, but I want to make sure that it really will help. The reason I am hesitating is because I don't have health insurance, and the one visit will cost me $150 :/. As many of you I am poor and broke so I have to be really careful with my expenses. I have applied for Obamacare but haven't gotten approved yet. So I can wait it out till after the appeal hearing until the insurance is improved, but if you guys think it's very important I'll just go through with the appointment tomorrow and have my letter in time for the hearing.

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[SouthernSurgeon]

I failed too many courses, was dismissed, sent in an appeal letter, and am facing the appeal committee in a hearing to (hopefully) reverse the decision for dismissal. The reason I failed, and gave to them, was because I was depressed for a significant part of the semester due to a personal reason. I have heard from people that I should visit a psychologist and have them write a letter for me, indicating my current condition and if necessary, a treatment plan, to show the committee. I have an appointment for tomorrow actually, but I want to make sure that it really will help. The reason I am hesitating is because I don't have health insurance, and the one visit will cost me $150 :/. As many of you I am poor and broke so I have to be really careful with my expenses. I have applied for Obamacare but haven't gotten approved yet. So I can wait it out till after the appeal hearing until the insurance is improved, but if you guys think it's very important I'll just go through with the appointment tomorrow and have my letter in time for the hearing.

If the basis for your appeal is psychiatric illness, I would say having corroboration of that from a physician, and more importantly, a well thought out treatment plan and plan for maintaining your mental health during the academic year, is pretty damn important.

Unfortunately, if you are just now going to see a psychologist tomorrow, this doesn't exact make a convincing argument to your school...

 

[Smiths11]

Thanks for your reply. I was dealing with depression but it wasn't so bad that I felt I needed a doctor. I ended up getting better on my own with family and friend support. At the time I never thought this day would come and never thought that a psychology visit would be helpful not to get dismissed.

Any other opinions?

 

[SouthernSurgeon]

Thanks for your reply. I was dealing with depression but it wasn't so bad that I felt I needed a doctor. I ended up getting better on my own with family and friend support. At the time I never thought this day would come and never thought that a psychology visit would be helpful not to get dismissed.

Any other opinions?

Well frankly, if your depression was so bad that it led to you failing out of med school, then yes, it was that bad. And a lack of insight and just saying "I got better" is not going to convince the school that you have taken the necessary steps to succeed.

I'm not trying to be harsh. But you're in a bad spot, and the only shot you have is to (a) show some serious introspection and (b) show a clear plan of how you will change your approach and succeed in the future. You can't walk into this appeal meeting and expect them to just welcome you with open arms.

 

[Winged Scapula]

My opinion is the same as southernIM's.

You state that you were dismissed from medical school for multiple failures. You further state that the reason for the failures was depression. However, for some reason, you don't think that qualifies as "serious enough" to see a physician. When one is depressed enough that it impacts their daily activities in a negative fashion, it is by definition, "serious".

As southernIM implies, the very fact that you've delayed seeking treatment not only looks like you're only doing it to appease the appeal committee but it also appears that you lack any insight into your disease and your current predicament.

My residency program required any one on academic or personal leave due to psychiatric reasons see a mental health worker to be released back to work. I would not be surprised if your medical school had a similar policy. They need some sort of assurance that the problem which caused the academic difficulties is being treated and that you can move forward successfully. Since it is clear that most of us, including you, are not the best judge of our own abilities, having a non-biased professional give input on your status.

Finally, you may find that if you have been approved for ACA coverage, you will be reimbursed your out of pocket expenses for the visit.

 

[Smiths11]

Well frankly, if your depression was so bad that it led to you failing out of med school, then yes, it was that bad. And a lack of insight and just saying "I got better" is not going to convince the school that you have taken the necessary steps to succeed.

I'm not trying to be harsh. But you're in a bad spot, and the only shot you have is to (a) show some serious introspection and (b) show a clear plan of how you will change your approach and succeed in the future. You can't walk into this appeal meeting and expect them to just welcome you with open arms.

Well, I can't talk about specifics, but the trigger of my depression is gone. It was a one off event. I wasn't depressed because of the workload of medical school, or anything else permanent in my life. In my appeal letter and hearing I will clearly outline everything that happened and how the root cause was removed.

 

[Smiths11]

One concern I have, and if someone can enlighten me on this, is that if I am diagnosed and I share this information with the school, can they forward it to residency and rotation directors? Will I be disadvantaged somehow because I am seen as a liability in the medical community? Will I have to admit that I have a "history of depression" whenever I apply for jobs, etc.?

 

[dl2dp2]

Well, I can't talk about specifics, but the trigger of my depression is gone. It was a one off event. I wasn't depressed because of the workload of medical school, or anything else permanent in my life. In my appeal letter and hearing I will clearly outline everything that happened and how the root cause was removed.

This is much more serious than you think. If you really do have depression, the episode per se isn't caused by simply an external trigger, no matter what it is. The fact that you did not get treatment during your academic deterioration is problematic. Generally schools do not allow students to fail multiple courses before the remediation process occurs. Even if the root cause was removed, there's no guarantee that you will not relapse to another episode of depression--in fact, statistically it's the rule rather than the exception. I'm surprised that as a medical student you have very little understanding of psychiatric illnesses, which should be part of the curriculum.

Furthermore, the fact that you've failed multiple course WILL most certainly be a factor during the residency application process, should your appeal be successful (which, at best, I'll give you a 50/50 shot based on what you said.) Right now is not the time to save $150. Compared to medical school loans a thorough evaluation by a qualified psychiatrist is CHEAP.

 

[Winged Scapula]

1) As others have noted, the problem is not that you were depressed and failed some examinations.

The problem is that as a future medical professional, you are expected to recognize a problem or if it is presented to you, get and accept treatment. By your own admission, you were depressed and it caused failure of multiple examinations. However, you did not seek treatment and seem to be resistant to it. THAT is more important than the "root cause" of your depression. THAT is what the appeals board will look at.

Even if the root cause is gone and you are back to baseline, it helps bolster your case that you should be readmitted and allowed to graduate to seek professional help. IMHO this is no different than the student who gets a DUI and goes to alcohol counseling; they may not be an alcoholic but they clearly have a problem and have to prove they are seeking help for it.

2) If you disclose to your school that you were depressed and that caused the exam failures, they may very well disclose that to residency programs. However, you are required to disclose any disruption in your medical education; thus your dismissal will be a matter of public record and yes, you will be required to disclose that on residency applications. It may also be part of a medical license application.

If you have had treatment for a mental illness, some states ask that you disclose that within X number of years. Others only ask if you are currently being treated, have been treated within 5 years or have a problem which affects your ability to practice medicine. Every state license application, every employment application is different.

What I am sensing is that its not the $150 that bothers you as much as being "labeled" as depressed, or mentally ill. The medical community tends to be much more sensitive to these issues (given the high rate of depression amongst physicians) and is much more likely to cut you some slack than as some student who was dismissed for academic reasons and didn't get help for it.

 

[SouthernSurgeon]

Well, I can't talk about specifics, but the trigger of my depression is gone. It was a one off event. I wasn't depressed because of the workload of medical school, or anything else permanent in my life. In my appeal letter and hearing I will clearly outline everything that happened and how the root cause was removed.

One concern I have, and if someone can enlighten me on this, is that if I am diagnosed and I share this information with the school, can they forward it to residency and rotation directors? Will I be disadvantaged somehow because I am seen as a liability in the medical community? Will I have to admit that I have a "history of depression" whenever I apply for jobs, etc.?

I don't have a whole lot more to add, except for my strong agreeance with the posts by WS and sluox.

Just saying that the "trigger" for your depression is gone so you are A-OK is ridiculously naive, especially for a future medical professional. It's a huge problem that you let your depression get to the point that you failed multiple courses without seeking help, and as WS said, that portends very poorly when it comes to trying to predict your future behavior under pressure.

Additionally, as WS said, if you are stating that mental illness was a/the major contributor to your academic struggles, the fact that you haven't sought treatment yet may end up being a complete non-starter with the appeals committee. As she said, we had similar rules in place in our residency - one of my co-residents a few years ago had to take some time off due to mental illness and the program required a letter from their psychiatrist clearing them for return to full clinical duty.

And, worrying about what will be on your residency applications is putting the cart before the horse. Right now, you are no longer a medical student. This appeal is your last chance. It doesn't particularly matter at this point what PD's might think, if you can't get back into medical school. All of your posts seem to lack an understanding of how serious this situation is. If you come to this appeals meeting with the same level of insight you are demonstrating here, I'd say a 50/50 shot of readmission is very optimistic.

 

[pdxhopeful]

I'm very sympathetic to your struggles - one of the worst things about depression is how it can affect your cognition and initiative to deal with it constructively, and that's something a lot of people don't 'get'.

Unfortunately, my sympathy is largely meaningless. As others have said, your best shot - and it's no guarantee - is to show you've recognized you need help and have a plan in place should you face this again. Seeing a psychologist is an important step on that, and may help with some of the lack of insight others have noted.

 

[HelpPleaseMD]

^ 100% agree.

 

[JGimpel]

You will need one trip to a psychiatrist for a full eval, with follow up visits to track your progress on new meds or therapy twice a month for a while, then once a while to establish something that shows you able to handle the situation you failed out of again with a much better probability of getting through.

You will need to be evaluated by a learning disability specialist, every major University either has one on staff or can refer you to one, for a full evaluation and report.

When ready, you should take classes at the undergraduate level that have subject matter very close to the subjects you did the worst in while in medical school and do everything you can to get an A and a letter of recommendation from the professor.

Plan on living at home and having a part-time job, possibly work-study through your school while all of this is going on as the above as it will cost a few thousand to do this right. Many, many students/residents have gone through the same situation you have, so you can do this, just look at the additional time and money spent as an investment to recoup the money you've already spent.

This stuff works.

I wish you the best of luck.

 

[Akali]

Thanks for your reply. I was dealing with depression but it wasn't so bad that I felt I needed a doctor. I ended up getting better on my own with family and friend support. At the time I never thought this day would come and never thought that a psychology visit would be helpful not to get dismissed.

Any other opinions?

So you're saying the depression wasn't that bad, but you're also saying that it's the reason you failed multiple courses? That really doesn't sound legitimate at all to me then as even anywhere near a decent basis for a repeal of dismissal. But obviously you aren't going to share with the committee that your depression wasn't really that bad...

Anyways, my 2 cents: Your life is on the line. I assume you're already thousands of dollars in debt? Might as well blow the $150, most definitely if it is the basis of your appeal.

 

[Smiths11]

Thanks for all your replies.

Here is an update:

I did visit the psych, and did get an evaluation. That's the good news.

The bad news is I had my appeal meeting, and my gut feeling is that my appeal is not going to go through. I am trying to meet with the dean to try to plea with him in person (he was not a part of the appeal committee). The problem is that it seems like the dean doesn't want to meet with me. I've been trying to schedule a meeting for weeks with his secretary but I'm getting a generic response saying "the appeals process is outlined in the handbook".

Why won't the dean meet with me? Is this normal?

 

[SouthernSurgeon]

Why won't the dean meet with me? Is this normal?

Presumably because he has no obligation to do so, and doesn't want to circumvent/go outside of the normal appeals process.

 

[Raryn]

Why won't the dean meet with me? Is this normal?

Because the appeals process is outlined in the handbook. It's there for a reason, and he isn't going to circumvent it.

 

[Lovely Bones]

I am sorry to hear you are going through this. I also had a difficult time in medical school due to depression and, though I never failed anything, I almost got kicked out of school when I tried to take a year off to address my depression. I, too, tried to meet with the dean who refused to meet with me even when I was in tears in front of his office. The day before I graduated, I went to student affairs and told them how unhelpful they (and the dean) had been during such a difficult time for me. At graduation, he mysteriously appeared in front of me and shook my hand. It was really weird.

My depression carried over into residency, and after my intern year I attempted suicide. Flash forward several years... I am ok and I am practicing... but I am in disbelief of the stigma attached to physicians with depression in the medical field. Specifically, the field of psychiatry, which is what my residency was in.

You, my friend, are living the nightmare. It is difficult to think clearly when trying to manage everything going on in the life of a medical student/resident against very serious personal and/or medical issues.

Your school may not let you back in, but that is ok. All is not lost. Try to pull things together for yourself, get the help you obviously need, and look to the Caribbean if you still want to pursue a medical degree. You will definitely have to answer for this for the next several years of your medical education (in terms of residency and licensure), so you need to seek help and follow advice and a therapy plan. If you really want to pursue your career.

But, with that said, if I pulled through... you can too. Hang in there.