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interview disclosure, how much is too much??

Discussion in 'Psychiatry' started by markglt, Dec 20, 2008.

  1. markglt

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    I had a friend who, when asked "why psychiatry" during an interview, disclosed that one of the big reasons that she wanted to go into psychiatry was her mother's suicide, and her father's bipolar disorder, and that she wanted to dedicate her life to helping people with mental illness.

    I told my friend, that i thought that was too much information to disclose and might hurt her chances at that program.

    I'm just wondering what people think about disclosing personal information like that. Is it looked down upon, or was it okay for her to be that personal?
     
    #1 markglt, Dec 20, 2008
    Last edited: Apr 18, 2009
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  3. masterofmonkeys

    masterofmonkeys Angy Old Man
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    I'm an applicant myself, but if I were interviewing someone it would certainly make me put my guard up. I decided AGAINST PM&R precisely because I was too personally and emotionally involved with the area, but I know several individuals who've gone that route because of their personal experiences.

    In the end it just depends on how maturely they were in deciding on psychiatry based on personal experience. Are they going into it to 'save' other people the way they couldn't 'save' their mom and dad? Or did they simply come to appreciate how devastating mental illness could be to people and their families and decide it'd be a worthy cause.

    Using myself as an example, I chose NOT to go into PM&R because in the course of my own rehabilitation I have done some very nutty things. Until very very recently I was having to spend 10-20 hours in the gym, I'd put in full days with multiple subluxated ribs and raging radiculopathy. I even intentionally tore an intercostal muscle. When I've partially torn other muscles, I've worked around them without missing a day and started using those same muscles within 2-3 weeks again.

    I've got the results (and the scars) to prove it and every specialist I've seen has told me they'd never seen someone with my level of nerve damage and spinal pathology doing the kinds of things I was doing. All are on pain meds, and none are as active or have as much function as I do.

    For me, it was and continues to be a price worth paying and I can't even imagine choosing a different route. That said, it sucks, and what I do comes at a huge cost and remains a serious burden. That said, even though I'm a pretty psychologically mature guy and I realize objectively that my decision is not right for everyone, and that not everyone can be expected to push themselves the way I push myself, I doubt I'd have the ability to emotionally distance myself enough to NOT start screaming and yelling at what pansies my patients are because they won't make the sacrifices I do.

    How is she going to deal with a noncompliant bipolar patient with a family who is hospitalized for the umpteenth time having cheated on his wife and squandered the family savings because he wasn't willing to take his depakote? Is she going to bring her anger with her own father to the table when she meets with this patient?

    How is she going to react if a patient with children of her own gets admitted after a suicide attempt? Is she going to be able to approach the patient free of prejudice or will issues of abandonment surface? What if one of her patients actually does suicide? That's hard for anyone, but will she be able to handle that stress and still be an effective psychiatrist?

    On the other hand, I think it's great when someone comes to psychiatry with a full understanding of how devastating psychiatric illness can be for patients and their families and how helpful psychiatry can be in giving meaning to these patients' lives.

    It would all depend on how she approached the subject and what she verbalized regarding exactly how her experiences motivated her to go into psychiatry.

    It's hardly the kiss of death though.
     
  4. whopper

    whopper Former jolly good fellow
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    For the most part depends on the way its presented & the interviewer.

    Since there is no specific answer and the types of answers that can be given vary.....zenwise you want to show you got passion for the field, but also in a manner where you can demonstrate that you can keep your clinical objectivity.

    Its great to hear someone show their sincerity by mentioning personal experience with certain issues in mental health, but don't say something to the effect of, "I'll never commit a patient against their will because I was committed!", while bashing your fist into the desk.
     
    #3 whopper, Dec 20, 2008
    Last edited: Dec 20, 2008
  5. BobA

    BobA Member
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    First, I'll say that it's probably better to err on the side of only disclosing as much information as is socially appropriate. Talking about parent's suicide and bipolar disorder is probably going too far unless it's done with the utmost class and precision. Probably too risky, since after all this is a job interview.

    My question is why does mental illness cause everyone such shame?

    If one were applying for peds heme/onc and talked about their own childhood battle with ALL we'd cry tears of joy.

    It's sad, really, when even as psychiatrists we can't unburden ourselves of shame and stigma from mental illness.
     
  6. Abram Hoffer

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    This is an example of why a lot of other physicians do not take psychiatrists seriously. Red flags all over the place. Too much information. Essentially, she told them that she received a double dose. And she thinks this will make her an ideal resident. The sad thing is... this may help land her a job at their program.
     
  7. erg923

    erg923 Regional Clinical Officer, Cenpatico National
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    Abram:
    Why is it "sad" that this experience has inspired the applicant. This seems like a natural part of the human experience to me. Hopefully, she is not going in to psych to "fix" herself, or her past, but denying that events(including tragedies) will influence our drives in life seems quite naive. Why would psych be immune? Im not sure any other specialty is.
     
  8. silas2642

    silas2642 silas2642
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    Why is it sad that she answered this way? I probably wouldn't have said this at my interview because people like you tend to have such stigma against people with a history of mental illness, but it certainly isn't "sad" for her that she was willing to share her personal reasons for entering the field of psychiatry no more than someone wanting to enter oncology due to losing a loved one to cancer or wanting to specialize in cardiology because he/she lost a mother to an MI.

    Who said that this person thinks that his/her family history of mental illness is going to make them an ideal resident? Their interviewer asked them a question and instead of giving the generic, "I'm interested in the brain and talking to people..." answer she gave an honest answer. I would consider think that takes some form of guts.

    Physicians can have skeletons in their closets, too.
     
  9. nancysinatra

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    Already in this thread people are saying the applicant has a genetic predisposition to these illnesses AND implied we know something, possibly, about HER history. For all we know, Abram, she could have been adopted. Maybe she watched the events that happened to her parents in horror from a cool distance and later decided to become a psychiatrist out of detached intellectual interest. I'm just saying, your smug little summary is just speculation. This applicant was asked a question during an interview, and apparently answered it. We do not know enough to make any judgments other than that!

    I agree it's always best to err on the side of social appropriatness. I would imagine that's true in all fields. If you go to your pathology interview and brag about much you LOVE the morgue, how you grew up hanging out in the morgue with your dad and your uncles who were all autopsy assistants, that would sound wierd too. I met a guy at my church once who talked like that. It was totally weird and I would not advise it as a strategy.
     
  10. Abram Hoffer

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    The brief background info coupled with my experience suggest that she was not adopted. This isn't a slight. I have seen far too many in the field doing more harm than good due to their desire to decrease the suffering of others who have had to endure. Unfortunately, this is often an unconscious attempt at self-understanding and does not bode well for the legitimacy of the field--which has recently made tremendous strides.
     
  11. Doc Samson

    Doc Samson gamma irradiated
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    Fair enough, but as has been previously noted, context is everything. What if the applicant is making a conscious decision based on thorough exploration and self-awareness?
     
  12. Abram Hoffer

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    Perhaps I simply view this issue differently: to me, it is a comparison of apples and oranges. Emotion and cognition are very different entities. If, for example, your beloved (fill in the blank) came in as a trauma, under your care, it would be difficult to remained poised emotionally; one step further, it may even compromise your ability to provide the utmost in care. This is not to say that a psychiatrist who has had emotional issues in the past (or even present) can never be therapeutically effective; it is in the fact that one chose the field due to the emotional chaos endured that makes me believe that they are not in a position to remain emotionally unbiased and remain within appropriate boundaries.
     
  13. Abram Hoffer

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    In this case, it is a different issue. But, within the parameters of appropriateness (ERAS rules), it would be difficult to weed out whether or not the person is emotionally sound. I'd rather not argue the issue of whether or not someone who has a family history of emotional problems would make a competent psychiatrist as much as I would prefer to argue about appropriate disclosure during a psych residency interview. I think these are very different arguments. It has to be challenging for Psych Program Directors to choose candidates within the ERAS parameters.
     
  14. Doc Samson

    Doc Samson gamma irradiated
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    I agree, but again, it's all in the context. I've had applicants share essentially the same information about family history and had it come off as either incredibly naive and potentially dangerous or well-thought out and indicative of good insight. Disclosure is risky for the applicant, but it's not an automatic red flag.
     
  15. whopper

    whopper Former jolly good fellow
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    IMHO disclosure of mental illness should not be held against a candidate. It only shows our own hypocrisy--we treat people with mental illness & want them to get better, but at the same time we hold something against a candidate with mental illness?

    From my own experience, I would say the majority of programs have something against a candidate with mental illness. Not because I ever had an Axis I, but because a lot of programs think I did because I took a year off. Its as if taking a year off of medschool was a common theme programs encountered with candidates who had mental illness. They all brought it up as if I had something to hide.

    However, I do think that the candidate has to be competent, and the the candidate's mental illness can only go so far in defending the candidate from something on that person's transcript. If a candidate disclosed mental illness, but there was nothing on the transcript, letters of rec, etc showing the candidate would be a poor resident, I dont' think I'd have any reason to hold it against the candidate. If the candidate does mention personal dealings with mental illness, in a manner that shows they cannot be objective in treating patients, I would consider that too, more likely against that person getting in.
     
  16. silas2642

    silas2642 silas2642
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    I agree with Doc Samson-- context is everything. The candidate may be completely emotionally sound without any Axis I or II pathology-- she may have undergone psychotherapy to deal with what must have been a very traumatic background or may be a very resilient person. Her response may have been very well thought out and she may be totally aware of the possible consequences of be completely honest.

    I mean, what do you tell your patients when they're on the couch-- hide your pathology because you're going to be discriminated against? You're a second class citizen in the world, you're never going to be normal, viewed as normal, or function as well as others? Don't ever talk openly about your family's history of mental illness? If you guys can't even talk about this in your own field, what does that say about psychiatry/psychology?

    I know that you are worried about choosing residents that are going to be able to function effectively as physicians, but shouldn't red flags be present at the interview and in their folders? Don't you see warning signs in dean's letters, grades, and letters of recommendation? A person with a history of mental illness or a family hx of mental illness who can cut it in every other way should not be discriminated against no more than a person with any other disability.
     
    #15 silas2642, Dec 23, 2008
    Last edited: Dec 23, 2008
  17. nancysinatra

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    What if the applicant revealed that her parents had Axis II conditions, which aren't even agreed upon as far as DSM criteria, let alone genetics? Or god forbid, say they had somatoform disorders or were incorigible malingerers? And say the applicant revealed this in a socially appropriate way. Say, in fact, it was forced out of her peicemeal by intrusive interviewers asking one question after another about her parents' occupation and lifestyle. What if, instead of being empathetic towards her parents, she was--gasp--ashamed? Then what would you say, Abram? Too much information? And who's fault is that?

    What if the applicants' parents were in jail?

    I'm just asking because if you dig around long enough, you can probably find enough closet skeletons to disqualify everyone from psychiatry.

    So, if a surgeon "assumes" a patient has normal anatomy, based on "brief background information coupled" with his or her "experience," instead of some rare anatomic variation, and the patient dies or suffers injury as a result of this assumption, we would consider this GROSS GROSS GROSS malpractice. But in assessing a candidate for psychiatry residency, it's ok to just sort of play it by ear? THIS, I would argue--this playing it by ear and making assumptions about people without having any evidence--seems to me like a far scarier problem than some roving horde of psychiatrists who are motivated by an "unconscious attempt at self-understanding" which, if you are going to claim exists, you should provide some specific examples of, to enlighten those of reading your post who aren't as "experienced" and might not recognize them should we come across them unawares.
     
  18. Abram Hoffer

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    All of the emotion of this aside, I do not feel that an interview for a job is the place to disclose a highly stigmatized thing such as direct lineage of mental illness. Obviously, there is still a stigma, and to believe idealistically that it only exists outside of the profession is naive. Is it right, just, or fair? That's an entirely different argument. One's record does stand for itself, and if your track record is one that shows stability--shows up almost every single day on time, performs consistently, and plays well with others, then hands down, your genetic make-up is a non-issue. Unfortunately, there has to be a way to measure who has the best set of skills to do the job.
     
  19. michaelrack

    michaelrack All In at the wrong time
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    Except for the part about being a 2nd class citizen, that's pretty much what I tell my patients (who are applying for regular jobs, not residency positions). You shouldn't reveal psychiatric illness to an employer until you have the job, and even then it should only be revealed if you are asking for some type of accomodation under the ADA. This advice also applies to patients with narcolepsy and idiopathic hypersomnia.
     
  20. surftheiop

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    Would it be a different situation if someone interviewing for medschool/residency mentioned that seeing a friend go through depression in undergrad was what originally motivated me to consider the medical field?

    I always assumed this would part of my to the "why medicine" answer in an interview b/c I hadn't even considered medicine before then, but I don't want to take a chance of shooting myself in the foot it its bad to mention this sort of stuff.
     
  21. whopper

    whopper Former jolly good fellow
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    Its not like the program's going to spend dozens of hours trying to understand everyone. The applicants they interview will be in the dozens, filtered from hundreds to thousands of applicants.

    Even when its filtered down to that level, the program may still not have the time to put the level of scrutiny for something that may sound like such an incredibly shocking red flag, when there's several others who may not have those red flags.

    My point is that there are of course some very strange things any of us may have in our past that may enhance our ability to be good psychiatrists, but it has to be something the program's going to be able to understand in the limited means & time you have to sell yourself to them.

    I do think that some programs will be open minded, & take the time, but I don't think it'd be most of those places.
     
  22. michaelrack

    michaelrack All In at the wrong time
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    1. for a med school interview, it's dangerous to say you want to be a psychiatrist

    2. If you do decide to say that watching a friend/family member go through an illness led you to consider medicine as a career, you better have confirmed that interest with medical volunteer or other medical experience.
     
  23. surftheiop

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    1. I wasn't going to say i neccesarily wanted to do psych (I figure how can you really know till you do rotations) , just if they ask how I became interested that would be the start of my responce (b/c that was the start of my interest.

    2. Yeah I definately plan on volunteering, I dont want to go to med school unless im sure its for me. Im a sophmore now so Im going to do a little shadowing at the end of christmas break then I plan on volunteering at hospital during summer. Might try to do stuff at nursing home during school semester to get another perspective.
     

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