Licensing and mental health

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nonnyyy122018

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Got my question answered, thanks. See last post for takeaways.
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I wouldn't put yes. Your PD was not acting in the capacity of a treating physician when he said that and the question is "a treating physician ever told me that I have a condition that *if left untreated* could impair me in practicing medicine with reasonable safety and competency."

So unless a treating physician told you that, I would answer no and would sleep just fine at night.

Also, I want to say shame on State B for asking that.
 
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nonnyyy122018 said:
Reasonable. Indeed, the hilarious thing is that my actual treating MD never told me anything like that. I went to *her* to ask if she could refer me to an IOP.

But how do I then explain the FMLA, if asked? My PD does have to report that I took one, though I've yet to discuss with him how much he's able/obligated to divulge as to why.
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You should probably consult an attorney. I don't want to give you advice that could get you in trouble. Suffice it to say, this licensing thing is a huge concern for me as a psychiatrist and I'd be tempted to answer that you took FMLA for personal reasons and leave it at that and if they push, have an attorney tell you what you are required to divulge.
 
nonnyyy122018 said:
But how do I then explain the FMLA, if asked? My PD does have to report that I took one, though I've yet to discuss with him how much he's able/obligated to divulge as to why.
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I’m not an expert on such things, but I don’t believe you have to answer such a question. Since FMLA falls under ADA accommodations, I think youre probably entitled to privacy.
 
I've never made any bones about the fact that I've led less than a charmed life and have struggled with some mental health challenges. It's also why over the course of my life I've also been privileged to be privy to a lot of other people's struggles.

The person that didn't really struggle more than average in medical school or residency is in a poor position to advise those who have, in my experience. There's people who have struggled more than me, and come further than I have, and their advice is probably worth more.

forums.studentdoctor.net

why do physicians pay out of pocket for psychiatric treatment?

I work in the mental health field and have seen many physicians pay out of pocket for treatment even though it is very costly and I am sure their insurance must cover it. Why? Do State medical licensing boards have access to insurance records?
forums.studentdoctor.net forums.studentdoctor.net

This was one of my favorite threads on the topic, recently. Especially since it was commented on by some of the actual psychiatrist regulars we have on SDN, and of all the specialists, psych seems to have more direct experience with some of these issues.

@splik is someone who is a psychiatrist and also does some work that is forensic. Not a lawyer in any case.

Splik maintains that since these questions are illegal you can just say no. Although another poster points out, who wants to be the test case?

I would either: say no to these questions anywhere I thought I could defend having done so as being honest, and in the other cases, I would get an attorney. NEVER lie to a medical board, however, lying has a legal definition in these dealings, so it isn't lying to get an attorney and find out what the "truth" is here, and how much the board is entitled to. It's also butt-covering if it comes up in the future why you answered one way or the other.

I'll say it again: when you have a dealing with the medical board where you could be negatively effected in any way shape or form, get an attorney. It's a drop in the bucket finances-wise when you weigh any amount of time and money you make in practice, against the attorney fees meant to protect your ability to do so.

I know in cases of expunged records, one is legally entitled to answer "no" to certain questions, even questions that specifically ask about expungement. It renders an expungement essentially pointless if one doesn't have some protection in answering. This is what an attorney has told me. The protection provided by law in the expungement entitles you to answering no.

I think in other instances in law, that if a question is illegal then you are not liable for answering no. But I'm not an attorney, so go get one.
 
It seems like the truthful answer to that question is yes, considering you had to take a medical leave for treatment so that it wouldn't affect work. The follow up answer is that yes, you plan to continue treatment to avoid future issues. But perhaps no doctor ever actually said that bad things would happen if you didn't get treated so technically you could answer no.
 
nonnyyy122018 said:
I have no issue with saying yes to State B. I just worry that I said "no" two years ago to State A, so I might be accused of lying. Should I update State A on the new development of me having taken a LOA? If I do, what might they do? (Likely nothing, just say "thanks for the info.")

Somehow, letting anyone know anything is not a Pandora's box I want to open, but I guess it's better for me to let them know than for them to find out through other channels.
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For state A, you would answer the question they ask on the renewal once you are up for renewal.
 
nonnyyy122018 said:
They don't ask *any* question about health status on the renewal for State A, which I just did. However, state B told me that there's a small chance the info I disclose on their form could come back to state A.
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They don't ask then you don't have to tell. You gave the truth at the first application and your records will back that up.
 
If you answer yes to either state, they are likely to demand all of your medical records. Some people don't feel comfortable handing over their mental health records. A letter from your physician stating that your health is fine will usually not suffice.
 
In Massachusetts I was able to get by with a vague letter from my psychiatrist, even though I was warned that they might demand all my records. Feel free to message me if you'd like to speak further! I'm on vacation this week.
 
I'm pretty sure I told you last time you posted this that you should consult an attorney. I stand by that. We can give you all the advice in the world based on what we would do or what we think is the right thing to do, but the bottom line is, we don't have to do the fighting for you when it comes back to bite you in the rear.

More generally, I find the fact that any state gets away with such questions the bigger issue.
 
I think the point here is that legal advice was hard to come by.

Also, at the end of the day, even with legal advice, you still have to make your own choices. It's reasonable to ask other physicians, because except for a few attorneys I might imagine are out there, we have more experience filling out this sort of paperwork and board fallout.

I think it's better to ask forgiveness than permission from the medical board. I would answer whatever I thought was best for myself, while at the same time being sure that if I were ever in a bad way about one of my answers with the medical board, that an attorney and providers in my corner, could make and stand behind a reasonable explanation for why what I said was honest. You're not allowed to lie. However, I think one can argue that some things are open to interpretation or misunderstood. I don't know how well that kind of "asking forgiveness" defense works, all I know is the harm from "asking permission."

Others will state that they don't see the big deal disclosing what you have discussed so far, that they have themselves, and had no issues. For those stories, there are other more negative ones.

Personally I seek to avoid handing over my medical information to anyone but a treating provider.

Some of this only comes up if you are ever in a position to have to disclose to a medical board, or to have to provide medical records. You have some control over this, and the risk is nonzero whichever way you choose.
 
Merging multiple threads on the same topic.
Crayola227 said:
I think the point here is that legal advice was hard to come by.
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The OP has received advice from the board, her PD, and several co-residents who all agree that she probably doesn't need to disclose garden-variety mental illness. There are a few posters here who seem to feel differently. Nothing is ever going to completely alleviate the OP's anxiety, but at a certain point he/she has to either accept or reject the advice that has been given. I don't think anyone can really add anything beyond what has already been suggested.
 
The question is pretty clear about what it wants. Not do you have a condition YOU worry may cause a problem if untreated, but has your doctor ever said it would interfere with work if you didn't get treatment. I would imagine most people with any health or mental health issue that they seek treatment for and are compliant with treatment don't get told they must continue treatment or it will affect their work. Certainly without a thyroid I would absolutely have my work affected if I discontinued hormone replacement for long enough. However no doctor has warned me about this because I never questioned the need for treatment or demonstrated no compliance. But the op actually took time off for intensive treatment which makes me wonder if perhaps the doctor did say hey you better take a break and do this or else your work might get affected in which case answering no would be a lie. And lying on the application is a bad idea. But if they didn't say anything like that then they are golden
 
dpmd said:
But if a doctor ever documented that they were told this they can be in a bigger world of hurt later.
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Exactly why it's time to ask for a legal opinion. Most attorneys give free consultations and frankly, it would be worth the money to me to check this out. That said, I'm awaiting the brave soul who is ready to the sue the pants off these medical boards for requiring such information.
 
Updating everyone:
I did talk to a lawyer who had been a lay member of state B's medical board for a while. I also talked to my own doctor.

The lawyer asked me what my actual doctor said (which was "no need to disclose, since I never told you anything like that"), and also if I'd ever tried practicing with the condition not controlled (yes and I did fine). Lawyer told me don't disclose, and if they ask about the medical leave, just say "yes, I did this, but not because of impairment or anyone being concerned about risk thereof." Which is true. I wasn't doing poorly at work. I was just abjectly miserable.

I also called state A's board and they said this didn't need to be disclosed to them unless there'd been some legal or disciplinary issue directly related to my illness.

I think it's time to put this issue to rest. Thanks, all, for your input. 🙂
 
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nonnyyy122018 said:
I approached my doctor about taking a leave, and not because of issues with practice, but because of issues with overall quality of life. I asked my doctor what to put for the question, and he said no is reasonable because he'd never told me anything like that, nor would he be uncomfortable with me practicing without treatment. And I doubt he'd say what he did and yet document radically differently.

Talking to lawyers, my PD, my doctor I feel comfortable with not disclosing. Then when I go on SDN I feel like I have to. Maybe I shouldn't come here anymore.
Click to expand...

That's kinda a slap in the face. You came here for advice. You were told what we would do and you were told (repeatedly) to contact an attorney. You contacted an attorney. Issue was solved. How did you reach the conclusion you shouldn't come here anymore? We helped you as best we could with our personal perspectives, which we gave you with no strings attached. You may not have agreed with some and you may not have wanted to hear what we told you, but you asked the question, we answered, and in the end, it sounds like we helped you by directing you to your lawyer.
 
nonnyyy122018 said:
I approached my doctor about taking a leave, and not because of issues with practice, but because of issues with overall quality of life. I asked my doctor what to put for the question, and he said no is reasonable because he'd never told me anything like that, nor would he be uncomfortable with me practicing without treatment. And I doubt he'd say what he did and yet document radically differently.

Talking to lawyers, my PD, my doctor I feel comfortable with not disclosing. Then when I go on SDN I feel like I have to. Maybe I shouldn't come here anymore.
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No problem! Maybe you should...bye!
 
nonnyyy122018 said:
Talking to lawyers, my PD, my doctor I feel comfortable with not disclosing. Then when I go on SDN I feel like I have to. Maybe I shouldn't come here anymore.
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What? I just re-read this thread and the consensus seems to be not to disclose. What posts did you read that gave you the opposite impression?
 
hamstergang said:
What? I just re-read this thread and the consensus seems to be not to disclose. What posts did you read that gave you the opposite impression?
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He replied that to my post which essentially laid out when he would or wouldn't have to disclose which talking to his doc actually settled the question in the no disclosure needed category even without the lawyer input agreeing with that. Yet somehow he still feels undecided :shrug:
 
I personally wouldn't do any of the above. It's like asking for trouble being overly defensive like this.

Go back to your posts about what shook out after talking to an attorney. I wouldn't waste an attorney's time or your money sending the above. I can't imagine an attorney who gave you the advice previously, would think this was a good idea. But I'm not an attorney. But it just seems to invite more scrutiny.
 
nonnyyy122018 said:
I sent my lawyer an email about disclosing, before I got this forum reply from you. His reply was literally “that’s fine.”

So much for lawyers.
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I am so confused. You posted your question here in two separate threads. In both threads, the majority said don't report it. Some of us told you to ask an attorney. You not only asked the attorney, but you also asked your doctor (per attorney's recommendation), and both told you that you don't have to report it. Still, you vacillated, told the SDN community that we somehow made you feel that you had to report even though we didn't say anything like that, and continued to spin the wheels of indecision, ultimately deciding you'd give a non-answer in the form of "yes and no" to the board.

I really hope we're not being trolled because this is an extremely important topic that genuinely affects many of our colleagues.
 
nonnyyy122018 said:
Not a troll, 100%. Just don't feel comfortable with either decision, including the intermediate "yes and no" one.

It was dpmd's post that made me question the choice to put no.

I also think he had a point in that for most conditions the issue of "you need to get treatment or else your work may be affected" never explicitly comes up, so if you take the question literally you can put "no" for lots of things that can be impairing if untreated.

Also, dpmd brought up documentation. While my doctor did say "no, that was never a part of our conversations" in reference to the board's question, who the heck knows what he actually did or didn't document and how the board could choose to interpret it. No, my doctor didn't even recommend the leave; I came to him with the request for one, but still, my colleagues and I use the term "impairment" almost too casually in our notes.

Hence, questioning.

I know I should make a choice and just submit the darn thing, though. I hear a lot of people here and in real life saying that if one can reasonably put no, then put no, since anything else "invites trouble." I think I can do that.
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Just do it and get it done. You will be fine. Say no. No one is subpoenaing your docs notes. It makes no sense to keep wondering or want to say yes and no when both your attorney and your physician has said it's a no.
 
Ok, I talked in a more depth to my doc since it was just a brief phone conversation before, and here are the takeaways.

The question, to remind everyone, was "have you been told by a treating provider that you have a condition, that if untreated, would be likely to impair your ability to take care of patients in a reasonably safe and competent manner?"

For my doc, the response hinges on the wording of "would be likely." The words "would" and "likely" imply a degree of certainty, which leads him to say "no" in my case. (Compare to "would likely" to "could possibly," the latter casting a wider net.)

Also, he said "impairment" is a big deal, and he is mindful of not using that word lightly, especially in notes about people in high-stakes professions like ours. Could my condition affect my practice? Yes, it could. But impair and affect are by no means the same. A good litmus test is, consider yourself on a bad day - maybe you're at the end of a long call shift, haven't slept, haven't eaten, and just got yelled at by a patient. Chances are your next clinical encounter won't be your best. Compare that to how your health condition affects you, or would affect you if untreated. If it affects you to an extent well beyond the normal variation that comes with everyday demands and stressors, that's an argument in favor of impairment.

Another way to think about it is were I to go off my meds and leave care, would he be concerned about me practicing safely and feel compelled to report me to the board. There are some conditions where he could say with a degree of certainty that things would go very poorly if one goes off their meds, such as Type I diabetes, or Bipolar disorder, or even thyroid disease. But my case isn't one of them.

The takeaway for posterity:
--the language of the question is important. Check with the board if they have a working definition of "impairment," "reasonably safe," and the like, and see my doc's reasoning about "would be likely." Lawyers are also very good at splitting the hairs of language.
--talk to your actual treating physician or therapist, if applicable. They know your case the best, and they're the ones who would have to back you up should the board start asking questions.
--"impairment" is a big deal.
--lawyers can be semi-helpful, but it can take a while to find one who was actually knowledgeable about this issue. Most lawyers who do medical law help doctors who are being sued or investigated by the board.
 
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nonnyyy122018 said:
Ok, I talked in a more depth to my doc since it was just a brief phone conversation before, and here are the takeaways.

The question, to remind everyone, was "have you been told by a treating provider that you have a condition, that if untreated, would be likely to impair your ability to take care of patients in a reasonably safe and competent manner?"

For my doc, the response hinges on the wording of "would be likely." The words "would" and "likely" imply a degree of certainty, which leads him to say "no" in my case. (Compare to "would likely" to "could possibly," the latter casting a wider net.)

Also, he said "impairment" is a big deal, and he is mindful of not using that word lightly, especially in notes about people in high-stakes professions like ours. Could my condition affect my practice? Yes, it could. But impair and affect are by no means the same. A good litmus test is, consider yourself on a bad day - maybe you're at the end of a long call shift, haven't slept, haven't eaten, and just got yelled at by a patient. Chances are your next clinical encounter won't be your best. Compare that to how your health condition affects you, or would affect you if untreated. If it affects you to an extent well beyond the normal variation that comes with everyday demands and stressors, that's an argument in favor of impairment.

Another way to think about it is were I to go off my meds and leave care, would he be concerned about me practicing safely and feel compelled to report me to the board. There are some conditions where he could say with a degree of certainty that things would go very poorly if one goes off their meds, such as Type I diabetes, or Bipolar disorder, or even thyroid disease. But my case isn't one of them.

The takeaway for posterity:
--the language of the question is important. Check with the board if they have a working definition of "impairment," "reasonably safe," and the like, and see my doc's reasoning about "would be likely." Lawyers are also very good at splitting the hairs of language.
--talk to your actual treating physician or therapist, if applicable. They know your case the best, and they're the ones who would have to back you up should the board start asking questions.
--"impairment" is a big deal.
--lawyers can be semi-helpful, but it can take a while to find one who was actually knowledgeable about this issue. Most lawyers who do medical law help doctors who are being sued or investigated by the board.
Click to expand...

You called your doctor again to ask this question? Dude.
 
Why in the world would you delete all your other posts but the final one? For anyone in a similar situation that this could have helped you erased the initial questions. 🙄
 
samac said:
Why in the world would you delete all your other posts but the final one? For anyone in a similar situation that this could have helped you erased the initial questions. 🙄
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Look through the thread... most of his post are in the replies to the posts... deleting them doesn’t really make them go away.
 
nonnyyy122018 said:
Ok, I talked in a more depth to my doc since it was just a brief phone conversation before, and here are the takeaways.

The question, to remind everyone, was "have you been told by a treating provider that you have a condition, that if untreated, would be likely to impair your ability to take care of patients in a reasonably safe and competent manner?"

For my doc, the response hinges on the wording of "would be likely." The words "would" and "likely" imply a degree of certainty, which leads him to say "no" in my case. (Compare to "would likely" to "could possibly," the latter casting a wider net.)

Also, he said "impairment" is a big deal, and he is mindful of not using that word lightly, especially in notes about people in high-stakes professions like ours. Could my condition affect my practice? Yes, it could. But impair and affect are by no means the same. A good litmus test is, consider yourself on a bad day - maybe you're at the end of a long call shift, haven't slept, haven't eaten, and just got yelled at by a patient. Chances are your next clinical encounter won't be your best. Compare that to how your health condition affects you, or would affect you if untreated. If it affects you to an extent well beyond the normal variation that comes with everyday demands and stressors, that's an argument in favor of impairment.

Another way to think about it is were I to go off my meds and leave care, would he be concerned about me practicing safely and feel compelled to report me to the board. There are some conditions where he could say with a degree of certainty that things would go very poorly if one goes off their meds, such as Type I diabetes, or Bipolar disorder, or even thyroid disease. But my case isn't one of them.

The takeaway for posterity:
--the language of the question is important. Check with the board if they have a working definition of "impairment," "reasonably safe," and the like, and see my doc's reasoning about "would be likely." Lawyers are also very good at splitting the hairs of language.
--talk to your actual treating physician or therapist, if applicable. They know your case the best, and they're the ones who would have to back you up should the board start asking questions.
--"impairment" is a big deal.
--lawyers can be semi-helpful, but it can take a while to find one who was actually knowledgeable about this issue. Most lawyers who do medical law help doctors who are being sued or investigated by the board.
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You had to take a month off your job. That's impairment
 
Mass Effect said:
I'm pretty sure I told you last time you posted this that you should consult an attorney. I stand by that. We can give you all the advice in the world based on what we would do or what we think is the right thing to do, but the bottom line is, we don't have to do the fighting for you when it comes back to bite you in the rear.

More generally, I find the fact that any state gets away with such questions the bigger issue.
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It's about public safety
 
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