Personal experience

[marie337]

I've been asked several times during my psychiatry rotation about what has sparked my interest in psychiatry. There are several reasons, so I'm able to give reasonable answers, but the most influential factor is my own personal experience with OCD and depression. So, my question is, when (if ever) does it become appropriate to share this with my colleagues? Right now, I'm looking to apply to this program, so I don't want to give too much information. But, what about my personal statement? Is this something that I can tactfully write about? It definitely gives me a better perspective on what it's like to struggle with an illness. And, I've been on every SSRI on the market.

Also, today in the office the resident was telling me that she moonlights at the office where my therapist works. That was awkward! I just kept thinking, "I hope I never run into you there!" It's so weird, because I wouldn't care at all if I knew someone who worked at my Ob/Gyn's office, or my dentist's office.

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[erg923]

I would not volunteer the information to superiors or supervisors, just in the interest of being professional and not disclosing too much personal info. However, I certainly wouldn't worry or feel ashamed of running into you colleague at your therapist's office. I don't think anyone in the field would look down upon you for practicing what we preach, so to speak. That is, if we think psychotherapy and feelings are so important and healthy, why would one look down upon on one of our colleagues who wants to be in therapy. I would actually see this as mature, insightful, and as an effort to better understand yourself. Very important in this field actually. Many programs encourage their residents to be in psychotherapy themselves. My clincial psychology Ph.D program requires us to complete 20 sessions of psychotherapy.

 

[toby jones]

I wouldn't disclose that information in a professional setting. I might share it with my colleagues if my colleagues were my close friends but I wouldn't share it with my colleagues if my colleagues weren't my close friends.

You could say something about how you have known people who suffered through mental illness and that has inspired you. That would be true. I don't think they need to know who that person is. It is true that that person is close to you.

I think that often the greatest stigma comes from mental health professionals. Not ALL of them, but a fair few of them.

I'd have a few words to your therapist to ensure that any identifying information about you is kept well concealed. If you explain that you wouldn't want people who know you in a professional capacity to know your reason for going to see a therapist (which is reasonable) then your therapist should be able to take extra steps to ensure your confidentiality. For example, giving you a different first name if your case comes up in supervision, not disclosing that they have a patient who is doing psychiatry rotations etc.

I wouldn't worry about people seeing you coming and going... But it really isn't any of their business why you are seeing the therapist. It could well be personal development. They also shouldn't talk or gossip about having seen you there only... That doesn't stop some people...

 

[billypilgrim37]

So, my question is, when (if ever) does it become appropriate to share this with my colleagues?

Probably about two weeks after you get tenure.

It's always appropriate to share what you will with your friends, and if your friends and your colleagues are the same people, then share as you feel comfortable.

 

[sunlioness]

I had to face that same dilemma. My own personal experience was the entire reason I wanted to change my specialty to psychiatry. And at that time, my personal experience was not at all something I felt comfortable sharing. It made for an awkward interview with one attending actually who kept asking me how I had "tested" my desire to be a psychiatrist. Because admittedly, it was very sudden. I was an intern in internal medicine at the time. But my story at the time was that in working in primary care clinic as an intern, I realized how many patients had psychiatric issues and I hated having to refer them out. This was perfectly true, but nowhere near as compelling as my own personal experience. So I would say be cautious about it. I've been more open with my own stuff since I've now mostly resolved it and haven't seen a psychiatrist for about a year (and obviously so since my PD reads these forums from time to time ). And it's been fine. But back when I was applying it isn't something I would have been comfortable talking about and I'm not sure how it would have affected things then.

I kind of like the idea above about talking about your own experience in the guise of someone close to you. That actually never occurred to me.

 

[marie337]

But back when I was applying it isn't something I would have been comfortable talking about and I'm not sure how it would have affected things then.

I have no problem talking about the issues I've dealt with and I have no shame for the fact that I still see a therapist as needed. But, at the same time these aren't things that I want to discuss or defend on the interview trail. Also, I agree that a future supervisor does not need to know about my particular brand of obsessions and compulsions! My experience has been a huge part of my interest in mental health and I feel like I would be lying if I didn't mention it, so I love the idea of talking about my experience from a third person perspective. That is a great idea.

Why is so the stigma perpetuated within the field? It seems like it should be so easy to talk about this within the field. If I had preeclampsia I would probably talk about my experience within an Ob/Gyn residency, why should this be so different?

 

[michaelrack]

If I had preeclampsia I would probably talk about my experience within an Ob/Gyn residency, why should this be so different?

Would a prospective orthopedics resident talk about his personal experience with chronic back pain??

would a prospective urologist talk about his h/o childhood enuresis?

would a prospective neurologist talk about his seizures?

I would advise you to keep your issues to yourself and not talk about them on the interview trail (or during training- you never know when you'll need a letter of rec)

 

[whopper]

So, my question is, when (if ever) does it become appropriate to share this with my colleagues?

Disclosing that you had a mental illness IMHO can go either way during an interview.

It can prove you're passionate about treating people because you-yourself suffered the same problems.

It can also create a situation where some programs may consider you a problem because you'll relapse.

I took a year off from medschool. Why? The real answer was women. I was a single guy in my 20s and had little time to date women because of premed & medschool responsibilities. Most of my college buddies were by that time successful in their careers and living life for real--either married or doing something fun in their free time. I felt like I was missing out on life.

During that year, I day-traded, & ran a small Ebay business. I made a lot of cash, dated & basically felt like a human being. I don't regret it. I think it made me a better person, resolidified my desire to go back to medschool & become a psychiatrist and gave me better life experience.

OK-, so now every residency I interviewed at brings up the year gap. Some of them even claimed they knew why I took the year off---> "we know what's going on. You were diagnosed with some mental illness right?".

It appeared that some programs have had bad experiences with residents because of their mental illnesses and may have had some shell-shock over it. No they didn't say it, but let's just say my taking a year off seemed to touch a nerve; a nerve that had to be there for a reason.

My own program admitted someone as a resident who appeared to have histrionic personality disorder. She was also diagnosed with Bipolar & OCD. She was removed from the program. She did several things out of line such as make false accusations against several of her colleagues & attendings, dressed inappropriately at work & didn't set proper boundaries with patients. I'm being very tame in my descriptions.

So are we shell shocked over this? Yes. Do we want someone else coming in with that same problem? Of course not.

But at the same time, if someone came in, mentioned they had mental illness, but also made it clear that it would not affect their performance & that they also showed themself to be a good candidate, I wouldn't hold it against them, it might even prove their enthusiasm for the field. However I don't know if others would be as open minded about it.

I've heard a saying. Medical students go into psychiatry because 1) they're lazy (don't want to work in high pressure fields like surgery) or 2) they're crazy (had a mental illness) or 3) they actually like psychiatry.

I don't want #1s coming into the program. I don't mind #2s if they'll be good psychiatrists, and definitely want #3s in.

 

[Anasazi23]

Agree with Dr. Rack. Keep your problems to yourself. Trust me, it'll get talked about and it won't look good in the long run. Make yourself as capable as possible in the eyes of other docs.

 

[marie337]

Agree with Dr. Rack. Keep your problems to yourself. Trust me, it'll get talked about and it won't look good in the long run. Make yourself as capable as possible in the eyes of other docs.

OKay...thanks for the advice everyone.

 

[sunlioness]

I've heard a saying. Medical students go into psychiatry because 1) they're lazy (don't want to work in high pressure fields like surgery) or 2) they're crazy (had a mental illness) or 3) they actually like psychiatry.

I don't want #1s coming into the program. I don't mind #2s if they'll be good psychiatrists, and definitely want #3s in.

I think #2 and #3 are connected. At least they are for me. But I can also see #2 going either way. I think personal experience is a huge asset IF you've worked through it appropriately on your own and aren't running from your own stuff through working with others. It's the difference between saying "I've learned so much through this process that I want to facilitate it for someone else" and saying "I sure as hell can't figure myself out, but I can help you instead." The first is wonderful and the latter is a bit scary.

 

[cleareyedguy]

I'd keep quiet in the hospital. Can't help.

 

[sunlioness]

would a prospective neurologist talk about his seizures?

Actually I DO know a neurologist who talked about his seizures. But whether that was a wise thing to do is another thing entirely.

 

[marie337]

"I've learned so much through this process that I want to facilitate it for someone else"

I definitely fall into this category, which is why I'm so comfortable talking about it. I don't intend to tell anyone in the program about it, unless we're close friends. But, one attending who asked me about my interest said that most people have personal experience or have family/friends with mental health issues. So, I just told him that my mom has had issues with anxiety and depression (which is true) and left it at that. I have seen enough people deal with issues that I really don't need to go into detail about my own! I have plenty of stories to tell! I was just curious how other people have dealt with this issue.

 

[michaelrack]

Actually I DO know a neurologist who talked about his seizures. But whether that was a wise thing to do is another thing entirely.

I know a psychiatrist who talked about being depressed and feeling suicidal (in the past) for a local newspaper. Don't think it's a wise thing to talk about your h/o mental or medical illness, unless you have to. However, If you have obvious Tardive dyskinesia and are interviewing for a psych residency, it might be wise to discuss your history (came across this situation several yrs ago when I was interviewing resident candidates- however, she didn't volunteer any info about this and I didn't ask)

 

[nancysinatra]

Agree with Dr. Rack. Keep your problems to yourself. Trust me, it'll get talked about and it won't look good in the long run. Make yourself as capable as possible in the eyes of other docs.

I agree too that it would be best to keep quiet. But can I ask--why would it not "look good in the long run?" If anything, knowing colleagues through the long run is how people build trust. If a colleague had suffered from a mental health problem at some point in their life, and I found out about it, I wouldn't necessarily think that person was less capable. (Unless they were, truly, less capable.)

Now if someone I hardly knew was broadcasting the details of their personal life in a professional setting, that WOULD erode my confidence in them. That actually happened on OB/Gyn in a way--certain residents were forever gabbing about their boyfriends and weddings, which I felt was inappropriate. We had some serious histrionic moments on our team, but it wasn't stigmatized in that setting, so does that make it ok? Then again, each specialty has a culture--in surgery, for example, I wouldn't even reveal whether I'd sprained an ankle in the past. There's a certain feigned superhuman robotic quality to the way surgeons seem to work. (I don't mind it though--in a strange way it has a leveling effect and I feel much more an "equal" on the team!)

Also, mental illness runs such a huge range. Who cares if someone has a phobia of spiders? Or had some adjustment problem as a child? It's not something I'd mention at the hospital, obviously, but I wouldn't care if I found that out about someone. If they turned out to be a sociopath, that's different.

I'm not sure I would personally want to offer information about a family member either. Who knows, some people might form a judgment or suspicion based on that too.

 

[nancysinatra]

Would a prospective orthopedics resident talk about his personal experience with chronic back pain??

I've heard of prospective orthopedics residents talking about their past athletic injuries. Sustaining an orthopedic injury makes a person look tough though, that's the difference. I'd guess that in sports medicine, candidates don't hesitate to discuss their personal experiences either.

And don't get me started on women who've recently had kids who suddenly spark an interest in OB/Gyn. I know some who have no shyness in bringing this up in relation to how their interest developed. I don't know if it's acceptable to discuss in a residency interview, but I hear it a lot in med student conversation.

 

[Iquitos]

Since I was inspired by the movie silence of the lambs, I assume that would be safe topic to bring up in an interview- Unless the PD isn't an Anthony Hopkins fan. I would have to assure the PD that I am cured of my cannabalistic nature and promise not to relapse.

 

[michaelrack]

I've heard of prospective orthopedics residents talking about their past athletic injuries. Sustaining an orthopedic injury makes a person look tough though, that's the difference. I'd guess that in sports medicine, candidates don't hesitate to discuss their personal experiences either.

And don't get me started on women who've recently had kids who suddenly spark an interest in OB/Gyn. I know some who have no shyness in bringing this up in relation to how their interest developed. I don't know if it's acceptable to discuss in a residency interview, but I hear it a lot in med student conversation.

that's a good point about orthopedics/sports medicine. Though I'm not sure if a condition that makes you look tough would be a good thing to bring up when applying for a psych residency- antisocial personality disorder comes to mind

 

[michaelrack]

Also, mental illness runs such a huge range. Who cares if someone has a phobia of spiders?

You've given me the courage to admit that I am scared of cockroaches.

 

[Anasazi23]

I agree too that it would be best to keep quiet. But can I ask--why would it not "look good in the long run?"it though--in a strange way it has a leveling effect and I feel much more an "equal" on the team!)

You hit the nail on the head. Residencies are hotbeds of gossip and conjecture. Believe me, other residents will speculate on your perceived weaknesses as it is. Don't give them fuel for their fire.

 

[nancysinatra]

You hit the nail on the head. Residencies are hotbeds of gossip and conjecture. Believe me, other residents will speculate on your perceived weaknesses as it is. Don't give them fuel for their fire.

Yeah, but shouldn't residents aspire to rise ABOVE being such gossip-mongerers? How is residency any different from med school then? What am I getting myself into??

You've given me the courage to admit that I am scared of cockroaches.

Just don't admit that in a hospital setting! However, if I have helped you to come forward with your problem (cockroaches), start seeking help, and contribute to reducing the worldwide stigma of this affliction, I am happy.

I myself am afraid of elementary school lunch room monitors.

 

[Faebinder]

Alright... since we are doing confessions all around, I'll confess.

Once I begin eating pistachios from a container, I cannot stop. They scare me.

 

[OldPsychDoc]

I used to believe that the people who made the coloring books were going to come to my house and check to see if I colored outside the lines.

 

[nancysinatra]

I used to believe that the people who made the coloring books were going to come to my house and check to see if I colored outside the lines.

Actually, they are going to come by, eventually. That's a part of the lunch room monitor's job. They are authorized to conduct random audits of ANYTHING, at ANY TIME in your life. This applies to everyone.

 

[nancysinatra]

Once I begin eating pistachios from a container, I cannot stop. They scare me.

What, specifically, is it that scares you about these pistachios? If you tell us, I bet we can get to the bottom of this.

 

[Faebinder]

Actually, they are going to come by, eventually. That's a part of the lunch room monitor's job. They are authorized to conduct random audits of ANYTHING, at ANY TIME in your life. This applies to everyone.

Gosh, I didn't realize my mom is a member. That explains the random audits.

 

[Faebinder]

What, specifically, is it that scares you about these pistachios? If you tell us, I bet we can get to the bottom of this.

They go straight to my a$$ and destroy several days of diet.

 

[OldPsychDoc]

Our apologies for going off topic. Such gallows humor is how we all keep ourselves sane, and is absolutely not a trivialization of your concerns in the original post.

Many of us have personal experience of one form or another. Our ability to maintain boundaries with this experience is a reflection of our maturity and professionalism (or lack thereof). When a student on my service starts blathering mindlessly about their experience with an SSRI, for example, it raises concerns about their ability to manage difficult patient interactions. On the other hand, a student who talks openly and reflectively about their journey in an appropriate setting, like 1:1 supervision, demonstrates that they have turned a difficult experience into a professional strength.

 

[Anasazi23]

Yeah, but shouldn't residents aspire to rise ABOVE being such gossip-mongerers? How is residency any different from med school then? What am I getting myself into??

Puh-leeze.

 

[bjolly]

Actually I DO know a neurologist who talked about his seizures. But whether that was a wise thing to do is another thing entirely.

I actually heard (from a reliable source) of a neurologist who had a seizure during his residency interview. Poor guy, you know that was probably his deepest fear! Apparently it didn't hurt him though.

 

[nancysinatra]

Puh-leeze.

Ok, but I just can't believe how much gossip there is in med school! I went out with some classmates last night, and for 2 or 3 hours, all we did was gossip, gossip, gossip. Some guy I never ever talk to even informed me of a rumor about myself that had apparently gone around the whole class. At the end of the night, someone mentioned the upcoming presidential election and we were all like "huh? an election? what's that?" So much for smart med students.

 

[Rena]

n

 

[marie337]

Our apologies for going off topic. Such gallows humor is how we all keep ourselves sane, and is absolutely not a trivialization of your concerns in the original post.

Many of us have personal experience of one form or another. Our ability to maintain boundaries with this experience is a reflection of our maturity and professionalism (or lack thereof). When a student on my service starts blathering mindlessly about their experience with an SSRI, for example, it raises concerns about their ability to manage difficult patient interactions. On the other hand, a student who talks openly and reflectively about their journey in an appropriate setting, like 1:1 supervision, demonstrates that they have turned a difficult experience into a professional strength.

This is exactly what I'm talking about. I would never go into a patient interview and start telling them about my experiences on Prozac or something. But, if I'm having a conversation in a private setting with an attending who specifically asks about what has sparked my interest in psychiatry, is it ever appropriate to mention personal experience (especially after they begin the question by saying that in his experience most people have personal or family experience with psychiatry)? As I"ve mentioned, I have enough other experiences to draw upon, but my own experience is obviously one of my main motivators.

 

[whopper]

Trust me, it'll get talked about and it won't look good in the long run.

Hypocritical (not on your Anasazi, on all of us) but true.

You figure we as psychiatrists would be a bit more supportive, but I've noticed several programs don't want residents with mental illness.

I've also noticed that at some programs, the environment is ripe with some barbed gossip. Depends on the individuals in the residency. Its very hard to weed out who will be a potential gossiper during interviews.

Regarding personal disclosure to patients (mentinoned above), its hardly ever a good thing. Often times the patient sees the therapist then as another patient, not as a therapist.

We had a therapist on our inpatient unit (no longer with us) who gave personal disclosure quite a bit, and it looked unprofessional. The patients were turned off by her when she made those comments. She also blew up in anger quite easily (not surprising given her self disclosures gave you enough to know she had a lot of cluster B traits). Since the patients knew a lot of her history, they often mentioned that they seemed to be better in the head than she was, and several of them were correct. This in turn killed a lot of her credibility with patients.

 

[TheWowEffect]

Self-disclosure can back fire if you are using it to say that you understand patients better. What if you really are not that good at what you do, everything is going to be blamed at your history. What if you run into conflict with a patient, colleague or a superior, everyone is going to be quick to blame it on your past history of whatever.

So, I would advise against self-disclosure of any kind to people, especially when you are just starting. Once you are successful and fairly well-established, you may want to do it if you feel compelled enough.

One way of validating your patients empathically is to acknowledge that we all go through periods of anxiety and depression but it does not last long enough for most of us. For our patients, it is progressive and longer lasting. One might say that this a form of self-disclosure because we all go through some of the subjective symptoms at times. This is true for many medical illnesses as well. Remebember the last time you had tachycardia and feeling of panic when that cop flashed his lights behind you. Remember last time you made that embarrassing remark in front of a group of people and you wanted the earth to swallow you.

 

[nancysinatra]

This is exactly what I'm talking about. I would never go into a patient interview and start telling them about my experiences on Prozac or something. But, if I'm having a conversation in a private setting with an attending who specifically asks about what has sparked my interest in psychiatry, is it ever appropriate to mention personal experience (especially after they begin the question by saying that in his experience most people have personal or family experience with psychiatry)? As I"ve mentioned, I have enough other experiences to draw upon, but my own experience is obviously one of my main motivators.

Hi marie337--I just wanted to add that I too hope you did not mind the off-topic humor. I think your question is a really good one. In the beginning, you were asking about what you should say in your personal statement. Well, from what people are advising in this thread, I would think the personal statement might not be the best place to bring up the issues you're talking about. In 1 to 2 pages, it would hard to do justice to such a complex part of your life experience, I'd think. I honestly think that in personal statements, it is always best to stay away from subjects you feel extremely strongly about, or have super close experience with. These things get read by god-only-knows-who, before they've even met you face to face.

Maybe once you have gotten to know some of your future colleagues better, the subject will come up in a natural way where you might feel comfortable discussing things with some of them, and not with others. I'm not a resident so I can't say with any certainty, but going on my other experiences that's usually how professional relationships unfold. But if I were in your shoes and an attending asked about personal or family experience, I wouldn't reveal confidential personal information to them, any more than I would disclose it to anyone else I'd just met for the first time.

During my psych rotation, we had a grand rounds on the topic of physician impairment, where we got into the subject of a colleague being depressed. The people who spoke all expressed compassion. I'd like to think that that's true and that doctors do care about each other, and won't just rush to judge and perpetuate gossip at the slightest mention of a personal experience relating to mental illness, but instead will be fair-minded in their response. If I were you, I'd just play it by ear as you go along, but make the personal statement about something less, well, personal. ;-)

 

[OldPsychDoc]

...During my psych rotation, we had a grand rounds on the topic of physician impairment, where we got into the subject of a colleague being depressed. The people who spoke all expressed compassion. I'd like to think that that's true and that doctors do care about each other, and won't just rush to judge and perpetuate gossip at the slightest mention of a personal experience relating to mental illness, but instead will be fair-minded in their response. If I were you, I'd just play it by ear as you go along, but make the personal statement about something less, well, personal. ;-)

For more about depression and the medical profession, see this article in this week's Newsweek.

 

[Faebinder]

For more about depression and the medical profession, see this article in this week's Newsweek.

Does this come as a surprise? Really? After medical school? And residency? And then you meet medicare and it's friends? Then lawsuits? And loans?

You could classify the 7 years of med school + residency as a long traumatic event.

 

[marie337]

You could classify the 7 years of med school + residency as a long traumatic event.

Seriously, I think more and more residencies are incorporating stress reduction time into their programs. Although, I sat in on a IM process group when I was on the rotation, and it was nearly useless because nobody wanted to admit to having any difficulties.

That is an interesting article. I didn't realize that female physician depression rates are so much higher than non-physician females. I'll have to check out that documentary. On a side note, the psychiatry attendings that I've been working with this month seem to be the happiest group that I've seen. They actually all seem to enjoy their jobs which I couldn't really say for any other field I"ve rotated through.

 

[whopper]

Seriously, I think more and more residencies are incorporating stress reduction time into their programs.

While this is true, several programs are in violation of ACGME guidelines concerning stress reduction. CNN did its own study on it and it showed an overwhelming majority of residents lied when they reported their work hours because the resident feared backlash from the program or that the program would get shut down by the ACGME. Forgot the exact %, and I looked for the article but couldn't find it. From my own memory, it was something near 75%

Psychiatry residencies in general though are less stressful than other residencies, but I have heard of several psyche programs also overworking residents.

Not psychiatry, but a buddy of mine was interviewed at an Ob-Gyn program. The program told him upfront that he would be working over 80 hrs a week--on the order of 100-120. They said that one of the criterion to be ranked was during interview, the applicant had to say they understood & would accept this. Of course my friend could've been making the story up, but I've heard enough & seen enough of these types of cases.

And I've also seen my fair share of attendings get upset with ACGME's moves to reduce work hours, all mentioning how in the good old days they worked 100 hrs a week, and how they were not going to follow ACGME's rules. My own program is following ACGME guidelines, but during medschool, I've seen several that were not.

 

[Faebinder]

Programs get around the 80 hour rule by making call as "Home Call". Despite the fact that you can be woken up 10 times a night (happened to me) for complete BS (which is expected) and some serious issues, it is not counted towards the working hours.

How do you know a program will break the 80 hour rule? They will ask you at the interview or some point before the match of your thoughts about the 80 hour rule.

Psychiatry and the rest of the life style specialties doesn't suffer this abuse as often/much.

 

[nancysinatra]

You could classify the 7 years of med school + residency as a long traumatic event.

Has anyone ever studied the traumatizing effects of medical education? Just from some of the comments here--such as residents fearing backlash from their programs for following rules (and it's not like this is some anarchist colony we've joined--we're indoctrinated to FOLLOW rules when it comes to patient care, but somehow we're supposed to know to BREAK the ones that apply to schedules and work hours??), or programs being hotbeds of gossip, or attendings belittling the newer generation by bragging about the good ol days (which I'm sure weren't really so great--just look at the amount of polyester they wore)--I can't imagine some well-intentioned students or residents don't get a little churned up in the process!

We had a lecture from the chair of Ob/Gyn about the different ways organizations can respond to criticism and problems. The best way was a kind of utopian democracy where the administration was open to hearing new ideas and followed up on trying to fix things, and made its expectations of people clear. The worst way was a "postmodernist" type regime in which there was no relationship between the "rules" and what was truly expected of people. Ten minutes after leaving this lecture, I got yelled at by a chief resident for telling him that I couldn't go to the OR because our course director was REQUIRING me to go to clinic. He told me I was in violation of HIS rules and would have to deal with the consequences. Oh well, I love these moments where the lowly med student suddenly becomes oh-so-important to everyone in the hospital! If I'm not in 2 places at once, I'm in trouble! ;-) But talk about mind games.