Physicians with Mental Illness

[frescanese]

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What kind of disclosure must physicians make if they have mental illness? (eg, when applying for residency, when getting a license, when getting privileges at a hospital)

I heard from an IM Chief at one of our hospitals that they ask questions about past depression and past treatment for mental illness when applicants apply for residency positions.

(I searched the forums and didn't find anything on this, so sorry if this has already been discussed.)

 

[Annette]

There have been several threads on this before. But there are also thousands of "do I have a chance" threads as well.

I was never asked about mental illness for residency or job/ credentialing. States vary on the language they use in asking. Most are looking for the more serious mental illnesses such as schizophrenia. You can check out the questions on the licensing forms. (try www.fsmb.org for links). Your experience may differ, but I wouldn't worry about it too much. There are a large number of physicians who have delt with personal mental illness.

 

[buckley]

this is a very sensitive issue i think. there's a particular book that i like called "wounded healers"...it's a compilation of essays from people working in the medical field and many of them express how they feel the need to hide and suppress their symptoms of depression because it would be such a career-blow. i have a friend in medical school who took a leave of absence for depression. she never came back. honestly, she said she felt she couldn't anyway because the stigma would always be there. she's happier where she is now anyway, but what she said made me think. don't you guys find it odd that being a physician is a risk factor for depression and yet it's stull a taboo to be a depressed physician? sometimes the superego white coat is just too much...

 

[Kubed]

...there's a particular book that i like called "wounded healers"...

Hey Buckley, this sounds like a great read. Are either of these books the one you are referring to?
http://www.amazon.com/Wounded-Heale...bs_sr_2?ie=UTF8&s=books&qid=1198910891&sr=8-2
http://www.amazon.com/Wounded-Heale...=sr_1_4?ie=UTF8&s=books&qid=1198910891&sr=8-4

 

[Winged Scapula]

There ARE several states that DO ask about mental illness and whether or not it has affected your ability to work or whether you've been treated for it in the past.

In addition, you may expect to be asked these questions when you go through credentialing for admitting privileges.

Unfortunately, the questions are vague, they do now specify what they mean by "mental illness". I would presume they mean illness which include thought disorders but they *may* mean depression, ADHD, ADD, Bipolar, etc. Frankly, I don't know what they are asking for but as others note, things like depression, anxiety, drug/ETOH abuse are fairly common and while it may delay your application, generally it doesn't prevent you from being licensed or credentialed (unless you harmed someone while ill).

 

[Ypo.]

this is a very sensitive issue i think. there's a particular book that i like called "wounded healers"...it's a compilation of essays from people working in the medical field and many of them express how they feel the need to hide and suppress their symptoms of depression because it would be such a career-blow. i have a friend in medical school who took a leave of absence for depression. she never came back. honestly, she said she felt she couldn't anyway because the stigma would always be there. she's happier where she is now anyway, but what she said made me think. don't you guys find it odd that being a physician is a risk factor for depression and yet it's stull a taboo to be a depressed physician? sometimes the superego white coat is just too much...

Wow. I think that's a bit much. No offense to your friend, but I think the stigma is mostly in her head.

It would be hard today to find someone whose life has been untouched by depression in some way.

 

[Winged Scapula]

Wow. I think that's a bit much. No offense to your friend, but I think the stigma is mostly in her head.

It would be hard today to find someone whose life has been untouched by depression in some way.

Agreed...the incidence of clinical depression and the use of anti-depressants is very high in the medical profession. Many, many of my colleagues used them during residency.

While there might be some bitter feelings (dependent on the program and the individual) about taking time off during residency, if one feels the need they should. It was the best thing I ever did for myself. I was fortunate to have supportive colleagues and never felt any "stigma" - and even for those who thought I wouldn't come back and were perhaps more negative about it, it was not enough to keep me from doing what I wanted; I was welcomed back. I think your friend is overstating the case of stigma amongst her colleagues...it was likely SHE who felt it, not the others and if she really was prepared to go back, she would have, regardless of what the others may or may not have felt.

 

[buckley]

Hey Buckley, this sounds like a great read. Are either of these books the one you are referring to?
http://www.amazon.com/Wounded-Heale...bs_sr_2?ie=UTF8&s=books&qid=1198910891&sr=8-2
http://www.amazon.com/Wounded-Heale...=sr_1_4?ie=UTF8&s=books&qid=1198910891&sr=8-4

I've heard about Nouwen and I will check him out. These books seem right on the money too, but the book I'm talking about is called "Wounded Healers"--it's published in the 90's, published by Lippincott I think...I just got it off a 2nd hand bookstore, but it has a navy blue cover. Many of the authors are anonymous physicians/psychologist/nurses--which makes me "believe" it more... I'll look it up when I get home, ok?

 

[buckley]

Wow. I think that's a bit much. No offense to your friend, but I think the stigma is mostly in her head.

It would be hard today to find someone whose life has been untouched by depression in some way.

maybe...but that was the way she felt...and to be honest, I think she does have some basis. unfortunately, depressed people aren't the most compassionate towards other depressed people. then again, i agree that it is a case-to-case basis. i was simply illustrating how the stigma affects people

 

[buckley]

Agreed...the incidence of clinical depression and the use of anti-depressants is very high in the medical profession. Many, many of my colleagues used them during residency.

While there might be some bitter feelings (dependent on the program and the individual) about taking time off during residency, if one feels the need they should. It was the best thing I ever did for myself. I was fortunate to have supportive colleagues and never felt any "stigma" - and even for those who thought I wouldn't come back and were perhaps more negative about it, it was not enough to keep me from doing what I wanted; I was welcomed back. I think your friend is overstating the case of stigma amongst her colleagues...it was likely SHE who felt it, not the others and if she really was prepared to go back, she would have, regardless of what the others may or may not have felt.

yes, i also have many friends who took a year off and then came back. she was my closest friend, and the only one who did not come back. like i said, she is happy now where she is. and though it was a huge blow to me when she quit, in the end, i am happy for her still.

im happy to hear the US seems more compassionate towards ailing doctors.

 

[docB]

I believe programs (and employers, licensing boards, credentialing comittees, etc.) are allowed to ask if you will be requesting an accomodation under the ADA or if you have required such accomodations in the past. In theory they are then not allowed to discriminate against you based on your answer.

 

[michaelrack]

I have applied for (and received) several state medical licenses as well as staff privileges at multiple hospitals. All have asked about history of psychiatric illness, though the exact questions vary. IF you are applying for a job at a hospital, the application form will not have any psych questions (due to ADA, etc), but the application for staff privileges will- there's no way to get around it- you can't get a job at a hospital without staff privileges.

Here is the question on the Mississippi medical license application:

"Have you ever been diagnosed as having, or have you ever been treated for, pedophilia, exhibitionism or voyeurism, bipolar disorder, sexual disorder, schizophrenia, paranoia, or other psychiatric disorder?"

Being treated for psychiatric illness won't necessarily prevent you from practicing medicine, but you'll have to submit extra paperwork when applying for licensing and privileges. There is a good chance you will be discriminated against. ADA doesn't apply to licensing boards. I don't think (but I'm not sure about this) that it applies to getting hospital privileges.

 

[SippiGirl08]

IHere is the question on the Mississippi medical license application:

"Have you ever been diagnosed as having, or have you ever been treated for, pedophilia, exhibitionism or voyeurism, bipolar disorder, sexual disorder, schizophrenia, paranoia, or other psychiatric disorder?"

so are we supposed to interpret "other psychiatric disorder" to include depression, even though i'm sure none of us would include it on the same spectrum as pedophilia or sexual disorders?

 

[Winged Scapula]

so are we supposed to interpret "other psychiatric disorder" to include depression, even though i'm sure none of us would include it on the same spectrum as pedophilia or sexual disorders?

I believe that is where the confusion comes in. No one knows and I'd venture most people would say no in the context in which it is asked. But it is vague.

If in doubt, you can ask licensing boards and hospital boards where you are applying.

 

[DocNusum]

... [brevity edit]... sexual disorders...???

Yeah... pretty vague...
Does ED or Dyspareunia count... ???🙄🙄🙄

 

[frescanese]

"Have you ever been diagnosed as having, or have you ever been treated for, pedophilia, exhibitionism or voyeurism, bipolar disorder, sexual disorder, schizophrenia, paranoia, or other psychiatric disorder?"

1) Anyone have personal experience on dealing with this sort of question and / or the discrimination that might come with answering 'yes'?

2) I know one of the psychiatrists at my school has tried to remove this sort of question from applications. (I just wasn't sure at what leg of the process it came up--thanks guys.) People know about it and it could very well prevent someone from seeking treatment.

Sorry to beat a dead horse, but if anyone has personal experience (#1), I'd be interested in hearing about it.

Thanks again.

 

[McDoctor]

"depression" is not necessarily a psychiatric disorder. A number of mood disorders are described in the DSM-IV, including Major Depressive Disorder (with various modifiers and subtypes), Bipolar Disorder (again various modifiers/types) among other things. Being told you have "depression", usually by a primary care doctor, does not necessarily qualify as a psychiatric disorder.

If someone is formally evaluated by a psychiatrist and they meet specific diagnostic criteria specified by the DSM-IV, and are given a specific DSM-IV diagnosis, then perhaps they should answer "yes". If someone has vague constitutional and emotional symptoms, and are prescribed an SSRI after a 10 minute office visit by a family doctor for "depression", then this person in my opinion should realistically answer "no".

My opinion. I'm not a lawyer. (I don't mean to brag.)

 

[MossPoh]

"Have you ever been diagnosed as having, or have you ever been treated for, pedophilia, exhibitionism or voyeurism, bipolar disorder, sexual disorder, schizophrenia, paranoia, or other psychiatric disorder?"

That question seems a bit ridiculous. I have depression and a question like that would MAKE me want to lie. You can't talk about pedophilia, schizophrenia and then go "Oh yea, and every other psychiatric disorder. We have to be safe!".

I can understand parts of that statement, but it is such a case by case thing. I get low energy, have trouble focusing, and all that stuff....I don't look at child porn, talk to thin air, or go streaking through the quad. I'd hope that this would be the one field where they have a basic grasp of depression. There still is a stigma with it (I got denied an ROTC scholarship because I didn't lie about it), but not as much in medicine from what I've seen. I know about 10 doctors in private practice that openly admitted to going on anti-depressants to me.

 

[Blade28]

"depression" is not necessarily a psychiatric disorder. A number of mood disorders are described in the DSM-IV, including Major Depressive Disorder (with various modifiers and subtypes), Bipolar Disorder (again various modifiers/types) among other things. Being told you have "depression", usually by a primary care doctor, does not necessarily qualify as a psychiatric disorder.

That's an excellent point, and bears repeating.

Having a single event of a major depressive episode DOES NOT equal a "psychiatric illness"!

 

[eforest]

Those who answer "yes" to having been diagnosed/treated with a mental illness are less of a threat than those who are mentally ill and who don't realize it or haven't been treated.

I think the stigma is lessening somewhat. I've had personal experience with mental illness and while I don't advertise it (this is not my real name obviously) those who do know (in the field of medicine) have only been supportive.

 

[Shalom77]

I would disagree - Having a major depressive episode certainly = having had a psychiatric illness. Doesn't matter whether it was treated by a PMD or psychiatrist.

I agree with eforest - better that someone has been treated than those people who avoid treatment.

Norm Fost, Peds professor wrote into JAMA:

When asked to respond to written questions regarding psychiatric problems or treatment I left the space blank and attached the following: "All of our residents and faculty have emotional problems. Some are sensible enough to seek professional help. If I believed Dr X's problems interfered with his/her ability to perform the duties of the position he/she is applying for, I would tell you."

 

[Blade28]

I would disagree - Having a major depressive episode certainly = having had a psychiatric illness. Doesn't matter whether it was treated by a PMD or psychiatrist.

Really?

But many people may have had a major depressive episode at least once in their life. Besides "SIG E CAPS," it only has to last for 2 weeks to meet the DSM-IV TR criteria. Many such people DON'T seek treatment (psychologist, psychiatrist, medications, therapy, counseling, etc.) and are fully functional throughout. May happen after a tough breakup, loss in the family, divorce, firing from a job, etc.

Would these people be considering as having a past medical history significant for psychiatric illness? I'd wager that many physicians, if posed this question, would emphatically answer "no."

Just my $0.02.

 

[medicinesux]

I wonder if I am ethically obligated to report some of the mentally ill physicians I work with on a daily business?😕

 

[docB]

I wonder if I am ethically obligated to report some of the mentally ill physicians I work with on a daily business?😕

Personality dosorders don't count😉.

 

[Shalom77]

Really?


Would these people be considering as having a past medical history significant for psychiatric illness? I'd wager that many physicians, if posed this question, would emphatically answer "no."

Just my $0.02.

I would definitely answer yes.

Part of decreasing the stigma of mental illness is recognizing that many people have had a mental illness at some point in their lives. It's as normal to experience a mental illness as a physical one. I agree psychiatric illnesses are common. A single episode of major depression (treated or not) counts.

It's part of the past medical history. Having had a prior episode of major depression does put one at increased risk for a future one.

 

[McDoctor]

"depression" is a nonspecific diagnosis of convenience for many family doctors and internists. This is probably best thought of as a symptom or non-specific descriptive term, unless a formal evaluation is undertaken (requires at least 30 to 60 minutes, with perhaps several follow up visits, ideally by a psychiatrist) and a specific DSM-IV disorder applies.

If everyone checks yes who ever had a bad day in their life and was sloppily prescribed an SSRI by a primary care doctor, the licensing board will have a much harder time identifying high risk physicians, those with profound mood disorders potentially affecting patient safety.

 

[Shalom77]

I disagree.

Just because someone has sought appropriate psychiatric care doesn't make them "high risk"

The only thing the board questions separate is those who have sought appropriate care and those who haven't.

Those who haven't are allowed to continue practicing unstigmatized (who may actually represent a greater risk) and those who have are stigmatized.

That makes no sense whatsoever.

If diagnosed with depression by a physician - I would think that both legally and ethically one should mark yes. Obviously if never formally diagnosed or if one has never sought treatment - there's no way for the board to discover the "lie."

But I don't think boards should be asking about treatment for mental illness at all. I think they should just ask about whether an illness that IMPACTS ones ability to practice.

That way doctors can be free to seek the most competant care without being unfairly stigmatized or forced to reveal private details that have no impact on their ability to practice.

As I said one way to reduce stigma is to recognized that mental illnesses are very common. They should not be treated differently from physical ones form a medical board perspective. Significant physical illness can also clearly impair ones ability to practice. Boards should focus on impairment not the presence or absence of a diagnosis.

 

[BrokenDoctor]

"Have you ever been diagnosed as having, or have you ever been treated for, pedophilia, exhibitionism or voyeurism, bipolar disorder, sexual disorder, schizophrenia, paranoia, or other psychiatric disorder?"

1) Anyone have personal experience on dealing with this sort of question and / or the discrimination that might come with answering 'yes'?

2) I know one of the psychiatrists at my school has tried to remove this sort of question from applications. (I just wasn't sure at what leg of the process it came up--thanks guys.) People know about it and it could very well prevent someone from seeking treatment.

Sorry to beat a dead horse, but if anyone has personal experience (#1), I'd be interested in hearing about it.

Thanks again.

I have had experience with this problem, unfortunately. Your fears about professional stigma and discrimination from medical licensing boards are well-founded.

I have been treated for depression for many years. When my state medical board found out (I reported it myself after taking a brief medical leave of absence), they chose to publicly discipline me simply for getting sick. In my case, there have never been any allegations of misconduct, incompetence, or practicing while impaired. Overall, this has been the most humiliating experience of my life. The professional damage is staggering and irreversible.

In 2007 the Journal of Medical Licensure and Discipline (the official quarterly publication of the Federation of State Medical Boards) published a revealing article entitled "Licensing and Physician Mental Health: Problems and Possibilities". http://spiorg.com/publications/Journalvol93no2_Hendin.pdf
This article reports that a significant number of medical licensing boards consider the diagnosis of mental illness by itself to be sufficient reason for sanctioning physicians, even without evidence of impairment or misconduct.

So, my advice to you would be to NEVER EVER EVER admit to your licensing board anything that could even remotely be considered mental illness. Until the professional stigma of mental illness is squarely addressed by organized medicine, your honesty will only get you in trouble.

 

[docB]

I have had experience with this problem, unfortunately. Your fears about professional stigma and discrimination from medical licensing boards are well-founded....
...So, my advice to you would be to NEVER EVER EVER admit to your licensing board anything that could even remotely be considered mental illness. Until the professional stigma of mental illness is squarely addressed by organized medicine, your honesty will only get you in trouble.

This is just an extraordinary post and I think it has summed up better than I've ever seen the destructive nature of the current, predominant system for dealing with physician impairment. It speaks very poorly of our profession when someone in all sincerity and based on their experiences has to advise others to hide their illness out of fear.

 

[Shalom77]

So, my advice to you would be to NEVER EVER EVER admit to your licensing board anything that could even remotely be considered mental illness. Until the professional stigma of mental illness is squarely addressed by organized medicine, your honesty will only get you in trouble.

I would not follow this advice without consulting a) one's treating physician b) a lawyer familiar with the consequences of deliberately providing false information on a license application.

If there's a record of having been treated for a psychiatric illness (either by a psychiatrist or primary care doctor/internist) even if it's just one episode of major depression - then I think the consequences for providing false information on a license if it were discovered are greater than the consequences for admitted to having been treated for a mental illness - particularly if your physician can say that it has no impact on your ability to practice medicine.

Yes I agree there is considerable stigma - but more effective than encouraging everyone to lie is to fight to change the question of those states that ask just about diagnosis and not whether the person was impaired. There was a physician in Minnesota that successfully fought the state medical board (who wanted access to his psychotherapy notes) and I think both the question and the requirements of documentation were changed.

 

[worryman]

I would not follow this advice without consulting a) one's treating physician b) a lawyer familiar with the consequences of deliberately providing false information on a license application.

If there's a record of having been treated for a psychiatric illness (either by a psychiatrist or primary care doctor/internist) even if it's just one episode of major depression - then I think the consequences for providing false information on a license if it were discovered are greater than the consequences for admitted to having been treated for a mental illness - particularly if your physician can say that it has no impact on your ability to practice medicine.

Yes I agree there is considerable stigma - but more effective than encouraging everyone to lie is to fight to change the question of those states that ask just about diagnosis and not whether the person was impaired. There was a physician in Minnesota that successfully fought the state medical board (who wanted access to his psychotherapy notes) and I think both the question and the requirements of documentation were changed.

Excellent point, but how can one fight the state boards anonymously? I am a medical student that is dreading the day I have to fill out the forms. My state asks specifically about mental illness treatment and not about competency.

 

[worryman]

Kimberli Cox,

If you dont mind me asking, how did you go about reporting your leave time?
Thanks!

 

[Winged Scapula]

Kimberli Cox,

If you dont mind me asking, how did you go about reporting your leave time? Thanks!

I think you are presuming too much here that may or may not necessarily apply to me. Since I use my real name here, I am not willing to divulge all the reasons on an anonymous BB which can be easily accessed by patients or licensing boards.

Nonetheless, I took time off for many reasons, but not the least of which was the death of a close family member.

My program director had to document that I took time off for the reasons that I said I did, but no other documentation was required beyond that (ie, no proof of death, physician note, etc.).

Unrelated but amusing given the discussion:

one of the hospitals I am applying to for privileges wants me to document the time gap between medical school and starting residency. If you are off for more than 3 months, they require it.

No big deal, I simply wrote that I moved home, laid on my parent's couch and sponged off them for a few months (since in Oz we finish in January). The hospital wanted a letter of verification from someone who could verify that's what I was doing. I wrote back, "do you want me to have my Mum call you and tell you I was a lazy bugger lying about her house, because she's the only one that could 'prove' it?!"

At any rate, when you take time off during residency, or more than 90 days off between med school and residency or residency and practice (which I also did), you have to document it and provide a source verification of your statement. It just generally needs to be someone who will sign a form that says, "yeah that's what they did." For you, it depends on how much you wish to divulge but the state of Arizona did not ask for more than the above.

 

[Blade28]

No big deal, I simply wrote that I moved home, laid on my parent's couch and sponged off them for a few months (since in Oz we finish in January). The hospital wanted a letter of verification from someone who could prove verify that's what I was doing. I wrote back, "do you want to have my Mum call you and tell you I was a lazy bugger lying about her house, because she's the only one that could 'prove' it?!"

Ah, moms. Gotta love 'em.

 

[McDoctor]

I disagree.

Just because someone has sought appropriate psychiatric care doesn't make them "high risk"

The only thing the board questions separate is those who have sought appropriate care and those who haven't.

Those who haven't are allowed to continue practicing unstigmatized (who may actually represent a greater risk) and those who have are stigmatized.

That makes no sense whatsoever.

If diagnosed with depression by a physician - I would think that both legally and ethically one should mark yes. Obviously if never formally diagnosed or if one has never sought treatment - there's no way for the board to discover the "lie."

But I don't think boards should be asking about treatment for mental illness at all. I think they should just ask about whether an illness that IMPACTS ones ability to practice.

That way doctors can be free to seek the most competant care without being unfairly stigmatized or forced to reveal private details that have no impact on their ability to practice.

As I said one way to reduce stigma is to recognized that mental illnesses are very common. They should not be treated differently from physical ones form a medical board perspective. Significant physical illness can also clearly impair ones ability to practice. Boards should focus on impairment not the presence or absence of a diagnosis.

I don't think having sought out psychiatric care necessarily qualifies as high risk either. That's not for me to determine.

The population of the respective state, and more specifically the state's legislature, determines how to license physicians. Probably, the way physicians answer the question has little impact. Many fall through the cracks I'm sure. Many are unfairly stigmatized as well. My advice was intended to prevent the latter. The questions are intended to identify physicians with severe recurrent disorders which jeopardize patient safety. This should not apply to people characterized as "depressed", and rather should refer to those with a pattern of disability as a result of a more specific physical or mental illness. At least until a better system can be formulated.

The physicians of each state can organize to police themselves, and form internal monitoring programs within their own state medical society. My state has a separate monitoring program carried out by the PA Medical Society. Probably not by coincidence, PA licensure is not as intrusive as other states in asking about mental illness.

I think in many ways we are on the same page, just that we are interpreting the question differently.

 

[worryman]

I think you are presuming too much here that may or may not necessarily apply to me. Since I use my real name here, I am not willing to divulge all the reasons on an anonymous BB which can be easily accessed by patients or licensing boards.

Nonetheless, I took time off for many reasons, but not the least of which was the death of a close family member.

My program director had to document that I took time off for the reasons that I said I did, but no other documentation was required beyond that (ie, no proof of death, physician note, etc.).

Unrelated but amusing given the discussion:

one of the hospitals I am applying to for privileges wants me to document the time gap between medical school and starting residency. If you are off for more than 3 months, they require it.

No big deal, I simply wrote that I moved home, laid on my parent's couch and sponged off them for a few months (since in Oz we finish in January). The hospital wanted a letter of verification from someone who could prove verify that's what I was doing. I wrote back, "do you want to have my Mum call you and tell you I was a lazy bugger lying about her house, because she's the only one that could 'prove' it?!"

At any rate, when you take time off during residency, or more than 90 days off between med school and residency or residency and practice (which I also did), you have to document it and provide a source verification of your statement. It just generally needs to be someone who will sign a form that says, "yeah that's what they did." For you, it depends on how much you wish to divulge but the state of Arizona did not ask for more than the above.

I sincerely apologize for writing (assuming) depression on my previous post. I had been reading the other posts and had it on my mind. I am editing my above post to be more applicable.
Again, Im sorry and thank you for your response.

 

[vizslaky]

Does anyone have a list of state medical licensing boards that don't require disclosure of mental illness?

 

[worryman]

I know NY and Michigan dont. I think there are 5 others.

 

[rednucleus]

Attemtping to limit your practicing options based on disclosure is not a wise move in my opinion. In the future,applications can chan their questions and many malpractice insurances and hospital credentialing ask thesequestions. In think that different states vary. Many offer voluntary programs but you have to be involved with an approved provider.You have to have some type of monitoring. What I have seen answering yes to any question on a licensing application will require some evaluation by the board. The boards have the duty to protect the public and consider having a medical license a privilege. If the board was made aware of some potential problems and did not act and then something major happened that was associated with possible impairment things would get really bad. The downside to getting involved in some type of apporved treatment is that while very effective it is very time-consuming and expensive. If you are involved in a voluntayr program public disclosure does not occur. I have seen some very saavy people in this situation get involved with some intensive outpatient or even individual treatment before making the boards or impaired physician group aware. Usually if a person has been in this treatment and cleared by an approved clinician, residential treatment can be skipped. Be careful though as commitments to these programs are long-term. This is just my opinion.

 

[worryman]

what programs are you talking about

 

[rednucleus]

Impaired Physician Programs; almost every state has one. Most physicians are in them for substance abuse/dependency but many have a program for mental illness. Many medical boards work with these programs and let them case manage. Every state program does have its own requirements and conditions but most would require an initial assessment. To be honest if a person was evaluated and found not to have active depressive symptoms and no history of what are considered the more serious mental illnesses such as bipolar disorder, schizophrenia or borderline PD I could see a person being cleared. If there was some treatment needed they do usually send a person to a residential program that is intensive. After getting treatment at least in my state they require monitoring with documentation of regular therapy/psychiatry appointment and work monitoring. If the board is involved they may have you sign an agreement which basically states that as no formal disciplinary action will occur to your license as long as you stay with the program requirements. After a period anywhere from 3-5 yrs you're finished. The whole idea is that any potential problems are evaluated and addressed if needed. I also know that some states are not as concerned with mental illness as with substance abuse. ADA does play a piece in all of this. As long as you get treatment and are not actively impaired no one should be able to discriminate against you. That being said its not a perfect world. It's difficult to give specific advice because it's hard to know where a person is at without an evaluation. I think if you talked anonymously with the impaired physician program in your state that might give you a better idea what might be required. Also you if you have questions about how to fill out paperwork involving these questions they may be able to direct you in the direction of an attorney that has experience in this area. ( I think that a lot of physicians get themselves into trouble by not seeking out legal advice in these situations) If you get treatment on one's own as opposed to being forced after a patient's complaint or other bad consequence the medical boards, providers and hospitals look favorably. Moreover, you are really protected by the ADA.

 

[Doowai]

I have been treated for depression for many years. When my state medical board found out (I reported it myself after taking a brief medical leave of absence), they chose to publicly discipline me simply for getting sick. In my case, there have never been any allegations of misconduct, incompetence, or practicing while impaired. Overall, this has been the most humiliating experience of my life. The professional damage is staggering and irreversible.

Wow. That really sucks. Sorry that happened to you. Besides humiliating someone, it might also really anger some. That sort of censure for seeking help is really shameful.

 

[worryman]

I thought the ADA doesnt necessarily apply to licenses.
How often do you think physicians with less severe diagnoses who are being treated have to go through these programs. It seems like a waste of money and effort for licensing boards to make someone being treated for anxiety or depression go for even an evaluation. (Im talking about states that ask only about treatment for a mental illness and not impaired ability).

 

[Doowai]

It would seem a doctor being treated for anxiety after a near fatal car wreck or depression after the death of a spouse, is certainly less of a risk to the general public than a doctor with a history of DUI's. In the first situation the board should not penalize these doctors and in the second Mike Vick should get to treat them like a losing fighting dog. In fact I would worry about the competency of a doctor who did not suffer deep depression after the death of a spouse.

 

[McDoctor]

I thought the ADA doesnt necessarily apply to licenses.
How often do you think physicians with less severe diagnoses who are being treated have to go through these programs. It seems like a waste of money and effort for licensing boards to make someone being treated for anxiety or depression go for even an evaluation. (Im talking about states that ask only about treatment for a mental illness and not impaired ability).

This is why a distinction needs to be made between "depression" as commonly diagnosed in primary care, and mood disorders ad defined by the DSM-IV. Observationally, every 3rd or 4th patient I see is on, or at some point was prescribed, an SSRI from a prior physician (I am estimating off the top of my head). Much less common, I encounter a patient who has a pattern of disabling depression, with perhaps at least one hospitalization. This is the type of person who should be answering "yes".

The typical patient diagnosed with depression or anxiety has "symptoms of life", and was given a diagnsosis for a number of reasons, in part due to pharmaceutical industry influence, and in part due to the fact that fee for service does not reimburse unless a diagnosis is applied. Many patients who are prescribed an SSRI are self-diagnosed, and ask for the medication themselves. Primary care is busy and underappreciated, and I myself am guilty of this practice. My hope is that this action does not limit that type of patient's ability to pursue the career of their choice.

 

[Shalom77]

I think the issue is not so much overdiagnosing primary care doctors (who I think on the whole are much more likley to underdiagnose and undertreat). And psychiatrists do see people with situational depression as well. The real problem is the DSM itself which as Blade pointed - it's really not that hard to meet the criteria for an episode of major depression. Actually I think a lot of primary care doctors are less likely to code for a mental illness rather than physical symptoms because of the lack of reimbursement of "mental illnesses" They won't get paid for the visit with a psychiatric code but will if they code some physical symptoms.

That's another reason it always pays to talk to your treating physician.

There was an interesting article in JAMA a few years back that proposes distinguishing mental disorders into 4 categories one of which was those arising from difficult life situations (as opposed to those arising from "brain diseases," , or longstanding, fixed "maladaptive behaviors" and those with vulnerability because of "pschological make-up")

http://jama.ama-assn.org/cgi/content...urcetype=HWCIT

Regardless of what you think of his categories, one of his points was that "depression" and "anxiety" are really symptoms like cough and fever not diseases in themselves - the question is symptoms of what?

That's why those states that ask about disorders that result in impairment to practice medicine - have the right idea - that pretty excludes many with more benign anxiety disorders, 1 time episode of major depression that has long responded to treatment, etc. There's really no reason for the medical boards (or hospitals) to know about any illness mental or physical that does not impair functioning.

If you count states that only ask about impairment there are a lot more than 5 that don't require a disclosure of a diagnosis mental illness. Those states only require disclosure of mental (and physical) illnesses that cause impairment.

 

[Shalom77]

somehow I double posted.

 

[Leforte]

I agree with Brokendoctor -

Dislosure of a mental illness to a licensing board will cause them to investigate. Some states require that you send them treatment records, others that you see one of their mental health professionals for an evaluation. This can lead to enrollment in a physicians health program. Some require that you present yourself to the board to obtain a license - and this in itself is a reportable event. Nearly all applications for licensure, privileges, etc ask if you've ever been ask to be seen in front of a medical board and then explain the circumstances.

As far as impairment - I've seen some crazy things in internship/residency. In internship, there was the resident who needed an IV on Sunday am, because he was so dehydrated from the previous nights partying (how much do you want to bet his BAC was high). There was another who came into rounds an hour late, as we were getting ready to place a chest tube, took the case (he was an R3) - when we were finished an having breakfast, it reeked of EtOH - the resident then indicated that he was still buzzed (He got a lashing from the Chief, but that was about it). I've also seen a resident who self reported for alcohol, go off to treatment, have no impairment issues, but now is having difficulty getting a license in another state (he's trying to go to Cali, but they won't license him as they are discontinuing their physicians health program). There have also been Bipolar attendings, another who flipped out when he found out his wife was cheating on him and got arrested for confronting the other male attending in the same department (the husband subsequently lost his privileges once it became news on the local TV stations).

So, yes, disclosure can be a career altering move. Doesn't mean you won't get a job, but you'll have (as Ricky Ricardo would say), "some 'splaining to do!" Also, I would wonder about plaintiffs attorney's access to your licensure application in the disclosure for a malpractice suit - "Well doctor, you have a history of depression - were you depressed and distracted from the care of your patient when you did X and permanently disabled my client? You weren't? Were you on an antidepressant? No? So you have a history of mental illness and were not being treated for this, is that what you are saying?"

My advice, seek legal counsel from an attorney who deals with representing physicians in front of the board. It is well worth the 5k you'll spend in attorney fees.

 

[rednucleus]

I could see some boards not being that concerned with physicians with "minor" mental illnesses that are not currently active particularly if there have been no symptoms for many years (>yrs). It's also possible that if involvement in an impairment program was recommended it may be just for monitoring. One possibility would be to get an evaluation preferably from a reputable psychiatrist (one that boards use) and that would state that no impairment exists and no additional treatment or monitoring is needed. I would think that if you reports mental illness on an application the board is obligated to make sure a person is fit to act as a physician. If you sent the report with the application you might not have to anything additional. Again talking anonymously to an impaired physician program might give you some good advice. If you don't like what they say ask them for the name of an attorney that deals with these issues. I have seen Personal Data Information forms that they use in Pennsylvania. The questions focus on things like bipolar disorder, schizophrenia, and psychotic disorders as well as suicidality. They do ask questions about prior treatments and medications but are not the focus. I think when you hear about physicians getting disciplined for mental illness there is more to the story than just having a mental illness; most boards and medical societies want doctors to get help and understand that conditions like mental illness or substance abuse are very treatable and doctors that get the right help do very well. If a person lies on an application or doesn't get help and patients get hurt then disciplinary action occurs. You could look through the various disciplinary actions in your state and what I have seen is rarely does a physician lose their license for mental illness; it if far more common to lose a license for not following a voluntary agreement or providing false/misleading information. Most state medical boards have a list those publicly disciplined. Anyone in a voluntary program has confidentiality and no public disclosure. Probably 30% of physicians will suffer some mental illness in their lifetimes and probably 20% of physicians will meet criteria for some form of substance abuse/dependence. Society could not afford to lose this amount of physicians. Moreover, studies have been done mainly with substance abusing physicians that proper treatment can have an over 90% success rate. Boards and medical malpractice insurers are satisfied with this. The best source may be a physician in your state that has had some interaction with the boards after disclosing a minor mental illness. My sense from reading these posts is that this is really troubling you. I would think that if you don't disclose on an application or get solid reassurance you will worry yourself too much. The trouble with these forums is every state differs in handing these situations and second hand information might not be accurate.

 

[worryman]

My prescribing physician has told me multiple times that I do not need to report anything on the licensing application.
However, I anonymously emailed my situation to my state's licensing board. Of course, they said I do have to report it.

Do you think I have plausible deniability in not reporting because my physician told me I dont have to? I know this is more a question for an attorney, but I wanted to get your opinions...
Thanks