Quoted: History of depression and licensing question

[Doodledog]

We'll see what aPD and others say. My inclination would be for you to discuss this with your PD.

Hello. I am about to begin my Psychiatry Residency, and have a history of depression myself. (Well-controlled with medication times many years, has NOT affected my academic progress or "professional persona" during medical school, etc.)

I had always heard the license apps would ask us if we had any condition that would prevent us from safely practicing medicine, and had long ago decided I could say "no" in good conscience because I have been very compliant with treatment and have been very stable for over a decade (since I first began treatment); as the meds have kept things in check so well for so long (includilng through many periods of lifes assorted stressors) I don't really see the condition spiraling out of control in the future...

I now have some licensure paperwork to fill out, and the specific question I'm being asked is "Have you ever been diagnosed or treated for any mental or physical illness or condition that has hindered or might serve to hinder your ability to practice medicine?" I'm now facing a "crisis of conscience" wondering how far I should carry the interpretaton of "might serve to hinder" in how I answer this question. Realistically, do I think it is a problem? No. But on some statistical, theoretical basis, MIGHT it serve to hinder my abilities - well, sure, there's always some certain level of risk there, but I'd say it's pretty low. I don't want to lie, but I don't want to disclose more than I need to (or more than is professionally wise for me to disclose). (Any reasonable person would probably answer this question as "no" - but I am unfortunately honest TO A FAULT [and often to my own detriment] so I just needed to bounce this off of someone.

(Some arguments I'm trying to make with myself:
(1)I've read something like 25% of med students suffer from depression at some point during med school. But most of them don't get help. Are the ones who never got a formal dx going to disclose anything? Probably not. But if anything, they might be an even HIGHER liability than *I* am since I have been so compliant with medication.
(2)RE: the idea of "MIGHT" hinder... I also have a little bit of carpal tunnel syndrome (NOT formally dx'd). "MIGHT" that flare up at some point to become so debilitating that it would interfere with my "ability" to practice medicine - perhaps requiring me to take some time off to recuperate, etc.? Yes, it MIGHT. But it's highly unlikely, and I don't feel the least bit bad about not "disclosing" my carpal tunnel. (I think this must have something to do with the distinction we tend to make between "mental" and "physical" illnesses.)

So - in brief - my question is:
(1)Do I disclose on the app
-and-
(2)Should I perhaps call my future program director for advice on this issue? It's not really the way I want to "start things off" - I don't want to forever be known as the "depressed" resident and any time I'm in a slightly bad mood people are going to attribute it to my "depression" or be tiptoeing around me on eggshells for fear they might do something to send me over the edge...
(Yet, I do think I'll have to disclose this to my PD at some point early on because the health plan for all the residencies where I'll be working is through the hospital's own health-care system. And I am definitely going to need to find out about how to get mental health care for myself OUTSIDE of the system. [ie - I don't want my personal physician to end up being my supervising attending on some future rotation (!)] I guess I just didn't think disclosing my medical hx was going to have to be my FIRST communication with my future PD - I really don't want to start things off on the "wrong foot", so to speak.

Thanks in advance - any and all input is appreciated. Unfortunately, I have to fill this form out SOON, I hope you'll be able to provide some advice in time...

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[Regnvejr]

Generally, if you say yes, it always hangs over your head. If you are stable and have been for a long time, then the past diagnosis does not affect or hinder your ability to practice medicine. So the diagnosis doesn't matter in your abilities to practice.

These questions are a remnant of old bigotry against mental illness. But the way they are worded, they do give you the way out, and that way out is deliberately put in there, they didn't have to put the qualifier about abilities in there. They could simply ask if you had been diagnosed. The expanded question is lawyer speak. It shows that the board is vigilant, but the conditional attachment is about not hindering you from practicing if it doesn't affect you. If you bicycle, you could get hit by a car, if you ski, you could fall. Lots of things "might" affect your function, but it is based on your realistic self-assessment, which you have already given. Your mood doesn't affect becoming a good physician, so it is nobody's business.

If you're stable, the board has no interest in knowing all the details of your life. The board is there to make sure physicians are competent and will help their patients, that's all. They are not an insurance company looking for pre-existing conditions.

I know a couple of physicians with depression, and they are stable and reliable and a godsend to their patients. That's all the board need or want to know. These physicians pay cash for their meds at different pharmacies, or as residents can sometimes get samples, pay cash for office visits etc, no insurance paper trail exactly because of the stereotypes and just not knowing what happens to information that get into the great insurance computer in the sky, but NOT because of any doubt as to their abilities.

And do your PD need to know? Maybe, maybe not. Trust your instinct. Somebody probably should know, but pick wisely, both per tolerance toward having depression, and also "duty" to disclose to higher echelons.

 

[Doodledog]

Basically, some of the old posts alluded to the fact that depending on the politics of the state involved, disclosing this info might be more or less risky and might result in involvement from an "impaired physicians" oversight type group, which (again, depending on the state) might be a benign/helpful/supportive group or might be really draconian. (I really don't want to have to be checking in with the medical board on a constant basis letting them know that yes, I'm still being compliant with treatment. I would find that very insulting since I don't feel I require that level of "supervision".)

I'm really wondering if people might have first-hand knowledge about the "politics" of different states - ie which have been benign in this sort of situation, and which have been "draconian".

 

[dragonfly99]

I would not ask your PD about this. As you said, you don't want to get off on the wrong foot.

I think even if you put this on your medical license application, it's unlikely to be a problem for you in getting a license and I doubt they would put you under any kind of supervision, other than that already provided by your residency program. Personally, in the situation you have described, I wouldn't feel compelled to disclose, and because I am paranoid, I would not

I think your comment about being "honest to a fault" is probably relevant here. As you said, there are likely many other med students and house staff (including ones you will work with or have) who have undiagnosed depression, or who have been dx'ed but choose to not disclose it. Realistically, there are a lot of psych house staff and attendings who have had or do have a psych diagnosis, so I think the attendings in psych would be less likely to discriminate against you than, say, surgical attendings, but you really haven't been to your program yet and don't know what the "lay of the land" is there, so to speak, so why even take the risk?

The way the question is worded on your medical license application, I think you can answer negatively and you aren't really lying...maybe a bit of stretching the truth but nothing that hasn't been done by many others. My answer would be different if your depression had affected your med school performance, or if you had some sort of psychosis, but this doesn't seem to be the case. Having been through a resident (though not in psych) and medical licensing applications in two states, my opinion is don't open that can of worms if you don't have to.

 

[NotAProgDirector]

If by "depression" you mean that you are on an SSRI, then for certain I would not mention it to anyone, although if you have a good PD it would be fine to disclose it there (but still I probably wouldn't)

If by "depression" you mean that you were admitted to a psych institution for trying to strangle your SO because voices were telling you to do so, then you absolutely should.

You can figure out where you are on this spectrum. If you were never admitted to psych, homicidal, or suicidal, and if you are not on any impairing medication, then there is no need to disclose.

I am always torn when dealing with physicians on benzos or other medications which can be impairing. These types of meds can impair you (based on their pharmacology) but you could be "more impaired" off of them. In that case, you likely need to see psych and get a clinical opinion.

If after reading this you are still torn, consider being seen by occ med at your new program. They should be able to give you a "second opinion", and anything you tell them should be covered by pt-doc confidentiality.

 

[eforest]

Licensing questions terrify me- I had to take time off during third year to tend to my mental illness! There is no way to hide it on a licensing application. I go to a top 10 med school so I'm listening to people complaining about how they didn't honor this or that and therefore they're not going to match in dermatology or ENT at such and such top program - and I sit quietly with my terrible secret (classmates know I took time off, most don't know why), wondering about getting ANY residency or ANY career. The deans office and administration tries to be helpful, but honestly, I feel like they're there to help stellar students figure out which stellar residency program they're going to. Hopefully things will work out.

 

[GH253]

Why not just answer no?

What business is it of theirs?

Do they have any way of finding out?

 

[NotAProgDirector]

Why not just answer no?

What business is it of theirs?

Do they have any way of finding out?

If they ask you, and you omit it, and it is EVER discovered, you can have your licenses revoked. Lying is a big deal.

Whether it is any of their business is an interesting question. But if they ask it on an app, you have to answer truthfully. Or, sue them to have the licensing process changed.

 

[Doodledog]

Posted anonymously for a member:

I was reading on the confidential forums the thread on Mental Illness and Licensing issues. I was hoping to get some feedback on my situation.

I'm an MS-1 who was clinically depressed ~7 years ago but was misdiagnosed as suicidal. Due to this misdiagnosis, I was admitted to the hospital under a 51/50 watch. The doctor who made the initial diagnosis had never met me before and came to his erroneous conclusion partway through the only session I ever had with him. After I was released from the hospital I started seeing a different psychiatrist as an ongoing patient for a few years. She believes that the initial diagnosis was an overreaction and that I was never suicidal, nor did I need to be under observation for those days (and I agree with her).

My question is, would this be the type of situation that I would have to disclose on the licensing application question? I have been fully recovered for years and feel completely stable, and my mental illness was never bad enough to warrant the initial diagnosis and observation. Obviously due to the stigma against mental illness I would rather not disclose this history if I don't have to, but I also would not want to risk losing my license if the board disagreed with my interpretation of the question.

I'd appreciate any input, even though I have a couple years to go before having to fill out this application myself.

 

[Regnvejr]

Since you have a few years, this is where you consult an attorney that specializes in licensing (such do exist) and work it out with them.