Seeking help for anxiety as a practicing MD?

[AnxiousMD2018]

I would like to see a psychiatrist for anxiety and sleep problems.... Mainly for CBT and possibly a SSRI.

I am a practicing physician. I do not believe my symptoms are so bad that they are affecting my job yet.

I have concerns about confidentiality though. Must psychiatrists keep this information confidential (as long as I'm not at risk of hurting myself or someone else)? By seeking help, could this adversely affect me career, hospital accreditation, or state license? Thanks!

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[TexasPhysician]

Unless a danger to society requiring psych admission, I don’t see why I would tell anyone anything about a fellow physician.

 

[wolfvgang22]

Nothing wrong with seeing a psychiatrist and being up front about your concern before the evaluation begins. If he or she can't put your mind at ease, you can thank them for their time and decline to continue with the initial evaluation. Most psychiatrists (and all good psychiatrists) are not going break confidentiality unless you are an imminent danger to yourself or others. Breaking confidentiality without such a reason could be as bad for the psychiatrist as it would be for you.

 

[AnxiousMD2018]

Unless a danger to society requiring psych admission, I don’t see why I would tell anyone anything about a fellow physician.

Thanks everyone. Yeah, I know according to HIPPA things should be confidential. I'm just nervous about admitting to another physician in the area that I have symptoms of GAD. We may have a common aquaintance. I wouldn't want anyone in my group to think less of me.

 

[TexasPhysician]

Thanks everyone. Yeah, I know according to HIPPA things should be confidential. I'm just nervous about admitting to another physician in the area that I have symptoms of GAD. We may have a common aquaintance. I wouldn't want anyone in my group to think less of me.

Anxiety is not really exciting news to a psychiatrist worth sharing with anyone.

 

[splik]

Thanks everyone. Yeah, I know according to HIPPA things should be confidential. I'm just nervous about admitting to another physician in the area that I have symptoms of GAD. We may have a common aquaintance. I wouldn't want anyone in my group to think less of me.

i can assure you than everyone already knows you have GAD. it is very hard to hide. it is a sad state of affairs that physicians feel they have to think twice about seeking care for their mental health problems. anxiety is extremely common in medical students and physicians. seeking help for anxiety would not impact your career, hospital accreditation or state licensing. the same would also be true of more severe mental disorders. a diagnosis or seeking treatment in itself would not impact your career. the answer to any questions about mental disorders on licesning applications etc is going to be "no" for almost everyone, regardless of whether they have a mental illness, assuming you are not impaired. they are not allowed to ask otherwise (though many states still do, which is illegal).

 

[futuredo32]

HIPPA does apply but if you want to try not to run into anyone you know, you could see someone a farther distance away. That's what my patients with "prestigious occupations" do. One comes from out of state- only a 45 minute drive. She pays cash. But in my second residency I think we were all on something for anxiety/depression.

 

[LTPpowered90]

i can assure you than everyone already knows you have GAD. it is very hard to hide. it is a sad state of affairs that physicians feel they have to think twice about seeking care for their mental health problems. anxiety is extremely common in medical students and physicians. seeking help for anxiety would not impact your career, hospital accreditation or state licensing. the same would also be true of more severe mental disorders. a diagnosis or seeking treatment in itself would not impact your career. the answer to any questions about mental disorders on licesning applications etc is going to be "no" for almost everyone, regardless of whether they have a mental illness, assuming you are not impaired. they are not allowed to ask otherwise (though many states still do, which is illegal).

Except of course in the states where even on re-licensing, the question is framed, "have you EVER been diagnosed with a mental illness?" It's almost more frightening to get the help and then have to own up to it to a board more concerned with its own liability than physicians' actual well being.

 

[alina_s]

Do you have disability insurance? That application was the most prying of any I’ve filled out. If you’re going to get it, might want to do so before you see someone. We had to get therapy in residency and that application was the only place I’ve had to disclose it.

 

[VA Hopeful Dr]

Anxiety is not really exciting news to a psychiatrist worth sharing with anyone.

That was kinda my thought. If I, as an FP, don't find anxiety anything special I would think y'all would be even less impressed by it.

And as an aside, if you can pay cash. That way life/disability insurance don't see it.

I took Wellbutrin for 3 years during med school, my disability policy that I applied for 4 years later doesn't cover depression because of it.

 

[PikminOC]

Except of course in the states where even on re-licensing, the question is framed, "have you EVER been diagnosed with a mental illness?" It's almost more frightening to get the help and then have to own up to it to a board more concerned with its own liability than physicians' actual well being.

There are states where they want physicians to report physicians for any psychiatric care, no matter who delivers it, pcp, etc.
The board wants to look into it themselves

 

[MacDonaldTriad]

There are states where they want physicians to report physicians for any psychiatric care, no matter who delivers it, pcp, etc.
The board wants to look into it themselves

So we have the ACGME stressing physician wellness and care measures implemented into the clinical learning environment, but if I see any house staff as a clinician, I'm obligated to report it to the state medical board. Sounds like two regulatory entities reacting to bad outcomes with complete opposite points of view.

 

[WisNeuro]

Anxiety and sleep problems are some of the easiest things to treat in therapy. Don't worry about medication, find a good CBT psychologist who specializes in anxiety and is cash pay. At that point, the only way they have to report something is if they think you are an imminent danger to your patients. Which, in most cases, is a pretty high bar to clear. Unless you're like a neurosurgeon and come in talking about how you get one hour of sleep for nights on end and then go in to operate all of the time.

 

[futuredo32]

Except of course in the states where even on re-licensing, the question is framed, "have you EVER been diagnosed with a mental illness?" It's almost more frightening to get the help and then have to own up to it to a board more concerned with its own liability than physicians' actual well being.

Fortunately Michigan isn't one of those states. I have heard in some states it takes longer or there are more hoops if you have a psych illness but I would personally not pay cash. I would NEVER lie to the licensing board, if you got busted...…. I don't know what would happen. Just my two cents. In Mich it says do you have a physical, psych, neuro illness that impairs your ability to function in your profession (or something close).

 

[PikminOC]

So we have the ACGME stressing physician wellness and care measures implemented into the clinical learning environment, but if I see any house staff as a clinician, I'm obligated to report it to the state medical board. Sounds like two regulatory entities reacting to bad outcomes with complete opposite points of view.

I think the board wants to send docs to their standardized facilities for treatment

 

[PikminOC]

Anxiety and sleep problems are some of the easiest things to treat in therapy. Don't worry about medication, find a good CBT psychologist who specializes in anxiety and is cash pay. At that point, the only way they have to report something is if they think you are an imminent danger to your patients. Which, in most cases, is a pretty high bar to clear. Unless you're like a neurosurgeon and come in talking about how you get one hour of sleep for nights on end and then go in to operate all of the time.

I have not found any therapists in private practice that do straight cbt.

 

[WisNeuro]

Seriously? I can name about 20 or so on my metro area off the top of my head. For better chances, I'd stick to PhD providers, masters level and PsyDs tend to call themselves "eclectic," whatever that means and so a lot of dynamic type stuff. Most reputable PhD programs have their students spend a few years getting supervision in CBT.

 

[DisorderedDoc417]

Except of course in the states where even on re-licensing, the question is framed, "have you EVER been diagnosed with a mental illness?" It's almost more frightening to get the help and then have to own up to it to a board more concerned with its own liability than physicians' actual well being.

And it also means a note from every provider that prescribes for you essentially giving permission for you to work and guarantee your safety. Despite a surgeon who is diabetic and doesn’t need to report it even though he could easily become hypoglycemic and absolutely wreak havoc in the middle of a delicate operation.

 

[PsyDr]

While there is no empirical evidence for psychoanalysis as a treatment for anxiety, it is commonly accepted that ones own psychoanalysis is part of ones education in becoming analyst.

One could even say that such expenses are educational rather than relates to healthcare.

And a wise person could read between the lines.

@WisNeuro has some issues with my degree. It’s not unlike DOs vs MDs.

 

[PikminOC]

Seriously? I can name about 20 or so on my metro area off the top of my head. For better chances, I'd stick to PhD providers, masters level and PsyDs tend to call themselves "eclectic," whatever that means and so a lot of dynamic type stuff. Most reputable PhD programs have their students spend a few years getting supervision in CBT.

The ones in my area may get the training, but out in private practice they work more eclectically

 

[WisNeuro]

@WisNeuro has some issues with my degree. It’s not unlike DOs vs MDs.

🙂 I have issues with what it's become. The distinction is just irrelevant for the reputable PsyDs, as they operate the same as a balanced clinical PhD these days. And, the non-reputable ones just flood certain saturated markets with ill-prepared practitioners with mountains of debt who will take any job they can get and drive down our salaries across the board.

The ones in my area may get the training, but out in private practice they work more eclectically

I'd ask around, many people are trained in several areas. I myself had several years of CBT, but also had two years of psychodynamic training. So, some people may list several different modalities, but they may still be abel to practice straight CBT for certain presentations.

 

[HIPAAHasOneP]

If you are prescribed medication, even if paying cash, there is a decent chance other physicians you see, your insurance company, etc will know it. It's not like it used to be. Most pharmacies now share with Surescripts who then shares our information in most EMRs today. There are no secrets anymore, when it comes to medication, anyway. So, even if you see a psychiatrist who uses a paper medical record and even if you pay cash for medication - keep that in mind. I guess in today's world, the only way to keep medications out of an EMR is to ask the psychiatrist for samples or get your drugs from Canada. It's sad that we don't respect patient privacy anymore, but that's the way it is now.

If needed, I would be willing to see a therapist or psychiatrist who uses a paper record. But, the only way I would take psychiatric medication is if the psychiatrist had samples to provide. Like you, I wouldn't want everyone knowing my business.

 

[PikminOC]

🙂 I have issues with what it's become. The distinction is just irrelevant for the reputable PsyDs, as they operate the same as a balanced clinical PhD these days. And, the non-reputable ones just flood certain saturated markets with ill-prepared practitioners with mountains of debt who will take any job they can get and drive down our salaries across the board.

I'd ask around, many people are trained in several areas. I myself had several years of CBT, but also had two years of psychodynamic training. So, some people may list several different modalities, but they may still be abel to practice straight CBT for certain presentations.

I am not saying they are not trained in cbt. In their practices they dont practice straight cbt when needed. I have numerous therapists in private practices in my area. None of them do

 

[AnxiousMD2018]

Thanks for the advice! Thankfully I have two disability polices, one with a mental health rider.

I made an appointment a ways away with a different hospital system.

I don't think anyone would know from talking with me that okay have any issue with anxiety... That's the thing. I just come as quiet and maybe a little aloof to people who don't know me well. I think I keep it pretty well hidden.

 

[Mass Effect]

There are states where they want physicians to report physicians for any psychiatric care, no matter who delivers it, pcp, etc.
The board wants to look into it themselves

Those states can kiss my ass. In fact, you should name them because I have a hard time believing this is true. Any physician who turns in another physician who isn't a danger to him/herself or patients is a rotten human being.

 

[rkaz]

I took Wellbutrin for 3 years during med school, my disability policy that I applied for 4 years later doesn't cover depression because of it.

Wow, is this common and acceptable practice to deny coverage for an issue that was suspected in past? Uggh.

 

[TexasPhysician]

Wow, is this common and acceptable practice to deny coverage for an issue that was suspected in past? Uggh.

Yes. Disability insurance should be obtained as early as possible. Any illness you get could effect your ability to get coverage.

 

[deleted862527]

I would like to see a psychiatrist for anxiety and sleep problems.... Mainly for CBT and possibly a SSRI.

I am a practicing physician. I do not believe my symptoms are so bad that they are affecting my job yet.

I have concerns about confidentiality though. Must psychiatrists keep this information confidential (as long as I'm not at risk of hurting myself or someone else)? By seeking help, could this adversely affect me career, hospital accreditation, or state license? Thanks!

I'm not a doctor, but I read a book called 'The New Drug Therapy' by Dr. David Burns, M.D. He details (without identifying his patients, as this would be a violation of HIPPA) the common cognitive trends existing in his patients suffering from anxiety and depressive disorders, including doctors and how to deal with them without requiring pharmacological intervention. If you are worried that a psychiatrist may 'stigma' you for being a doctor for having anxious thoughts, I would question the validity of that statement and its legitimacy. More than likely, it may be possible that the psychiatrist you inquire of has had patients in the past who were involved in the medical profession as well, including other doctors, nurses, PA's, etc. Having anxiety as a doctor is realistic and expected---expecting the contrary is not realistic. Anyone who claims to be a doctor and not experienced anxiety is a liar.

 

[hamstergang]

Having anxiety as a doctor is realistic and expected---expecting the contrary is not realistic. Anyone who claims to be a doctor and not experienced anxiety is a liar.

Having anxiety to a clinically significant degree (whatever that actually means) is not expected nor the norm. Not that it's uncommon or something to be stigmatized, but I think that equivocating anxiety with an anxiety disorder is somewhat harmful to the field.

 

[deleted862527]

Having anxiety to a clinically significant degree (whatever that actually means) is not expected nor the norm. Not that it's uncommon or something to be stigmatized, but I think that equivocating anxiety with an anxiety disorder is somewhat harmful to the field.

No! That's not what I meant. Sorry about the confusion.