Should med school applicants be required to disclose past psychiatric/psychological issues?

[Eclipse010]

Given that various psychiatric and psychological issues (namely bipolar, chronic depression, drug/alcohol abuse, etc.) become serious, prevalent issues in the field of medicine, should med school applicants be required to disclose such issues (i.e., those that would not already be required to be disclosed as a part of an institutional action or misdemeanor/felony)?

Clearly, past instances of these issues present added risk factors for patients that can be avoided by eliminating or reducing the number of candidates from pursuing a career of medicine. Why shouldn't these issues be factored into the medical school admissions process? Perhaps there may be a few legal hurdles, but these are serious issues that affect the lives of patients and it could be argued that selecting against these traits would preserve the integrity and high standards of the field of medicine. I think this is a huge factor that needs to be addressed when evaluating an individual's ability to be a healthy, competent physician. I suspect a high proportion of these types of issues are present outside of IA, misdemeanors, and felonies, and can be an additional piece of information that adcoms can use to evaluate candidates.

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[lNVlNClBLE]

As long as someone with depression / bipolar etc. is being properly medicated / lifestyle changes and has their illness under control, I fail to see why they should be barred from entering medicine. No one is perfect.

 

[7331poas]

As long as someone with depression / bipolar etc. is being properly medicated / lifestyle changes and has their illness under control, I fail to see why they should be barred from entering medicine. No one is perfect.

I think the question here is whether that standard should be determined by the person with the illness or the institution which is admitting a person who (seemingly) is of completely good health.

 

[bananafish94]

I think that discriminating against people on the basis of medical conditions is the antithesis of "preserving the integrity and high standards of the field of medicine."

 

[Vitani]

Absolutely not. You should not be able to discriminate against people based on a mental disability (just like you shouldn't discriminate based on a physical disability) if it does not preclude them from doing their job effectively.--legally you also cannot due this due to the ADA and the equality act of 2010
Also, most people will have a bout of depression or other anxiety disorder at some point in their lives, at any given time nearly 20% of Americans suffer from depression. By completely ruling out these people from applying to med school you are bound to lose qualified applicants.
Thought processes like the OPs just contribute to the stigma of going to a mental health professional or being treated for depression and is a huge contributor to why only about 1/3 of people suffering from an anxiety disorder or depression get treated for it.

 

[Mansamusa]

So then someone with depression chooses not to seek treatment in order to keep their condition secret--> Leads to complications in the future, no?

You know how easy it would be to hide a history of depression? Incredibly easy. Now rather than not admitting students who have issues, you are teaching students that they are incompetent for not having perfect mental health and preventing people who could benefit from help from seeking treatment. What about a depressed med student? Do they get kicked out for going to therapy? In the post-med school medical world, this kind of shaming occurs and causes problems for many physicians and that stigma is being fought by health professionals.

Why would you say that someone's depression or former addictions would harm patients? Do you have any evidence for this?

You can claim that any imperfection in a physician harms patients or is a sign that a physician has some underlying psychological issue, so do we just demand perfection or do we extend the empathy we show patients to our colleagues?

If someone has issues so severe that it effects their work, they'll get called out on it.

Edit: Not to mention the fact that students getting treatment for depression are going to be much more stable than someone not managing their depression. If anything, students should be encouraged to be in tune with their psychological issues and seek treatment as soon as they sense something is off

 

[7331poas]

if it does not preclude them from doing their job effectively.

Yea well you kind of just glazed over the entire thought process here. The argument the schools would make is whether having severe mental illnesses might lower a persons likelihood of effectively finishing med school/residency/ and competently practicing medicine. I dont think the mental illness thing is just 100% a stigma and has zero thought behind it.

I need to look at some case law to see what kind of arguments could be made.

 

[Mansamusa]

Yea well you kind of just glazed over the entire thought process here. The argument the schools would make is whether having severe mental illnesses might lower a persons likelihood of effectively finishing med school/residency/ and competently practicing medicine. I dont think the mental illness thing is just 100% a stigma and has zero thought behind it.

Read OP's post. Nothing was said about not finishing med school. I was all about maintaining high standards and not harming patients. And that depression can harm the integrity and competency of physicians and the medical field

I agree that uncontrolled mental illness will harm someone's ability to finish school. That's why it would be good to see that a student is seeking help. But what OP was saying is just dumb

 

[7331poas]

Read OP's post. Nothing was said about not finishing med school. I was all about maintaining high standards and not harming patients. And that depression can harm the integrity and competency of physicians and the medical field

I agree that uncontrolled mental illness will harm someone's ability to finish school. That's why it would be good to see that a student is seeking help. But what OP was saying is just dumb

He is asking in the context of med school admissions. If the med school can rely on a sound argument which makes a claim that severe mental illness could impair their ability to finish the degree, the school has grounds to not accept an applicant. Like I said, I need to review the case law before talking too far out of my ass.

 

[lNVlNClBLE]

Yea well you kind of just glazed over the entire thought process here. The argument the schools would make is whether having severe mental illnesses might lower a persons likelihood of effectively finishing med school/residency/ and competently practicing medicine. I dont think the mental illness thing is just 100% a stigma and has zero thought behind it.

I need to look at some case law to see what kind of arguments could be made.

Okay, but on the same token you have no idea if the other applicants being admitted are pedophiles or have committed rape but got away with it without accusation. Adcoms have no idea if the people they're admitting are chronic cheaters that got away with it all throughout undergrad, or if they're bigots.

Point is, adcoms admit people who appear to be well-functioning in society. If someone has their depression under control, that includes them. There is no reason to discriminate against someone based on "what could happen" when tons of people are admitted that did things deserving of an IA / felony but just never got caught. If their depression becomes an issue then they can seek help while in medical school. Provide me data that shows depressed physicians make terrible decisions or kill more patients per career than physicians without depression.

 

[7331poas]

Okay, but on the same token you have no idea if the other applicants being admitted are pedophiles or have committed rape but got away with it without accusation. Adcoms have no idea if the people they're admitting are chronic cheaters that got away with it all throughout undergrad, or if they're bigots.

Point is, adcoms admit people who appear to be well-functioning in society. If someone has their depression under control, that includes them. There is no reason to discriminate against someone based on "what could happen" when tons of people are admitted that did things deserving of an IA / felony but just never got caught. If their depression becomes an issue then they can seek help while in medical school. Provide me data that shows depressed physicians make terrible decisions or kill more patients per career than physicians without depression.

Is your argument that if someone is a pedophile they should not feel obligated to disclose that to a medical school?

I do not have data but I would be willing to bet that the incidence of mental illness of people who fail out of medical school is disproportionate.

Its not just about who will make good doctors. Its also about the ability to cope with stress.

 

[Lawpy]

Given that various psychiatric and psychological issues (namely bipolar, chronic depression, drug/alcohol abuse, etc.) become serious, prevalent issues in the field of medicine, should med school applicants be required to disclose such issues (i.e., those that would not already be required to be disclosed as a part of an institutional action or misdemeanor/felony)?

Clearly, past instances of these issues present added risk factors for patients that can be avoided by eliminating or reducing the number of candidates from pursuing a career of medicine. Why shouldn't these issues be factored into the medical school admissions process? Perhaps there may be a few legal hurdles, but these are serious issues that affect the lives of patients and it could be argued that selecting against these traits would preserve the integrity and high standards of the field of medicine. I think this is a huge factor that needs to be addressed when evaluating an individual's ability to be a healthy, competent physician. I suspect a high proportion of these types of issues are present outside of IA, misdemeanors, and felonies, and can be an additional piece of information that adcoms can use to evaluate candidates.

Sorry, but this is a terrible, terrible idea. This will only worsen the mental health crisis that medical schools/education are suffering from. Not to mention that this is probably illegal as it promotes discrimination against those suffering from mental illness.

 

[lNVlNClBLE]

Is your argument that if someone is a pedophile they should not feel obligated to disclose that to a medical school?

I do not have data but I would be willing to bet that the incidence of mental illness of people who fail out of medical school is disproportionate.

Its not just about who will make good doctors. Its also about the ability to cope with stress.

No. My argument is that you can't tell the difference between a pedophile who is able to hide that fact vs. someone with well-controlled depression who is able to hide that fact. So you'd rather the applicant with depression be forced to disclose he has depression, which has a negative stigma, and have him declined over applicant #1?

So you don't have data but you *THINK* physicians with depression are not as suited to practice medicine as physicians without, or that those with well-controlled depression are more likely to drop out of medical school. Interesting.

If someone's depression is well-controlled, they should be able to cope with stress just as well as someone without depression.

 

[7331poas]

If someone's depression is well-controlled, they should be able to cope with stress just as well as someone without depression.

The medical school does not know if it is well-controlled...

Thats what I am getting that here.

So you don't have data but you *THINK* physicians with depression are not as suited to practice medicine as physicians without, or that those with well-controlled depression are more likely to drop out of medical school. Interesting..

there is no possible way someone could acquire that data so...

 

[Eclipse010]

I think there are a number of good responses here.

I am not arguing that adcoms should completely discriminate against individuals with histories of mental illness, instead I am stating that it should be a factor that is considered in context, similar to how MCAT, GPA, disciplinary/criminal histories, etc. are already evaluated. This issue is not so much about the medical school application as it is about the patient. The patient's well-being needs to take precedence, after all, that's the whole point of the medical field.

Although I would like to believe that "adequately" addressing past mental health issues would suffice, that is simply not the reality. For example, drug and alcohol addiction presents high relapse rates.

 

[Goro]

No, health records are private and it's none of our business. Med school applicants are adults and it's on them the to take care of their mental health. Many of them do.

The fact that med school is a furnace is a concern to us, but I'm NOT a mental health professional, and so who am I to say that this kid with depression shouldn't be a doctor, especially if s/he has a solid track record of academic excellence, which implies that their mental health issues are under control.

All I ask of applicants is that they go into this process eyes open, and have the blessing of their therapists or clinicians.

Would you even be asking this question if the issues were lupus or type I diabetes?

Given that various psychiatric and psychological issues (namely bipolar, chronic depression, drug/alcohol abuse, etc.) become serious, prevalent issues in the field of medicine, should med school applicants be required to disclose such issues (i.e., those that would not already be required to be disclosed as a part of an institutional action or misdemeanor/felony)?

Clearly, past instances of these issues present added risk factors for patients that can be avoided by eliminating or reducing the number of candidates from pursuing a career of medicine. Why shouldn't these issues be factored into the medical school admissions process? Perhaps there may be a few legal hurdles, but these are serious issues that affect the lives of patients and it could be argued that selecting against these traits would preserve the integrity and high standards of the field of medicine. I think this is a huge factor that needs to be addressed when evaluating an individual's ability to be a healthy, competent physician. I suspect a high proportion of these types of issues are present outside of IA, misdemeanors, and felonies, and can be an additional piece of information that adcoms can use to evaluate candidates.

 

[7331poas]

Would you even be asking this question if the issues were lupus or type I diabetes?

.....yes. Yes I would ask that. The same way we asked when a person posted on here about being a paraplegic and surgery. Thats the discussion. Whether they are similar cases.

Im curious if you think that these people are under a moral obligation to disclose their illness if the schools asks for it as well.

 

[Goro]

No. And go read up on HIPPA, while you're at it.

If the Adcom thinks an interviewee can be a good student, then the school is obligated to do everything in their power to help them.

.....yes. Yes I would ask that. The same way we asked when a person posted on here about being a paraplegic and surgery. Thats the discussion. Whether they are similar cases.

Im curious if you think that these people are under a moral obligation to disclose their illness if the schools asks for it as well.

 

[7331poas]

No. And go read up on HIPPA, while you're at it.

If the Adcom thinks an interviewee can be a good student, then the school is obligated to do everything in their power to help them.

yes, IF they think they can be a good student. Why is everyone just glossing over this caveat. On the other hand, if the med school DOES think the disability can impair their ability to finish school or do their job effectively, then they wont admit and they are within their right.

 

[Eclipse010]

No. And go read up on HIPPA, while you're at it.

If the Adcom thinks an interviewee can be a good student, then the school is obligated to do everything in their power to help them.

While I absolutely agree that under most circumstances, students have the right to privacy regarding the personal aspects of their lives, I also believe that due to the unique nature of the medical field, the best interests of the patients needs to supercede certain private aspects of doctors, including such serious matters as drug/alcohol abuse or histories thereof. In other words, should the patient be fully informed of such risk factors of the physician or surgeon that they're to whom they're entrusting their lives?

On a related note, there are some incidents of institutional actions that are a direct result of drug or alcohol abuse. Why should they be treated differently just because they "were caught". Although I used the example of substance abuse here, a similar argument regarding applicants with other mental health issues (e.g., severe depression, bipolar, schizophrenia, etc.) can be made here.

Importantly, I'm not making a legal argument here, rather I'm pondering what would be the more ethical decision.

 

[Crayola227]

Given that various psychiatric and psychological issues (namely bipolar, chronic depression, drug/alcohol abuse, etc.) become serious, prevalent issues in the field of medicine, should med school applicants be required to disclose such issues (i.e., those that would not already be required to be disclosed as a part of an institutional action or misdemeanor/felony)?

Clearly, past instances of these issues present added risk factors for patients that can be avoided by eliminating or reducing the number of candidates from pursuing a career of medicine. Why shouldn't these issues be factored into the medical school admissions process? Perhaps there may be a few legal hurdles, but these are serious issues that affect the lives of patients and it could be argued that selecting against these traits would preserve the integrity and high standards of the field of medicine. I think this is a huge factor that needs to be addressed when evaluating an individual's ability to be a healthy, competent physician. I suspect a high proportion of these types of issues are present outside of IA, misdemeanors, and felonies, and can be an additional piece of information that adcoms can use to evaluate candidates.

Smh.

 

[Mansamusa]

While I absolutely agree that under most circumstances, students have the right to privacy regarding the personal aspects of their lives, I also believe that due to the unique nature of the medical field, the best interests of the patients needs to supercede certain private aspects of doctors, including such serious matters as drug/alcohol abuse or histories thereof. In other words, should the patient be fully informed of such risk factors of the physician or surgeon that they're to whom they're entrusting their lives?

On a related note, there are some incidents of institutional actions that are a direct result of drug or alcohol abuse. Why should they be treated differently just because they "were caught". Although I used the example of substance abuse here, a similar argument regarding applicants with other mental health issues (e.g., severe depression, bipolar, schizophrenia, etc.) can be made here.

Importantly, I'm not making a legal argument here, rather I'm pondering what would be the more ethical decision.

We are already moving towards a system where physician outcomes will be posted on a roster and doctors will be ranked based on different measurements, so we can compete against each other like children, haha. So someone who has a drug addiction that creates bad outcomes (first, would probably lose their job) will have that reflected in their ranking.

It is entirely inappropriate for patients to know the medical history of their provider. Why should we lose our HIPAA rights while respecting the rights of our patients? And again, if this stuff had to be reported to patients, all you have to do is pay in cash at a treatment center while using an alias. It is very easy to get around, so all that requirement will do is stigmatize the illness

Edit: And, like I said before, you have no evidence that this issue is even a problem that occurs frequently enough to warrant attention. I've never heard of a patient dying because their doctor was too depressed to function

 

[Crayola227]

Did it ever occur to you that many of the physicians who have had their lives touched by such mental illnesses may actually be more effective in treating such issues in their patients?

Please go read the ACE Study, Adverse Childhood Events.

If we think the number one early killer/debilitator of patients is lifestyle, and we think we can chalk a lot of lifestyle practices to mental health / social factors, than one might say that addressing the mental health of this nation should be the foundation of how we improve its health, much as we would say that about education and the economy.

Also, did it ever occur to you that ALL students in medical school are at risk of developing situational depression if not just simple burn out? and that potentially the students with a history of psychiatric illness or psychological issues that had the coping skills to have functioned well enough to get into medical school might actually be better able to cope with the stresses or to deal with the mental health fallout?

we would need studies to settle this horrific little thought experiment of yours

aside from the fact it's illegal as ****

and nevermind the fact that there are more protections in place to protect patients from impaired physicians than to protect otherwise disabled physicians

plenty of state medical boards have the right to demand to see your psych records before licensing you, to subpoena them at any time, and many PHPs can demand you do whatever they want

at the med school level, well, they can do whatever they like to protect patients

the danger to patients from depressed physicians is vastly overstated

 

[edgerock24]

I think there are a number of good responses here.

I am not arguing that adcoms should completely discriminate against individuals with histories of mental illness, instead I am stating that it should be a factor that is considered in context, similar to how MCAT, GPA, disciplinary/criminal histories, etc. are already evaluated. This issue is not so much about the medical school application as it is about the patient. The patient's well-being needs to take precedence, after all, that's the whole point of the medical field.

Although I would like to believe that "adequately" addressing past mental health issues would suffice, that is simply not the reality. For example, drug and alcohol addiction presents high relapse rates.

The presence of mental illness is no different than the presence of any other type of illness. It is nobody's business but the person dealing with said illness.

I don't think you understand how confidentiality works.

 

[Eclipse010]

Did it ever occur to you that many of the physicians who have had their lives touched by such mental illnesses may actually be more effective in treating such issues in their patients?

Please go read the ACE Study, Adverse Childhood Events.

If we think the number one early killer/debilitator of patients is lifestyle, and we think we can chalk a lot of lifestyle practices to mental health / social factors, than one might say that addressing the mental health of this nation should be the foundation of how we improve its health, much as we would say that about education and the economy.

Also, did it ever occur to you that ALL students in medical school are at risk of developing situational depression if not just simple burn out? and that potentially the students with a history of psychiatric illness or psychological issues that had the coping skills to have functioned well enough to get into medical school might actually be better able to cope with the stresses or to deal with the mental health fallout?

we would need studies to settle this horrific little thought experiment of yours

aside from the fact it's illegal as ****

and nevermind the fact that there are more protections in place to protect patients from impaired physicians than to protect otherwise disabled physicians

plenty of state medical boards have the right to demand to see your psych records before licensing you, to subpoena them at any time, and many PHPs can demand you do whatever they want

at the med school level, well, they can do whatever they like to protect patients

the danger to patients from depressed physicians is vastly overstated

It would surprise me if medical trainees and doctors with histories of and actively presenting severe mental illness would deliver healthcare comparable to their counterparts without such issues. Obviously, there will be exceptions.

On one hand, physicians with a history of mental illness who relapse will probably more likely compromise patient care. After all, physicians are less likely to seek help and when they do, it's often too late. On the other hand, physician suicide rates are one of the highest of any profession, and the medical training and environment likely exacerbate these issues for individuals with a history of mental health issues.

Obviously, there are legal issues with requiring medical school applicants to disclose issues regarding health records on their applications. However, the ethical dilemma still remains.

 

[lNVlNClBLE]

It would surprise me if medical trainees and doctors with histories of and actively presenting severe mental illness would deliver healthcare comparable to their counterparts without such issues. Obviously, there will be exceptions.

On one hand, physicians with a history of mental illness who relapse will probably more likely compromise patient care. After all, physicians are less likely to seek help and when they do, it's often too late. On the other hand, physician suicide rates are one of the highest of any profession, and the medical training and environment likely exacerbate these issues for individuals with a history of mental health issues.

Obviously, there are legal issues with requiring medical school applicants to disclose issues regarding health records on their applications. However, the ethical dilemma still remains.

The problem is that you THINK a history of mental illness will compromise patient care, yet you have no data to back that up. If you're going to suggest changes to how applicants are viewed based on mental illness, you need to present fact.

As this stands, it is merely a hypothetical.

 

[Mansamusa]

It would surprise me if medical trainees and doctors with histories of and actively presenting severe mental illness would deliver healthcare comparable to their counterparts without such issues. Obviously, there will be exceptions.

On one hand, physicians with a history of mental illness who relapse will probably more likely compromise patient care. After all, physicians are less likely to seek help and when they do, it's often too late. On the other hand, physician suicide rates are one of the highest of any profession, and the medical training and environment likely exacerbate these issues for individuals with a history of mental health issues.

Obviously, there are legal issues with requiring medical school applicants to disclose issues regarding health records on their applications. However, the ethical dilemma still remains.

It wouldn't surprise me if physicians with well controlled mental health issues have similar quality outcomes as those without a history of mental health issues. So who is right?

Plusssss, history of mental health issues =/= actively presenting issues. If you know that someone has a history of mental health problems than that person must have taken measures to treat it! They are the people who aren't ignoring their problems and are actively seeking to manage it, so they are not waiting until it is too late

 

[Eclipse010]

It wouldn't surprise me if physicians with well controlled mental health issues have similar quality outcomes as those without a history of mental health issues. So who is right?

Plusssss, history of mental health issues =/= actively presenting issues. If you know that someone has a history of mental health problems than that person must have taken measures to treat it! They are the people who aren't ignoring their problems and are actively seeking to manage it, so they are not waiting until it is too late

It wouldn't surprise me if individuals with histories of mental illness are more likely to present with mental health issues in the future.

Generally speaking, the past is our best predictor of the future. This is the basis of many facets of the med school selection process.

 

[Mansamusa]

It wouldn't surprise me if individuals with histories of mental illness are more likely to present with mental health issues in the future.

Generally speaking, the past is our best predictor of the future. This is the basis of many facets of the med school selection process.

I would be willing to bet that there are more people walking around with untreated mental illness than there are those who sought help.

And your 2nd statement is odd to me. So someone who has issues and then manages them should be judged by the problem and not by the fact that they were mature enough to manage it? Both the illness and their ability to control it are a part of their past, so which one predicts their future? You see someone who won't be able to control themselves. I see someone who may relapse into depression, but who will have the tools to help themselves if they do. The ability to seek treatment and care for yourself is a sign of maturity and is a good sign that the applicant will know how to manage their stress in the future. No one makes it through this process without having any moments of mental health issues, so it is good to know that someone is aware of how to get help and seek treatment

 

[jqueb29]

Applicants should have to disclose if they've had shingles before. If they have, they likely suck at handling stress and should be rejected. In fact while we're at it, applicants should just have to bring their entire medical records to their interview! You're a type 1 diabetic? Yikes, we can't risk having you go into ketoacidosis while working on a long case so we're going to have to reject you.

 

[Eclipse010]

I would be willing to bet that there are more people walking around with untreated mental illness than there are those who sought help.

And your 2nd statement is odd to me. So someone who has issues and then manages them should be judged by the problem and not by the fact that they were mature enough to manage it? Both the illness and their ability to control it are a part of their past, so which one predicts their future? You see someone who won't be able to control themselves. I see someone who may relapse into depression, but who will have the tools to help themselves if they do. The ability to seek treatment and care for yourself is a sign of maturity and is a good sign that the applicant will know how to manage their stress in the future. No one makes it through this process without having any moments of mental health issues, so it is good to know that someone is aware of how to get help and seek treatment

The point is that there are candidates without mental health issues. Statistically speaking, they will less likely be prone to mental health issues in the future, if physicians' mental health profiles are comparable to the general population.

Don't get me wrong, I personally find it very respectable for someone with a serious mental health issue to overcome them, although they are typically reoccurring and will have that risk for their lifetimes. However, some instances of mental health issues, for example drug addiction, has very high relapse rates, despite many learned coping mechanisms. It's extremely unfortunate, but the risk will always be there, although to diminishing extents over one's lifetime.

As a simplified analogy, consider a candidate who had very poor grades initially but was finally able to attain competitive grades for several semesters. Is the risk profile of this candidate really equal to the candidate who had always and consistently attained competitive grades? Obviously, this is a hypothetical situation, because no two candidates will ever be so similar.

 

[Mansamusa]

The point is that there are candidates without mental health issues. Statistically speaking, they will less likely be prone to mental health issues in the future, if physicians' mental health profiles are comparable to the general population.

Don't get me wrong, I personally find it very respectable for someone with a serious mental health issue to overcome them, although they are typically reoccurring and will have that risk for their lifetimes. However, some instances of mental health issues, for example drug addiction, has very high relapse rates, despite many learned coping mechanisms. It's extremely unfortunate, but the risk will always be there, although to diminishing extents over one's lifetime.

As a simplified analogy, consider a candidate who had very poor grades initially but was finally able to attain competitive grades for several semesters. Is the risk profile of this candidate really equal to the candidate who had always and consistently attained competitive grades? Obviously, this is a hypothetical situation, because no two candidates will ever be so similar.

The person who consistently received high grades may have never been academically challenged. Then when they start med school, they can't handle it and don't know how to adjust. The person who started out low and then improved showed that they can recognize their weaknesses and address them. They are both risks for different reasons.

Someone who has never sought mental health treatment may have either never dealt with a situation in which they were psychologically compromised or they simply never had the opportunity to get treatment (or they don't have the maturity to recognize their issue). This path will challenge everyone mentally. Someone with a history of treated depression is likely to know how to manage their depression if it comes back during training. The person with no prior history of mental health illness is at risk for falling apart when they are challenged during school. They are both risks for different reasons.

The 3 important points are: 1) Empathy 2) Illegality of this situation 3) You have still failed to even establish a link between physician mental health history and poor outcomes

 

[Crayola227]

The point is that there are candidates without mental health issues. Statistically speaking, they will less likely be prone to mental health issues in the future, if physicians' mental health profiles are comparable to the general population.

Don't get me wrong, I personally find it very respectable for someone with a serious mental health issue to overcome them, although they are typically reoccurring and will have that risk for their lifetimes. However, some instances of mental health issues, for example drug addiction, has very high relapse rates, despite many learned coping mechanisms. It's extremely unfortunate, but the risk will always be there, although to diminishing extents over one's lifetime.

As a simplified analogy, consider a candidate who had very poor grades initially but was finally able to attain competitive grades for several semesters. Is the risk profile of this candidate really equal to the candidate who had always and consistently attained competitive grades? Obviously, this is a hypothetical situation, because no two candidates will ever be so similar.

Yes, and someone pointed out above there are candidates without DM1, and that DM1 even controlled could present "risk" to patients.

The is a slippery slope, and as has already been pointed out, looking for reasons to exclude physicians on the basis of the very sort of thing that can allow them to better empathize with their patients is just counterproductive.

There is a good body of literature about the importance of empathy in the therapeutic alliance.

In fact, a few studies I came across recently suggested people with bipolar rate higher on tests of empathy.

The ACE study I referred to, found improved outcomes simply by *asking* patients about adverse childhood events, even if it had nothing to do with their presenting complaint!

I may be wrong, but I believe they found that physicians who also rated on the ACE scale were more likely to talk about such experiences with patients and rated less discomfort in doing so.

I will try to dig up the paper and and read it again and post it here

 

[7331poas]

Applicants should have to disclose if they've had shingles before. If they have, they likely suck at handling stress and should be rejected. In fact while we're at it, applicants should just have to bring their entire medical records to their interview! You're a type 1 diabetic? Yikes, we can't risk having you go into ketoacidosis while working on a long case so we're going to have to reject you.

The problem with your statement is that we do that already. Applicants can be declined on the basis of not being able to preform the physical aspects of the job. Morbid obesity and paralysis is just one aspect. Those are extremes. But there is precedent where if the med school feels you can't handle the stress or complete your job as effectively as a non-afflicted applicant, they can use that against you.

This is no different.

 

[Crayola227]

we need to exclude physicians with higher risk of CAD because they are more likely to have events like strokes and MIs that could put them out of practice years earlier than their peers.

more than reviewing their records and diet/exercise habits, we should do a family history!

in fact, maybe we should genetically test them? just to weed out anyone that had Huntington's or hadn't presented yet with hemachromatosis (which can lead to neurological damage and disability), and the like

up to 1/3 with psoriasis develop psoriatic arthritis, this could be disabling, maybe they should disclose and not be admitted? stress can make some autoimmune conditions worse

family history of MS? why take the chance on you, that's a top disabler of otherwise young healthy women (men are affected too but what I said regarding women holds true)

let's not admit gay students, since statistically speaking that population is at higher risk for contracting HIV, never mind anything in particular about that student's risk/lack of risk factors

anyone that has lived/worked in a shipyard prior to whatever year I can't remember, because of exposure increasing their risk of lung disease or cancer

 

[Mansamusa]

The problem with your statement is that we do that already. Applicants can be declined on the basis of not being able to preform the physical aspects of the job. Morbid obesity and paralysis is just one aspect. Those are extremes. But there is precedent where if the med school feels you can't handle the stress or complete your job as effectively as a non-afflicted applicant, they can use that against you.

This is no different.

There are quite a few paralyzed students who got into med schools... and obese students (I've never hear of morbidly obese applicants, so can't comment on that).

And I can definitively say that someone who has paralyzed hands cannot do surgery. There is no evidence or even hint of evidence that shows that physicians with a prior history of depression are more likely than their colleagues to be depressed as attendings and that this depression harms their patients. They are not comparable because one is a definite assertion and the other is a baseless assumption. One is an obvious handicap; the other is an invisible illness that anyone, even those who have never been treated, may be suffering from

 

[Eclipse010]

The person who consistently received high grades may have never been academically challenged. Then when they start med school, they can't handle it and don't know how to adjust. The person who started out low and then improved showed that they can recognize their weaknesses and address them. They are both risks for different reasons.

Someone who has never sought mental health treatment may have either never dealt with a situation in which they were psychologically compromised or they simply never had the opportunity to get treatment (or they don't have the maturity to recognize their issue). This path will challenge everyone mentally. Someone with a history of treated depression is likely to know how to manage their depression if it comes back during training. The person with no prior history of mental health illness is at risk for falling apart when they are challenged during school. They are both risks for different reasons.

The 3 important points are: 1) Empathy 2) Illegality of this situation 3) You have still failed to even establish a link between physician mental health history and poor outcomes

I would argue that, on the population level, higher grades (and MCAT scores) are associated with lower risk of med school failure because they correlate with higher STEP scores and graduation rates. At the individual level, it's less clear. I'm pondering whether mental health history disclosure for the entire candidate pool be used for evaluation. It does not automatically bar anyone from pursuing a career of medicine, but it's one component that's considered, just like GPAs and MCATs but to a different extent.

I'm not familiar with any studies that shoe a correlation between mental health issues of physicians and patient care outcomes, but it's not unreasonable to believe there is a link. Admittedly, I'm not an expert on this topic, so these studies may very well exist. On a related note, there's ample discussion relating physician lifestyle factors such as stress, sleep, etc. that correlate with patient care outcomes. I'm proposing this ethical dilemma under the assumption that there is a statistically significant correlation between severe mental health issues and patient care outcomes - it's not a farfetched assumption.

Yes, legally, such a required disclosure would not be legally permissible, but I'm mostly concerned with the ethical implications.

In terms of empathy, this is possible, however it comes down to whether the benefits of perceived increased empathy from physicians with mental health issues outweigh the drawbacks of such issues. Additionally, there are many life experiences that instill empathy without additional risk to patient care.

I would further argue that candidates with institutional actions and misdemeanors that arise due to mental health issues, for example, drug addiction, are viewed more as individuals at risk than as individuals who will be comparable or superior physicians. In other words, shouldn't candidates with IAs due to drug abuse or addiction be viewed as risky?

 

[NimbleNavigator]

No, for the simple fact that then nobody will want to get help if they need it - which is just bad for everyone. I personally think that mental health histories shouldn't even be made available in court proceedings for that same reason.

 

[Mansamusa]

I would argue that, on the population level, higher grades (and MCAT scores) are associated with lower risk of med school failure because they correlate with higher STEP scores and graduation rates. At the individual level, it's less clear. I'm pondering whether mental health history disclosure for the entire candidate pool be used for evaluation. It does not automatically bar anyone from pursuing a career of medicine, but it's one component that's considered, just like GPAs and MCATs but to a different extent.

I'm not familiar with any studies that shoe a correlation between mental health issues of physicians and patient care outcomes, but it's not unreasonable to believe there is a link. Admittedly, I'm not an expert on this topic, so these studies may very well exist. On a related note, there's ample discussion relating physician lifestyle factors such as stress, sleep, etc. that correlate with patient care outcomes. I'm proposing this ethical dilemma under the assumption that there is a statistically significant correlation between severe mental health issues and patient care outcomes - it's not a farfetched assumption.

Yes, legally, such a required disclosure would not be legally permissible, but I'm mostly concerned with the ethical implications.

In terms of empathy, this is possible, however it comes down to whether the benefits of perceived increased empathy from physicians with mental health issues outweigh the drawbacks of such issues. Additionally, there are many life experiences that instill empathy without additional risk to patient care.

I would further argue that candidates with institutional actions and misdemeanors that arise due to mental health issues, for example, drug addiction, are viewed more as individuals at risk than as individuals who will be comparable or superior physicians. In other words, shouldn't candidates with IAs due to drug abuse or addiction be viewed as risky?

LizzyM, or someone, has posted a chart that shows that people with 27+ on the MCAT generally aren't at risk to fail- the average MCAT is as high as it is just because we have so many applicants compared to the number of seats.

I think it is unethical. There is no reason to assume a link. And you keep not understanding that we are talking about people who have controlled their issues. There are successful applicants who talked about their recovery from addiction. If you went to an interview and said, "Hey, is it okay if I pop some pills in between surgeries?" then you will not be accepted. Having a prior history that you dealt with and learned to manage does not imply that you will be in danger in the future. And again, you cannot differentiate between applicants with no mental health history that actually don't have any illness vs those who have untreated illness. So all you are doing is punishing people for taking care of themselves

I think it is completely unethical to discriminate against applicants based on assumptions that have no evidence backing them up. Everything we use to screen out applicants has evidence supporting those screens, why add in one that hasn't even shown itself to be a problem?

 

[Eclipse010]

LizzyM, or someone, has posted a chart that shows that people with 27+ on the MCAT generally aren't at risk to fail- the average MCAT is as high as it is just because we have so many applicants compared to the number of seats.

I think it is unethical. There is no reason to assume a link. And you keep not understanding that we are talking about people who have controlled their issues. There are successful applicants who talked about their recovery from addiction. If you went to an interview and said, "Hey, is it okay if I pop some pills in between surgeries?" then you will not be accepted. Having a prior history that you dealt with and learned to manage does not imply that you will be danger in the future. And again, you cannot differentiate between applicants with no mental health history that actually don't have any illness vs those who have untreated illness. So all you are doing is punishing people for taking care of themselves

I think it is completely unethical to discriminate against applicants based on assumptions that have no evidence backing them up. Everything we use to screen out applicants has evidence supporting those screens, why add in one that hasn't even shown itself to be a problem?

Regarding the comment about GPA and MCAT scores: it's not whether a particular individual is capable or not, but rather it's whether he is a more desirable candidate than another individual with higher scores. I agree that many applicants with below average scores will do just fine in med school, but students with higher scores will have slightly better chances of being more successful (STEP 1 scores, graduation rates). Likewise, why would an adcom admit a candidate with a history of debilitating mental illness over one who does not (with all other things being equal)?

I also agree that just because someone does not have a formal history of mental illness does not mean that he will not or currently does not suffer from some mental illness. However, given the information available at hand, we would have to make decisions based on what we know, while acknowledging it's limitations. We can't simply ignore some very potentially important information because we don't know everything. The fact that someone has a history of mental illness is a risk factor for presenting mental illness in the future. Someone without a history can either mean they may or may not. We can't predict the future, so we need to make decisions based on what we do know.

Regarding individuals who have controlled their issues: like I said, the rate of relapse for drug addicts is high. There's no doubt that drug addicts don't intend to use again, but it happens - a lot, unfortunately. It's a risk that individuals without a history of drug addiction will have.

I acknowledge that I personally have not found any studies that investigated the link between mental health issues of physicians and patient care outcomes, but I also didn't find any that showed no link. Like I said, it's not unreasonable to question whether there's a correlation. I welcome anyone to cite studies that may provide insight on either side of the issue.

On that note, if it's unethical for med school adcoms to inquire about mental health issues, do you think applicants should not have to disclose institutional disciplinary actions due to substance abuse?

 

[7331poas]

There is no evidence or even hint of evidence that shows that physicians with a prior history of depression are more likely than their colleagues to be depressed as attendings and that this depression harms their patients.

How about people whose depression isnt ancient history? How about people who battle severe mental illness every day? How about people whose illness might actually be a concern just like any other physical illness.

You guys are using conditions which fit your argument. However there are many many people in medical schools (and undergrads) across the US that struggle with mental illness and that struggle affects their grades and their success in college. That phenomenon is a concern for admission staff whose job it is to admit the best students to complete course work.

Like I keep saying. Its about more than just attendings with depression that is ancient history.

I think when the general public walks into a doctor's office, they do so in good faith that the medical colleges and "the system" has vetted the doctor to a certain standard. What that standard is not such a simple line as you guys are trying to draw I think.

 

[ATPsynthase123]

Yes. If you are a danger to yourself and others, or are unable to function in society it should be disclosed in the same manner as past law offenses.

Take the Drama TV Doctor Gregory House for example. In the show he is depicted as this genius with a vicodin problem, but he always is the best at his job. In reality, he wouldnt be able to function and like most addicts he would place "the fix" in priority of his job performance. This is bad news for any patient with him as a doctor.

Simply put, if your job is saving lives, you have to be on your A game at all times. You cant fight with "crippling depression", addictions, or any other form of mental disease, because if you mess up some one is dead.

So, Just like you cant own a gun if you have psychological issues, it should be the same for Medical school because both could result in someone losing their life at your hands.

 

[peridotthecat]

Have any of the people posting in favor of forcing applicants to disclose mental health history actually had a mental illness/addiction or been in treatment? I've had depression for about 10 years at this point. For the first 5 of those years, I did everything possible to stay in denial and to hide my symptoms from my family, friends, teachers, etc. I've only really had proper, sustained treatment for the past 2 years or so, and I can't tell you what a difference it makes to have professional support and feel like I have someone with whom I can talk about this stuff and work on changing it instead of letting it fester deeper.

Even at the height of my depression, I was always at the top of my class. I was always able to get **** done for school or work when it needed to happen. But my resilience and relationships and self-worth have grown immensely through treatment. If others of my friends hadn't gotten treatment and talked about it and opened up the stigma, I could have kept going as is. I could have gotten the same GPA and mCAT, done the same ECs, and I probably could have convinced an adcom--and convinced myself--that I wasn't "mentally ill," just shy or stressed or whatever. That would have been dangerous to patients.

 

[7331poas]

Have any of the people posting in favor of forcing applicants to disclose mental health history actually had a mental illness/addiction or been in treatment? I've had depression for about 10 years at this point. For the first 5 of those years, I did everything possible to stay in denial and to hide my symptoms from my family, friends, teachers, etc. I've only really had proper, sustained treatment for the past 2 years or so, and I can't tell you what a difference it makes to have professional support and feel like I have someone with whom I can talk about this stuff and work on changing it instead of letting it fester deeper.

Even at the height of my depression, I was always at the top of my class. I was always able to get **** done for school or work when it needed to happen. But my resilience and relationships and self-worth have grown immensely through treatment. If others of my friends hadn't gotten treatment and talked about it and opened up the stigma, I could have kept going as is. I could have gotten the same GPA and mCAT, done the same ECs, and I probably could have convinced an adcom--and convinced myself--that I wasn't "mentally ill," just shy or stressed or whatever. That would have been dangerous to patients.

...You know what else would have been dangerous? If you couldnt get "****" done. Thats the whole point here.

I mean, thats the entire argument from med schools. Like the whole thing. What if, an applicant's mental illness hinders him or her in any way from finishing the course work and STEP exams as effectively as the next guy.

No one here honestly believes that people with severe mental illness perform equally well on the MCAT, STEP, etc? Well, if a med school does then that can be considered.

 

[gillyfish]

...You know what else would have been dangerous? If you couldnt get "****" done. Thats the whole point here.

I mean, thats the entire argument from med schools. Like the whole thing. What if, an applicant's mental illness hinders him or her in any way from finishing the course work and STEP exams as effectively as the next guy.

No one here honestly believes that people with severe mental illness perform equally well on the MCAT, STEP, etc? Well, if a med school does then that can be considered.

I believe you may be mistaken, as that is not the point here. Admission committees are responsible for reviewing & selecting applicants that are well suited for their program & whom they believe will be positive investments (becoming licensed practitioners who ethically & responsibly serve a much needed role by providing care without compromise). If someone is fully aware of & chooses to acknowledge a "deficit" by seeking treatment and taking the appropriate steps to manage it, why the need to punish them for it? That is effectively placing a glass sealing over the heads of many otherwise choice candidates & perpetuating the grossly inflated negative stigma attached to mental health. This only leads to shame, denial, or a combination of both, as individuals avoid seeking care for a pressing issue out of fear of the repercussions that may follow. Sadly, this holds true for pre-professionals & professionals in a number of fields (most certainly in medicine). Disclaimer, this is given the fact that they are indeed quality applicants. That is a decision for committees to make in their assessment, including academics, personal attributes (maturation, initiative, judgement, compassion), etc.

If an individual with a history of concern is able to produce a comparable application, dare one say they have the potential to possibly be a superior applicant once treatment & management is implemented? People should not feel a need to hide or avoid care for an issue they deem necessary based on fear of the subsequent consequences. Personally, I believe there is even a need for prophylactic measures to become more widely accepted in this community. No one would question the positive actions a patient takes to maintain or improve their physical health through diet or exercise, so why the controversy when pertaining to one's mental health? They are of equal importance when assessing a patient's overall well-being, no matter their occupation. Patients are humans & in case you forgot, physicians are too.

I could have kept going as is. I could have gotten the same GPA and MCAT, done the same EC's, and I probably could have convinced an adcom--and convinced myself--that I wasn't "mentally ill," just shy or stressed or whatever. That would have been dangerous to patients

100%. I could not agree more.

 

[7331poas]

If someone is fully aware of & chooses to acknowledge a "deficit" by seeking treatment and taking the appropriate steps to manage it, why the need to punish them for it?

Thats why you punish them if they are a risk for the medical school. Thats the point. If the mental illness is truly ancient history like you say, then no big deal. It is current and debilitating, then the medical school can make a call.

 

[peridotthecat]

...You know what else would have been dangerous? If you couldnt get "****" done. Thats the whole point here.

I mean, thats the entire argument from med schools. Like the whole thing. What if, an applicant's mental illness hinders him or her in any way from finishing the course work and STEP exams as effectively as the next guy.

No one here honestly believes that people with severe mental illness perform equally well on the MCAT, STEP, etc? Well, if a med school does then that can be considered.

Yeah, but if I couldn't get **** done, that would probably mean I couldn't end up with the gpa/Mcat/Ecs to be a competitive applicant and would have been screened out anyway. Your argument would only apply to people who can function despite their mental illness(es). And, based on my own experience, I'd say that many of those people are likely able--often because of our academic success--to convince ourselves that it's "just a phase" or "not that serious" or otherwise is not diagnosable and therefore not applicable to a prompt that asks about a history of mental illness. Whereas someone who has acknowledged that history and is in treatment and is cautious to describe themselves as "fully recovered"--because these things are unpredictable--will be screened out. It shifts the balance of rewards further towards denial rather than towards health and treatment.

 

[Eclipse010]

Yeah, but if I couldn't get **** done, that would probably mean I couldn't end up with the gpa/Mcat/Ecs to be a competitive applicant and would have been screened out anyway. Your argument would only apply to people who can function despite their mental illness(es). And, based on my own experience, I'd say that many of those people are likely able--often because of our academic success--to convince ourselves that it's "just a phase" or "not that serious" or otherwise is not diagnosable and therefore not applicable to a prompt that asks about a history of mental illness. Whereas someone who has acknowledged that history and is in treatment and is cautious to describe themselves as "fully recovered"--because these things are unpredictable--will be screened out. It shifts the balance of rewards further towards denial rather than towards health and treatment.

Just to be clear, no one is doubting the abilities of a person with a history of mental illness when they are not actively presenting their illness.

Instead, the concern is that those unwelcomed symptoms will recur at a time that may jeopardize patient or even the physician's own health. This is difficult to predict, and although recognition of one's own mental illness and coping mechanisms will undoubtedly be beneficial for the individual, this is by no means an assurance that these symptoms will not spiral out of control. This is a hallmark feature of drug addiction. I'm using this as an example, because of its cogent behaviorial and cognitive maladies, but this argument can be extended to many debilitating mental health issues.

A debilitating mental health issue is one that is disruptive to one's own life in some way, typically affecting multiple facets of his life (personal, professional). If it affects a physician's ability to do his job properly, then there's a high chance that patient care will be compromised.

The question is whether or not an individual with a history of such illness should be viewed more favorably over one who has not.

 

[peridotthecat]

Just to be clear, no one is doubting the abilities of a person with a history of mental illness when they are not actively presenting their illness.

Instead, the concern is that those unwelcomed symptoms will recur at a time that may jeopardize patient or even the physician's own health. This is difficult to predict, and although recognition of one's own mental illness and coping mechanisms will undoubtedly be beneficial for the individual, this is by no means an assurance that these symptoms will not spiral out of control. This is a hallmark feature of drug addiction. I'm using this as an example, because of its cogent behaviorial and cognitive maladies, but this argument can be extended to many debilitating mental health issues.

A debilitating mental health issue is one that is disruptive to one's own life in some way, typically affecting multiple facets of his life (personal, professional). If it affects a physician's ability to do his job properly, then there's a high chance that patient care will be compromised.

The question is whether or not an individual with a history of such illness should be viewed more favorably over one who has not.

And my point is that there's no reliable way to screen for this. Asking if someone's been diagnosed etc. means that you will by definition catch pretty much anyone who's been in treatment and will miss a lot of people who haven't because they've seen the stigma and are doing their absolute best to stay in denial

 

[7331poas]

And my point is that there's no reliable way to screen for this. Asking if someone's been diagnosed etc. means that you will by definition catch pretty much anyone who's been in treatment and will miss a lot of people who haven't because they've seen the stigma and are doing their absolute best to stay in denial

Of course. But I wonder if IA's weren't listed on transcripts we would be having this same discussion about whether we should be obligated to report those.