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Advice regarding bipolar diagnosis

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Hey everyone,

I am a medical student and I was recently diagnosed with Bipolar Type 1 disorder. I was initially interested in pursuing ophthalmology. After my diagnosis, I am now thinking that maybe I should take it easy and go into family medicine as the duration of training will be shorter and also less stressful. Also in family medicine I will have more control over my schedule. I know family medicine won't be as fullfilling as ophthalmology but still I can see myself doing it. It won't be the end of the world.

What do you guys think? Any advice would be appreciated, especially from someone who is in a similar situation or knows someone in a similar situation. 

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6 hours ago, SGSP said:

Hey everyone,

I am a medical student and I was recently diagnosed with Bipolar Type 1 disorder. I was initially interested in pursuing ophthalmology. After my diagnosis, I am now thinking that maybe I should take it easy and go into family medicine as the duration of training will be shorter and also less stressful. Also in family medicine I will have more control over my schedule. I know family medicine won't be as fullfilling as ophthalmology but still I can see myself doing it. It won't be the end of the world.

What do you guys think? Any advice would be appreciated, especially from someone who is in a similar situation or knows someone in a similar situation. 

With all due respect, if you're letting that diagnosis limit you and drastically alter your career aspirations like that, then I'm not sure you're suitable for Family Medicine either. 

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14 minutes ago, Intrepid86 said:

With all due respect, if you're letting that diagnosis limit you and drastically alter your career aspirations like that, then I'm not sure you're suitable for Family Medicine either. 

With all due respect, I don't think you know what you are talking about. Bipolar is not a walk in the park. Try staying a full year in bed doing absolutely nothing and thinking about how to end your life, then you can come talk to me about "career aspirations".

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You asked for input - don't go postal on the feedback.   

A lot really depends on how well the symptoms you experience can be controlled or mitigated.    You have already gotten through undergrad and a portion of med school which is no easy task so you appear to have some coping skills developed already.   

Sure, family residency is shorter, but I doubt really less stressful.   Do you recognize what conditions trigger episodes ?

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19 minutes ago, SGSP said:

With all due respect, I don't think you know what you are talking about. Bipolar is not a walk in the park. Try staying a full year in bed doing absolutely nothing and thinking about how to end your life, then you can come talk to me about "career aspirations".

You said you were recently diagnosed with Bipolar Disorder. Clearly someone with uncontrolled Bipolar Disorder as you've described isn't going to achieve their potential. The situation can change with better management. You're not here for advice. You're here for affirmation of your decision.

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53 minutes ago, Meridian said:

You asked for input - don't go postal on the feedback.   

A lot really depends on how well the symptoms you experience can be controlled or mitigated.    You have already gotten through undergrad and a portion of med school which is no easy task so you appear to have some coping skills developed already.   

Sure, family residency is shorter, but I doubt really less stressful.   Do you recognize what conditions trigger episodes ?

I am open to feedback, but surely there are more empathetic ways to tell someone your opinion than the way Interpid86 put it.

Anyways, again if someone who has Bipolar is reading this, I would appreciate it if you can DM me.

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It might be really helpful to have this conversation with a trusted mentor (a staff or a resident) in ophthalmology or some surgical specialty if you can without making yourself vulnerable to repercussions, as well as with your psychiatrist. It probably to some degree depends how brittle your BPAD is and what your specific triggers are.

The biggest issue would likely be the call/sleep deprivation, especially on rotations like gen surg, which I’m assuming you’d need to do in residency. 

Some programs (like mine) allow residents with certain disabilities to not do call (they make up the experience in other ways). If I had to guess, I would guess that surgical specialties are likely to be less flexible in that way, but I can’t say from personal experience. So you’re right that FM might be more accommodating of your needs.

I’m not sure how active it still is, but for a while the Canadian Association of Physicians with Disabilities had an active-ish forum that would likely be a really good resource because you might be able to find some surgeons who could speak to the issue of disability accommodations in surgical specialties. 
 

Once you get to residency being ill at work becomes even more of an issue and you can get yourself into issues with the College and/or your program if you are symptomatic in a way that interferes with patient care. 

I’m hoping you get some answers from more surgical people. It’s a tough issue for sure. I think it’s really good that you’re thinking about it proactively. 

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Is the school aware of this diagnosis? I will say that there are publicly published cases of medical residents that couldn't transfer into FM from their speciality when their mental health compromised their residency performance. While I agree above that FM is not necessarily stress free it is 100% shorter than a surgical specialty and will generally offer a more relaxed environment. You only have to talk to FM residents regarding their week-to-week and exam prep year to understand the difference between their lives and that of residents in busier specialties. I'm not trying to disparage FM residents as they still have busy rotations and responsibilities but on average they will have less busy schedules. 

OP: I think you are smart to be thinking about this. I don't think it's great that you might have to compromise your future career path but I think the most important thing is finishing some sort of residency program. 

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Another advantage of family med is when you are staff, you will have much more flexibility. It's easier to work part time and it's easier to get a job in a location you desire. A surgical specialty means you are going to have a difficult time getting a job that you want in a location you desire. I can't imagine it would be good for your mental health to have to move to some rural area where you know nobody, 4 provinces away from your home. 

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Thank you everyone for your responses. When I say I was recently diagnosed, I meant like last week. I still did not get a chance to speak with my psychiatrist about this, but I can already see how my diagnosis could hinder my performance should I go into ophthalmology. I am particularly worried about lithium-induced tremor. I am also worried about what would happen if I become sick during residency and have to take several months off. In family medicine, each program has like 50 residents, so if one resident needs to take time-off, it is not that big of a deal. Obviously that may not be the case in a small program like ophthalmology. And then there is the longer duration of training, the need for fellowship, and then as NLengr mentioned the need to be flexible about where you work. Lots to think about for sure. I mean, according to uptodate, 10-15% of bipolar patients die by suicide. So, yeah being an ophthalmologist is great and all, but staying alive is better.

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1 hour ago, SGSP said:

Thank you everyone for your responses. When I say I was recently diagnosed, I meant like last week. I still did not get a chance to speak with my psychiatrist about this, but I can already see how my diagnosis could hinder my performance should I go into ophthalmology. I am particularly worried about lithium-induced tremor. I am also worried about what would happen if I become sick during residency and have to take several months off. In family medicine, each program has like 50 residents, so if one resident needs to take time-off, it is not that big of a deal. Obviously that may not be the case in a small program like ophthalmology. And then there is the longer duration of training, the need for fellowship, and then as NLengr mentioned the need to be flexible about where you work. Lots to think about for sure. I mean, according to uptodate, 10-15% of bipolar patients die by suicide. So, yeah being an ophthalmologist is great and all, but staying alive is better.

All of those concerns are legitimate and its great that you are proactively thinking ahead. How far are you into your med school education? Have you considered talking to your UME and taking a year off from med school to focus on your health and to get a good grasp on managing your BPD before jumping into CARMS? That may help with your ability to cope even within a competitive and difficult speciality like optho. 

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I do not have bipolar disorder, but I am a new psychiatrist--I can comment superficially, at least, based on my experience as a trainee having worked with individuals with bipolar.

I have noted that there are plenty of people in high demand careers, including medicine, with severe and persistent mental illness diagnoses. 

Also, a number of individuals with bipolar are high functioning, but maintaining that level of function closely correlates with close followup, strict medication adherence, family/social support, and maintaining excellent sleep hygiene.

It is a tall order to fill, no doubt, without adding the stressors that come with medicine.

First and foremost, you need to get on medications to stabilize your mood episodes and need to have open and frank conversations with your psychiatrist about your future, your hopes, your dreams. You will likely require accommodations even in medical school, best to get these discussions going ASAP. Don't throw the baby out with the bathwater yet regarding ophtho.

Good luck and all the best to you.

LL

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14 minutes ago, MedLife2018 said:

All of those concerns are legitimate and its great that you are proactively thinking ahead. How far are you into your med school education? Have you considered talking to your UME and taking a year off from med school to focus on your health and to get a good grasp on managing your BPD before jumping into CARMS? That may help with your ability to cope even within a competitive and difficult speciality like optho. 

I don't want to give too much information away for the sake of staying anonymous, but I still have a lot of time before CaRMS. I don't currently need a year off school, and I am not sure I want UGME to know about this unless I absolutely have to.

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If you’ve just been diagnosed it probably makes sense to focus on taking care of yourself, getting stable, and finding the right medication for you. 

Even if you do get a tremor, which you might not, there are ways to manage that. 

It’s great that you’re being proactive - AND you don’t have to make all these decisions right now. If you’ve just been diagnosed, that’s a lot to take in and think about all by itself. 

I don’t have bipolar but when I was a medical student UGME was aware of what I do have and having accommodations was really useful. You may very well need them for clerkship. 
 

But again, you don’t have to make that decision right now if you have some time before clerkship starts. 

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I am extremely happy to see people with expertise and experience finally responding to this, I was not having a nice time reading the beginning of this thread.

I can say I agree with everything that bpMed has said and I'm grateful for you sharing your story and insight for the OP.

I am currently completing my sciences one at a time while working full time (mental health nurse), and applying to med school in the next couple years.  I suffer with depression, anxiety, and PTSD from multiple traumas.  I will tell you that it will NOT be an easy road ahead, but clearly this is not news to you with what you've already been through.  And the fact that you have survived until this point without knowing the 'why' in how you were feeling speaks volumes to your strength out the gate.  What a terrifying time you must have had.  I am very proud of what you've overcome to be here with us today.  It's more difficult to deal with a struggle if we literally don't know why it's happening... know what I mean? (the too well-known "I am anxious because I don't know why I'm anxious" cycle for me).

I will also tell you that whatever you decide to do, you CAN do it.  The suggestions are right in making sure to take the time to figure out a self-care routine that keeps you at your most well, having support of your medical team and family/friends, and being open about your struggles early on and proactive with management.

The FM idea, in the past I had decided that when I get in, this is the residency I would aim for as it was the shortest.  With intensive work on myself and doing CBT, I now know that as long as I continue my management practices, I could be a surgeon if that's what I decide.  It all comes down to how we prepare ourselves to succeed, and that requires being vulnerable in admitting what we need.  Whether that is some time off for medical reasons, or not, is evidently your call.  I learned this the hard way and had to take a year off of work some time ago, in order to figure out how to take care of myself.  Choosing FM is totally fine, but not if you make the decision in the spirit of limiting yourself.  You need to be very honest with yourself because if you make this decision for the wrong reason, you may not feel fulfilled later on which would also feel terrible.

There are MANY successful people in high-stress careers that suffer with mental illness, the only time they aren't successful is by not taking the steps to manage it as needed, and it looks like you are already doing this in seeking advice.  Wish you the best of luck!

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Some great advice has already been posted, but I also want to offer you encouragement as you enter into treatment and management. If controlled, I wouldn't doubt your potential. Seeing a psychologist is a great way to get to know yourself and your needs, and if through that you decide you need to lower your stress, then by all means do that. But fulfillment is important, and burnout is real... if you aren't doing what you truly desire, consider the effect it will have on your mental health. I hope you find a great psychologist who can help you through this decision, better than people on the internet! 

 

And again, it's going to be okay. I was recently diagnosed with MDD and PTSD at the start of my first year (this past September). It's been rough, but we'll both get through it. I'm still aiming high, because I'm confident I'm going to get better and I KNOW going into Family Medicine (which I personally would find very unfulfilling), would make my depression worse. 

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6 hours ago, yonas said:

I would certainly leave medicine. How does such a diagnosis affect your ability to provide care?

I seriously hope you are a troll. This is highly insensitive. 
 

watxh the Mauro documentary (Bipolar Rock and Roller) to see how you can overcome this to be highly successful 

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On 11/11/2019 at 9:38 PM, Intrepid86 said:

With all due respect, if you're letting that diagnosis limit you and drastically alter your career aspirations like that, then I'm not sure you're suitable for Family Medicine either. 

What an incredibly bad take. It's not about 'choosing to let a diagnosis limit you', it's about understanding the realities of an illness (physical as it relates to medication side effects, and psychiatric as it relates to triggers). The reality is, fam med has a shorter duration of training, including the odd program with no overnights at all, and more flexibility in practice. 

Don't be discouraged, OP. You're the only one who gets to decide what you want your future to look like. 

 

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4 hours ago, Raptors905 said:

I seriously hope you are a troll. This is highly insensitive. 
 

watxh the Mauro documentary (Bipolar Rock and Roller) to see how you can overcome this to be highly successful 

Just because it is insensitive does not mean it is wrong. Foremost is the safety of our patients. And if I had a diagnosis that limited my ability to provide adequate care, I would leave medicine too.

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47 minutes ago, yonas said:

Just because it is insensitive does not mean it is wrong. Foremost is the safety of our patients. And if I had a diagnosis that limited my ability to provide adequate care, I would leave medicine too.

What level are you?

 

where is the evidence that someone with bipolar cannot provide effective patient care 

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