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Advice regarding bipolar diagnosis

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54 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.

A lack of empathy likewise limits one's ability to provide adequate care. 

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15 hours ago, yonas said:

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

I'd be a bit more concerned about your ability to provide care than OP, tbh.

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15 hours ago, yonas said:

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

actually that is exactly the question - and if the condition can be properly managed, and in many people that is exactly the case, then there can be no issue at all. There are doctors out there with disabilities and doing quite fine including various mental disabilities. There self-awareness of various conditions can make them quite effective.

Some aspects of medicine can make some conditions worse - lack of sleep, long hours, variable schedules, and high stress to name a few- but that is just something that has to be factored in. Anyone going into the field will have to know that and make an aware choice. Still a ton of room to work with inside of the various issues. 

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Apologies for the misunderstanding. I certainly agree that if managed well and not interfering with care provided a diagnosis of bipolar would be a non-issue. However, I would not personally feel comfortable or secure in providing adequate level of care if I had that diagnosis. How you decide if the condition is properly managed is the question of the day. Empathy is well and good but there is no point mincing words. Bipolar is a life-changing diagnosis. I do not want to discourage OP but there is a need to be realistic.

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1 hour ago, yonas said:

Apologies for the misunderstanding. I certainly agree that if managed well and not interfering with care provided a diagnosis of bipolar would be a non-issue. However, I would not personally feel comfortable or secure in providing adequate level of care if I had that diagnosis. How you decide if the condition is properly managed is the question of the day. Empathy is well and good but there is no point mincing words. Bipolar is a life-changing diagnosis. I do not want to discourage OP but there is a need to be realistic.

Sure - phrasing sometimes can be challenging with this sort of thing (plus bipolar like everything else falls on a range even when it crosses the line to being clinically classified as a true bipolar disorder). Anyone with any form of disability will have challenges in doing medicine, regardless of whether that is physical or mental, and each case is unique and evaluated as such. 

Yonas is reinforcing the point that this can be challenging - which is true. One of the reasons med schools rely so heavily on UG performance is for them it serves as a proxy of some of the high work loads that can happen in clinical training. Still for some that is a barrier they can cross with focus and proper supports. A balance of optimism and caution is probably wise followed with a reasonable plan for success.  

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1 hour ago, yonas said:

Apologies for the misunderstanding. I certainly agree that if managed well and not interfering with care provided a diagnosis of bipolar would be a non-issue. However, I would not personally feel comfortable or secure in providing adequate level of care if I had that diagnosis. How you decide if the condition is properly managed is the question of the day. Empathy is well and good but there is no point mincing words. Bipolar is a life-changing diagnosis. I do not want to discourage OP but there is a need to be realistic.

I guess I take issue (not that anyone cares) with several folks here responding just to say that OP should quit medicine. The original question was whether ppl have advice on whether fam med might be a better choice than a specialty, and seeking others who have been in this situation. 

Instead there are a bunch of folks making values judgements about how they would quit medicine if this were them. You don't know what you would do until you're in this position, and is that really helpful or productive commentary to offer here? 

I just want to make sure OP knows that not all future colleagues out there think the same way. It's a waste of time to say all the platitudes re. 'if it's managed well of course it's fine' but then to re-iterate that you don't think it's safe and you would quit. 

Also, telling someone with an actual diagnosis who lives with this every day that there is a 'need to be realistic' is a bit ridiculous IMO.

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3 hours ago, alextrebek said:

Also, telling someone with an actual diagnosis who lives with this every day that there is a 'need to be realistic' is a bit ridiculous IMO.

Implying that patients with bipolar in all cases have more insight into their disorder/limitations that impartial third parties is ridiculous. In reality for OP, family medicine vs ophthalmology  is not a decision that can be made on a forum. It entirely depends on the characteristics of their diagnosis and life situation. OP needs to discuss this with their medical school, psychiatrist, and licensing authority.

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9 hours ago, Raptors905 said:

What level are you?

 

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

How many doctors with Bipolar I do you know? It is all dependent on the OP's specific situation.

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8 hours ago, rmorelan said:

Sure - phrasing sometimes can be challenging with this sort of thing (plus bipolar like everything else falls on a range even when it crosses the line to being clinically classified as a true bipolar disorder).

I know this is another aside to the topic at hand, and I highly respect you, @rmorelan, but I’d like to clear up the common layperson and medical community assumption that bipolar doesn’t fall on a spectrum. Yes, the dsm chapter refers to it as a spectrum disorder, but if you *have* bipolar I (or bipolar II, or cyclothrmic disorder, etc.) then you had to have met criteria for it, end of story. 

we are real sticklers for this in psych, and there is nothing more frustrating than people referring to themselves as “bipolar” (or “OCD”) when they have the odd mood swing related to stress. It diminishes the true impact and severity of the illness.
 

to the OP: I hope you’re doing well—still rooting for you to get help, surround yourself with supports, and discover the path the works for you. 

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4 hours ago, yonas said:

How many doctors with Bipolar I do you know? It is all dependent on the OP's specific situation.

I think the real question is how many do you know? Likely none—based on your reactionary post—and I don’t want to upset you, but there’s WAY more than you’d think. The reason you’re unaware is they don’t advertise it, due to reactions similar to your own.

While we are at it, do you really know how many people in medicine have medical diagnoses that are limiting in some way, yet make perfectly good family docs, surgeons, internists, etc? 
 

you kinda remind me of the guy in my med school class who put up his hand when the endo asked in preclerkship if there was anyone who had never met a person with diabetes—we even had a classmate with it and the guy either forgot or was in denial...

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On 12/22/2019 at 2:21 AM, yonas said:

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

It wouldn’t if the clinician is able to be evaluated and is under the care of a psychiatrist who has deemed the clinician stable and capable. And to answer your other question, I know of a great physician who also has bipolar. Not just in clinical practice but in academia research and education as well. 

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7 hours ago, LostLamb said:

I know this is another aside to the topic at hand, and I highly respect you, @rmorelan, but I’d like to clear up the common layperson and medical community assumption that bipolar doesn’t fall on a spectrum. Yes, the dsm chapter refers to it as a spectrum disorder, but if you *have* bipolar I (or bipolar II, or cyclothrmic disorder, etc.) then you had to have met criteria for it, end of story. 

we are real sticklers for this in psych, and there is nothing more frustrating than people referring to themselves as “bipolar” (or “OCD”) when they have the odd mood swing related to stress. It diminishes the true impact and severity of the illness.
 

to the OP: I hope you’re doing well—still rooting for you to get help, surround yourself with supports, and discover the path the works for you. 

ha fair enough! again bouncing in and out of the language here and thanks for the correction. Been awhile since I went through the nuances of the terms (it is actually a bit shocking how rapidly med school become fair away). There are I would think though - and by all means correct me - there are still considerable degrees of severity of the condition within the entire group of those that match the clinical definition?  I do remember some seemed to be rather well controlled and some not on my rather limited clinical time (ha 6 weeks - barely enough time to learn where the bathrooms are....let alone grasp the complexities of the field). 

Is there a standardized name for something that doesn't reach the full point of bipolar? Still some form of mood disorder I would think (and like you I am not referring to "mood swings" from stress). Not everything in the world would have to be on a spectrum of course ha but I have always found the idea that things can be over wide ranges to a reminder that everyone has to be accessed for their own merits. 

 

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7 hours ago, LostLamb said:

I think the real question is how many do you know? Likely none—based on your reactionary post—and I don’t want to upset you, but there’s WAY more than you’d think. The reason you’re unaware is they don’t advertise it, due to reactions similar to your own.

While we are at it, do you really know how many people in medicine have medical diagnoses that are limiting in some way, yet make perfectly good family docs, surgeons, internists, etc? 
 

you kinda remind me of the guy in my med school class who put up his hand when the endo asked in preclerkship if there was anyone who had never met a person with diabetes—we even had a classmate with it and the guy either forgot or was in denial...

Ha true - med school blinders. As if a class of ~200 wouldn't have a range of conditions. 

I would second there are more than you would think - and not always who you would think either for that matter. In time if you create a trusting environment (even if that environment just surrounds you), and they happen to be willing you may find out just how diverse medicine actually is. We are all just human after all. 

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On 11/11/2019 at 4:11 PM, 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. 

I think that you should practice what you love, since you get recently diagnosed with bipolar I, you have a lot of time to get it under control.

There is a higher prevalence of depression, anxiety, substance use and mental health illnesses among physicians and health care professionals in general. A lot of people don't report and don't seek out help. I think that you are doing the right thing by actively seeking advice, the most importance advice that  I would give you now is to get a outpatient psychiatrist and family doctor NOT AFFILIATED in academics ASAP, and try to protect your diagnosis from your faculty. 

If you do end up needing accommodations, having your GP writing a letter saying Mr/Ms X needs protected hours due to medical condition. I will be very cautious of revealing your bipolar I in real life with your medical school . If you do end up disclose to someone in the faculty, make sure that he/she does not forward the information. 

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5 hours ago, rmorelan said:

ha fair enough! again bouncing in and out of the language here and thanks for the correction. Been awhile since I went through the nuances of the terms (it is actually a bit shocking how rapidly med school become fair away). There are I would think though - and by all means correct me - there are still considerable degrees of severity of the condition within the entire group of those that match the clinical definition?  I do remember some seemed to be rather well controlled and some not on my rather limited clinical time (ha 6 weeks - barely enough time to learn where the bathrooms are....let alone grasp the complexities of the field). 

Is there a standardized name for something that doesn't reach the full point of bipolar? Still some form of mood disorder I would think (and like you I am not referring to "mood swings" from stress). Not everything in the world would have to be on a spectrum of course ha but I have always found the idea that things can be over wide ranges to a reminder that everyone has to be accessed for their own merits. 

 

Back in DSM IV-TR days (which I think is what you would've trained under, as did I in med school and then had to learn DSM5 for residency), you'd probably have called such a person "Mood disorder not otherwise specified (NOS), or Bipolar NOS. There are other parsed out diagnoses that existed in DSM-IV as well as in DSM5--right now, if you can't diagnose bipolar but it kinda looks like a manic or hypomanic episode, then you'll call it 'unspecified bipolar disorder' (with the caveat that you get the collateral to rule it in or out asap so you're getting the person the right treatment).

I stand corrected that you CAN specify severity of the specific mood (manic, hypomanic, depressed) episode as mild, moderate, severe but it rarely is used in bipolar. I can't remember the last time I saw a manic episode that wasn't severe (meeting full criteria with functional decline/decompensation)--the mild/moderate presentations are the exception, and make me think there is probably a better diagnostic category to capture the issue. Again, don't forget DSM is a research tool and researchers love to create categorical diagnoses (and then revise them in 10 years!!)

There is a push by some in psychiatry that everything is on a spectrum, and I think for some of the illnesses that's true, but not all. That could just be my bias. I like to be cognizant that not every behaviour is pathological and that human behaviour is allowed to be odd/quirky and isn't deserving of diagnosis if not causing impairment or distress. In the above case, real bipolar disorder is quite disabling and hence my reaction to it being on a spectrum, because this minimizes its devastating impairment if not identified and treated efficiently and effectively.

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My advice - make a pros and cons list to each but don't make a definitive choice. Continue to update the list over the year(s).  Explore both fields as potential career choices.

It's still very early in you diagnosis: you'll have better insight on which area you want +  fits you better once you've gone through the channels, started meds, took care of urself, etc. It probably feels out of hand right now and messy - but you will get a better handle/grip on this and everything will fall into place. There is no way to predict how you do when BP is managed. And you can't predict how you do on calls and long hours until you actually do it i.e. will bp make it worse? or will it be normal reaction when bp is well-managed?  For now, ride the wave and focus on taking care of yourself.  

You are clearly a very capable individual and I have no doubt will get into either field based on ur choice. I am sorry some of the replies are trashy.

 

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