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Seeking mental healthcare during medical training


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Hi all,

I'm currently a medical student and am looking to seek professional help for what I think might be an anxiety disorder (or whatever it is; my mental health isn't the best and hasn't been for a while). I've never sought help before so I'm a little apprehensive. In particular, I'm worried that if I seek help with my med school's in-house counselor, the fact that I needed such services and my diagnosis (if I receive one) will end up on my school records in some way and will negatively impact my matching/career prospects down the line. Obviously they say everything is confidential and medical schools like to talk about how progressive they are about mental health nowadays, but the truth is the stigma is still very much there, and I'd rather not accidentally step on a landmine.

Is it safe to seek out mental health treatment during medical training? Any pitfalls I should be aware of to make sure this doesn't impact my professional future in any way whatsoever? Would it be better to seek help from a mental health professional who's not associated with my medical school?

Any advice would be appreciated. Thank you!

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My doctor is unaffiliated with the faculty, so whenever I needed a prescription or a referral to a specialist/physio, I knew that she wasn't going to be brushing shoulders with faculty members in charge of program assessment. I also always asked for referrals to be to specialists uninvolved with the faculty. 

Personally, I choose not to talk to anyone associated with the faculty about sensitive health issues. I know that everything you discuss with student affairs is supposed to be confidential, but I worry regardless. Unfortunately, if you need counselling and can't afford to pay for it privately, you may have to decide whether the free services provided by your school are worth the small risk of information getting out. 

 

 

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It’s certainly safe to seek treatment for mental health issues as a medical student, and if you’re starting to feel like you’re struggling then it’s really better to do it sooner rather than later.

I understand your hesitancy about using your school as a resource though. If the cost for private counselling is an issue, there are sometimes other alternatives. 

In BC the health ministry and doctors of BC provide the physician’s health program, which provides support to doctors (including medical students):  https://www.physicianhealth.com/ If you’re not in BC, there may be an equivalent in your province. They have physicians there who act as peer support, and they can put you in touch with a doctor if you need one, and will provide access to a limited amount of counselling for free. Everything is confidential and it’s not connected to your student file. Accessing counselling through them can take a few weeks, but you get a minimum of 6 sessions for free, and sometimes more if your peer support thinks it is needed. It’s been a good resource for me.

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I have had colleagues who have been burned by seeking mental healthcare and self-reporting to the college.

I 100% support seeking support as your health is the number 1 priority. I would be careful around disclosing it to anyone that could have an impact on your career. The leadership in this profession can be surprisingly callous.  

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I agree with the above:

1. Get disability and life insurance as early as possible. Talk to a good insurance agent (OMA or whoever) and make sure you have every rider avaliable plus the ability to increase coverage in the future without a medical. 

2. DO NOT TRUST YOUR UNIVERSITY or HOSPITAL. Do not disclose anything to them regarding your health unless legally required to do so. Ditto the college of physicians. If you think you must disclose, I would honestly seek legal advice prior to making any disclosure. If you need mental healthcare or sensitive physical healthcare, get it done outside of the university system (or your hospital) if at all possible. Never, ever believe anyone associated with your university or hospital when they say things are confidential because they aren't. Your university and/or hospital will have no hesitation to screw you over at the drop of a hat if they think there is the tiniest advantage to doing so.

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2 hours ago, NLengr said:

Physicians are literally some of the worst people I know. We treat each other worse than any other profession or group. It's so bad I am frequently ashamed to be part of the profession.

Look I know I'm definitely not as experienced as you but in almost every post you write you spill your own hatred towards physicians in general... 

I've had the (maybe unlikely) pleasure of working with some of the best kind hearted people and when I struggled with mental wellbeing the school was incredibly supportive at all points of my care. I just can't imagine everywhere you go being what you describe. 

- G 

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7 hours ago, GH0ST said:

Look I know I'm definitely not as experienced as you but in almost every post you write you spill your own hatred towards physicians in general... 

I've had the (maybe unlikely) pleasure of working with some of the best kind hearted people and when I struggled with mental wellbeing the school was incredibly supportive at all points of my care. I just can't imagine everywhere you go being what you describe. 

- G 

It seems like this might be a cry for help? When you've been personally wronged, what do people tend to do? You take your own experience to be the norm and intentionally (or not) you pass that on to those around/below you. It probably doesn't come from a bad place...probably years of bad experiences making you jaded and burned out.

With that being said, the advice doesn't sound that unreasonable to me, but based on my own limited understanding I thought disclosure of someone's mental health could only be made when there is a significant risk of harm to yourself or others? Confidentality and privacy is the rule rather than the exception I thought.

I haven't reviewed this in years...this is what a quick Google search brought to me:
http://www.ohrc.on.ca/en/human-rights-and-mental-health-fact-sheet

https://www.legalline.ca/legal-answers/are-mental-health-records-confidential/

https://www.omainsurance.com/Articles/Pages/Mental-Health-of-Physicians.aspx

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8 hours ago, GH0ST said:

Look I know I'm definitely not as experienced as you but in almost every post you write you spill your own hatred towards physicians in general... 

I've had the (maybe unlikely) pleasure of working with some of the best kind hearted people and when I struggled with mental wellbeing the school was incredibly supportive at all points of my care. I just can't imagine everywhere you go being what you describe. 

- G 

I'm not sure your viewpoints contradict each other. You felt supported by your school's administration (which is wonderful). From my understanding, NLengr's point is about how in the future when it is expedient, what someone previously disclosed can be used against them. Not the same thing.

 

OP - I'd also be careful with what you say and who you say it to.

I went to health services on campus (who told me that on campus counselling resources are limited and I'm better off going off campus, which didn't help because our insurance covered very little of it, but that's another story).

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18 minutes ago, sangria said:

I'm not sure your viewpoints contradict each other. You felt supported by your school's administration (which is wonderful). From my understanding, NLengr's point is about how in the future when it is expedient, what someone previously disclosed can be used against them. Not the same thing.

 

OP - I'd also be careful with what you say and who you say it to.

I went to health services on campus (who told me that on campus counselling resources are limited and I'm better off going off campus, which didn't help because our insurance covered very little of it, but that's another story).

In what circumstances can what someone previously disclosed be used against them if you don't mind me asking? Are you talking about disclosures to your own family doctor/counselor/psychiatrist/etc? Or disclosure to the College, your medical school, etc.?

I find this very interesting so I want to re-educate myself on the details. My understanding is that the details from your private consultations with your health care provider are confidential except in the most extenuating circumstances. Disclosure to the College is different as their responsibility isn't really to protect us, but to protect the public, so your disclosure could very well be used against you. Same thing with the insurance bit - signing up for disability or health insurance is harder (and more $$) once you have pre-existing diagnoses (mental health or not).

Would appreciate any info you guys have. I'm surprised that most of the forum feels so strongly against seeking mental health services. My own anecdotal experiences in Canada when I was in pharmacy school and in Ireland for medical school have been nothing but positive and supportive when seeking out these services. 

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3 hours ago, StarStrike said:

In what circumstances can what someone previously disclosed be used against them if you don't mind me asking? Are you talking about disclosures to your own family doctor/counselor/psychiatrist/etc? Or disclosure to the College, your medical school, etc.?

I find this very interesting so I want to re-educate myself on the details. My understanding is that the details from your private consultations with your health care provider are confidential except in the most extenuating circumstances. Disclosure to the College is different as their responsibility isn't really to protect us, but to protect the public, so your disclosure could very well be used against you. Same thing with the insurance bit - signing up for disability or health insurance is harder (and more $$) once you have pre-existing diagnoses (mental health or not).

Would appreciate any info you guys have. I'm surprised that most of the forum feels so strongly against seeking mental health services. My own anecdotal experiences in Canada when I was in pharmacy school and in Ireland for medical school have been nothing but positive and supportive when seeking out these services. 

Nobody is saying don't seek out mental health services. We are all saying be careful who you talk to and what you disclose to people in authority, whether they come from a university/hospital/college. 

 

The standards for confidentiality differ depending on the situation. If you disclose to your family doc you have a history of depression, then there is a well established standard of confidentiality. But if disclose to the university for example, then that standard is different (and may not exist at all). On top of that, just because your university/hospital/college might not broadcast to others that you have a history of x, y or z illness (or anything really) it doesn't mean that they will not put limitations or specific stipulations in your educational or occupational experience. I've seen it happen multiple times, and in most circumstances, the university or hospital was likely in the wrong. The physician or resident ended up in months to years of meetings/complaints/litigation before the university or hospital backed down. It's far far far far far safer for your personal well being and your career to be extremely guarded in anything you voluntarily disclose and to act to protect yourself.

The other thing to remember is while you can say that it's illegal to disclose information, it's a vastly different thing to PROVE that the disclosure occured. And proof of disclosure occurring is what is needed in a court of law. Like a lawyer I know says: "knowing something happened and proving something happened are very different things".

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It’s important to remember that the College of Physicians relies on self-report. They will ask something like if you have any medical condition that could interfere with your ability to practice medicine. If you have a mental health diagnosis you need to decide how to interpret that. 

If you say yes they will ask for additional documentation and you can either consent for it to be disclosed, or not have a license. 

So doctor patient confidentiality largely isn’t an issue as much as that you may have to disclose something yourself. 

Disability insurance questionnaires will often ask if you’ve ever had any mental health treatment and if so will deny you, jack up your premiums, or exclude mental health related claims entirely. So this is a huge issue. 

With respect to your doctor or counselor disclosing something, they really shouldn’t - though I believe if a physician has a concern that you are impaired in your ability to practice, this constitutes a permissive report to the College.  

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12 hours ago, GH0ST said:

Look I know I'm definitely not as experienced as you but in almost every post you write you spill your own hatred towards physicians in general... 

I've had the (maybe unlikely) pleasure of working with some of the best kind hearted people and when I struggled with mental wellbeing the school was incredibly supportive at all points of my care. I just can't imagine everywhere you go being what you describe. 

- G 

Don't get me wrong, I know good physicians. There are lots. But the percentage of socially incompetent, unprofessional, vindictive, self interested or just downright assholes in the profession is surprisingly high. Much higher than in most other professions I have worked in/with. And, unfortunately, many of those people seem to be the ones who seek out authority positions. 

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13 minutes ago, NLengr said:

Nobody is saying don't seek out mental health services. We are all saying be careful who you talk to and what you disclose to people in authority, whether they come from a university/hospital/college. 

 

The standards for confidentiality differ depending on the situation. If you disclose to your family doc you have a history of depression, then there is a well established standard of confidentiality. But if disclose to the university for example, then that standard is different (and may not exist at all). On top of that, just because your university/hospital/college might not broadcast to others that you have a history of x, y or z illness (or anything really) it doesn't mean that they will not put limitations or specific stipulations in your educational or occupational experience. I've seen it happen multiple times, and in most circumstances, the university or hospital was likely in the wrong. The physician or resident ended up in months to years of meetings/complaints/litigation before the university or hospital backed down. It's far far far far far safer for your personal well being and your career to be extremely guarded in anything you voluntarily disclose and to act to protect yourself.

The other thing to remember is while you can say that it's illegal to disclose information, it's a vastly different thing to PROVE that the disclosure occured. And proof of disclosure occurring is what is needed in a court of law. Like a lawyer I know says: "knowing something happened and proving something happened are very different things".

I see. Very sad to hear... Best to avoid the headache with the university/hospital/college in having to "prove" your potential mental health issue will not influence your abilities as a doctor for now. I suppose the argument could be made that this comes from a good place (e.g. we can easily see the risk posed in extreme situations if someone is acutely unwell), but it becomes problematic if they paint everyone with the same brush. 

Have you encountered situations where GPs/psychiatrists/etc have illegally disclosed one of their patient's information to an authority with malicious intent?

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37 minutes ago, NLengr said:

Don't get me wrong, I know good physicians. There are lots. But the percentage of socially incompetent, unprofessional, vindictive, self interested or just downright assholes in the profession is surprisingly high. Much higher than in most other professions I have worked in/with. And, unfortunately, many of those people seem to be the ones who seek out authority positions. 

I wonder if there are any statistics on this. In today's climate, I feel like we select for these sorts of people more than in the past. Medical schools, residency programs, etc only take the "top 1% of the top 1%" based on criteria they feel selects for great doctors. I wonder if those selection pressures inadvertently weed out those "soft" traits that are also important to be an effective and compassionate physician - because really those are things you can "fake" for 30 minutes during an interview, so you spend more time developing the things that actually get you to succeed. In the game of medicine, it actually costs you to spend more time than you need to developing yourself or connecting with others because they reduce the amount of time you spend doing things that bring you ahead (and its that fraction of a difference that can determine whether you get into school, get a residency, get that fellowship, etc.). Might explain why so many more people appear to be "unprofessional, vindictive, self-interested" assholes. (Sorry for the rant btw, I can totally relate to what you're describing. From my own peers in medical school, to some of the residents and consultants I've worked with, etc. It is amazing how many people could care less and don't see the suffering they're bringing to others).

 It would be really interesting to see how doctors compare to people like lawyers, politicians, bankers, CEOs, etc. 
 

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As mentioned previously you have to self-disclose anything that might "impact" your practice with patients.

The college often has a very different opinion of what would impact your practice vs what common sense would dictate. The amount of supervision and hurdles my friends have had to jump through is awful and in fact, worsens their mental health. Even things I would consider overall benign like post-partum depression. 

Also if you were not to disclose this and somehow you get reported and have to disclose your medical records (doctors can report each other if they are concerned) then you would be performing unprofessional behaviour in lying to the college which would bring consequences by itself. 

If you want to seek care it is best to do it as anonymously as possible. If I just need therapy, for instance, I would try to find some sort of cash-based practice and maybe not even use my real name to minimize any possible paper trail. You should be able to have the same mental health rights as any other human being but the college is willing to strip you of your livelihood in the name of public protection so look out for yourself. 

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On 3/23/2019 at 1:54 AM, lilyinapod said:

Hi all,

I'm currently a medical student and am looking to seek professional help for what I think might be an anxiety disorder (or whatever it is; my mental health isn't the best and hasn't been for a while). I've never sought help before so I'm a little apprehensive. In particular, I'm worried that if I seek help with my med school's in-house counselor, the fact that I needed such services and my diagnosis (if I receive one) will end up on my school records in some way and will negatively impact my matching/career prospects down the line. Obviously they say everything is confidential and medical schools like to talk about how progressive they are about mental health nowadays, but the truth is the stigma is still very much there, and I'd rather not accidentally step on a landmine.

Is it safe to seek out mental health treatment during medical training? Any pitfalls I should be aware of to make sure this doesn't impact my professional future in any way whatsoever? Would it be better to seek help from a mental health professional who's not associated with my medical school?

Any advice would be appreciated. Thank you!

I would recommend getting a Family Doctor outside of the university asap, and ask your GP to refer your for counselling.

You definitely could connect with University or Provincial Physician Health Programs, as others said above, there are some stigmatization and you might get more frequently monitored or having licensing issues down the road. 

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5 hours ago, StarStrike said:

I wonder if there are any statistics on this. In today's climate, I feel like we select for these sorts of people more than in the past. Medical schools, residency programs, etc only take the "top 1% of the top 1%" based on criteria they feel selects for great doctors. I wonder if those selection pressures inadvertently weed out those "soft" traits that are also important to be an effective and compassionate physician - because really those are things you can "fake" for 30 minutes during an interview, so you spend more time developing the things that actually get you to succeed. In the game of medicine, it actually costs you to spend more time than you need to developing yourself or connecting with others because they reduce the amount of time you spend doing things that bring you ahead (and its that fraction of a difference that can determine whether you get into school, get a residency, get that fellowship, etc.). Might explain why so many more people appear to be "unprofessional, vindictive, self-interested" assholes. (Sorry for the rant btw, I can totally relate to what you're describing. From my own peers in medical school, to some of the residents and consultants I've worked with, etc. It is amazing how many people could care less and don't see the suffering they're bringing to others).

 It would be really interesting to see how doctors compare to people like lawyers, politicians, bankers, CEOs, etc. 
 

When I was a clerk on IM, early on I tried to spend more time talking to patients. Because of this, one time I forgot to write down the CBC+lytes values on my sheet (even though I checked) so that when we were doing afternoon rounds, I realized I didn't have it available in front of me and we had to waste 5 min pulling up the pt's labs on the screen. 

I got told that it was 'unprofessional' that I didn't 'come prepared' to the rounds. 

After that, I spent more time looking at a screen and documenting lab values than speaking to the patient because that provided me with more 'valuable' information.

What I liked doing was talking to patients, but what got me 'ahead' was detecting minute changes to their lab values...smh

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26 minutes ago, mononoke said:

When I was a clerk on IM, early on I tried to spend more time talking to patients. Because of this, one time I forgot to write down the CBC+lytes values on my sheet (even though I checked) so that when we were doing afternoon rounds, I realized I didn't have it available in front of me and we had to waste 5 min pulling up the pt's labs on the screen. 

I got told that it was 'unprofessional' that I didn't 'come prepared' to the rounds. 

After that, I spent more time looking at a screen and documenting lab values than speaking to the patient because that provided me with more 'valuable' information.

What I liked doing was talking to patients, but what got me 'ahead' was detecting minute changes to their lab values...smh

Looks like you went UofT and I'm assuming you did IM rotation there too.

I'm very sorry someone told you this. If it was a Junior or Senior resident that said this they should pull their head out of their ass and stop being a D*$K

If it was a staff that said this then...they should pull their head out of their ass and stop being a D*$K

Maybe THEY should have came prepared for rounds and knew the lab values... cause ultimately THEY are the ones responsible

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42 minutes ago, mononoke said:

When I was a clerk on IM, early on I tried to spend more time talking to patients. Because of this, one time I forgot to write down the CBC+lytes values on my sheet (even though I checked) so that when we were doing afternoon rounds, I realized I didn't have it available in front of me and we had to waste 5 min pulling up the pt's labs on the screen. 

I got told that it was 'unprofessional' that I didn't 'come prepared' to the rounds. 

After that, I spent more time looking at a screen and documenting lab values than speaking to the patient because that provided me with more 'valuable' information.

What I liked doing was talking to patients, but what got me 'ahead' was detecting minute changes to their lab values...smh

Sorry to hear about that :(. I'm an IMG, but when I did my electives back home this summer, I was lucky that I didn't run into a situation like that. I enjoy spending time with patients... I probably wouldn't have taken it well if I got told off myself! Though I didn't end up matching to IM in the end (matched FM) so maybe its karma hah!

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43 minutes ago, mononoke said:

When I was a clerk on IM, early on I tried to spend more time talking to patients. Because of this, one time I forgot to write down the CBC+lytes values on my sheet (even though I checked) so that when we were doing afternoon rounds, I realized I didn't have it available in front of me and we had to waste 5 min pulling up the pt's labs on the screen. 

I got told that it was 'unprofessional' that I didn't 'come prepared' to the rounds. 

After that, I spent more time looking at a screen and documenting lab values than speaking to the patient because that provided me with more 'valuable' information.

What I liked doing was talking to patients, but what got me 'ahead' was detecting minute changes to their lab values...smh

Unfortunately, often when we try to do the right thing, it is not visible to others and we are not given the benefit of the doubt. You will have to rest in your knowledge that you had the best intentions and your patients benefited.

In the same vein, obviously it's inappropriate to tell someone they are unprofessional for a simple lapse, but try not to be too bitter. The person leading the rounds could have been under their own stresses (which not everyone handles well), and documenting the lab values might have been the way they expected the clerk to help them cope with their load. Burnout and lack of empathy are consequences of the perfection that is expected from human beings in medicine.

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Seek what help you need, but as others have said be cautious what you disclose. 

I have personally run into difficulty because I ended up in a position where I had to disclose a mental health diagnosis (postpartum depression.) What happened was that my entire history - including things like my phobia of wasps - was disclosed to the College by my psychiatrist who treated me for the postpartum depression and had no concerns about my ability to practice. None of the historical items had ever impacted my ability to work, nor would they as I am attentive to my mental health and pro-active about management  

I ended up getting a letter that they had reason to believe I wasn’t mentally competent to practice medicine, and I was put through the review process and am now required to be monitored. Because I had postpartum depression from which I completely recovered (which everyone agrees on; there’s no concern whatsoever that I have any ongoing issues.) The fact that I’ve been required to be monitored for mental health reasons will come up every time I seek to be licensed anywhere, so this will follow me for the remainder of my career. I don’t mind sharing the story with people because I’m angry, but in no way ashamed of my history. It’s a super common issue, I took appropriate steps to manage it, and I got kicked in the arse for it.

So seek help, but tread carefully. 

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