Advice? addiction

[MDplz1997 0]

Hello, 

 

23 year old first year UG student as mentioned. In my past, my gap between highschool and UG I was an athlete. I struggled for two years with opioid addiction after being overprescribed for an injury I sustained during my sport...

 

I am now volunteering in addiction and with vulnerable populations. I am wondering whether this sort of thing and "story" or angle can be used as experiences that shaped me on my medical school applications? It is the reason I want to pursue medicine I just do not know if it is too taboo.

 

Thanks

[InNeedofMD 10]

15 hours ago, MDplz1997 said:

Hello, 

 

23 year old first year UG student as mentioned. In my past, my gap between highschool and UG I was an athlete. I struggled for two years with opioid addiction after being overprescribed for an injury I sustained during my sport...

 

I am now volunteering in addiction and with vulnerable populations. I am wondering whether this sort of thing and "story" or angle can be used as experiences that shaped me on my medical school applications? It is the reason I want to pursue medicine I just do not know if it is too taboo.

 

Thanks

Hey first of all congrats on battling out of the addiction. I know how hard it really is as I have seen some close acquaintances go through a clean up act too. I think it is a great story to include in your 'other' section of the ABS (assuming you are applying in Ontario). Just be prepared to provide some insight on it as it may come up during interviews and be genuine. Don't overthink it, people that get through difficult times are needed in the field of medicine to show how it is possible for others. Best of luck.  

[MDplz1997 0]

Thanks, appreciated. Will do. Thanks for this

[bearded frog 458]

I agree that the best route forward is to be open an honest about it, especially if you're doing a lot of addictions work now. That being said you are going to run into roadblocks and challenges when it comes to licensing etc.

[MDplz1997 0]

On 10/24/2020 at 7:36 PM, bearded frog said:

I agree that the best route forward is to be open an honest about it, especially if you're doing a lot of addictions work now. That being said you are going to run into roadblocks and challenges when it comes to licensing etc.

Would you mind explaining what you mean?

 

Thanks

[bearded frog 458]

You're not gonna be an anesthesiologist, as unfair as that is. You might have to go through various monitoring programs etc. You have to disclose it on all your licensing applications.

[ellorie 609]

Pretty sure you could be an anesthesiologist?

Personally I would not go there on a medical school application - once the medical school knows things, they can't unknow them.  But I'm conservative and suspicious about this stuff.  I'd say - let them wonder why you're so passionate about addictions.  Many docs would see it as a valuable experience - some would stigmatize the heck out of you.  And you never know which will be which.

You don't have to say anything until you have already matched to residency (assuming you don't go around telling people).  When you apply for your training license in Canada, some provinces ask you some equivalent of - have you ever had a medical condition that could impair your ability to practice medicine?  I'm not sure what the wording is in all provinces - that's what it is in Ontario.  Not sure if other provinces license medical students?  If so, then they might do something but I'm not aware of it if they do.

If you say yes, your doctor sends a letter.  The CPSO then decides what they want to do with you - they license you in the end almost certainly but they may want you to be monitored for a while which may include check in meetings, drug testing, letters from your program director to say you're doing fine.  If you're monitored for a while and you're stable and fine they will eventually get bored of you and leave you alone.  If you've already been stable for years by that point they may not even bother monitoring you.

You might get asked stuff again when you apply for hospital privileges if you get an academic job.  Not sure how that works in the anesthesiology world and maybe that's where the hitch is, but if you can show you're fine, you can usually just get away with just jumping through an extra hoop or two.

You just want to be careful with your disclosures.  Stigma is bullshit and also stigma is real and you never know where you're going to run into it.  If it feels so important to you to disclose it, you can gamble and it may be fine or even to your advantage.  But it may also not and you'll never know if that's what did it.  Also once the information is out of the bag you can't get it back.

Licensing with a mental health history can be a pain in the ass but it's not the career ender that people sometimes make it out to be, at least in Canada (I think it's much worse in the US).

I was monitored in Ontario (not for addictions).  They monitored me for a few years, realized I'm totally well, and left me to my own devices.  When I applied for my independent practice license there were no hiccups at all - the physician health program just wrote a letter reiterating that I'm psychiatrically boring and fine, and so did my psychiatrist.  Being monitored wasn't the most fun thing in the world but honestly I felt like the PHP was very fair with me and very respectful of my privacy and my wishes.  I had ultimately as good an experience as you can have in that kind of situation.

[MD2015:) 44]

I agree with Ellorie. I wouldn't include it in your application package because you are not sure of the views of the person/people who will read that aspect of your application. There are a lot of people trying to get into med and so if they feel unsure about you for a certain reason they may be more tempted to say no without hearing your whole story. Congratulations for getting through your addiction and becoming involved in meaningful work to help others as well. Once you are in medicine/residency you may be able to be more forthcoming about your journey as it could be inspiring for many, but wouldn't talk about it now. And yes when you apply for your doctor's licence in residency and to get your independent licence you may be asked to disclose and provide medical documentation on this. For example, in Ontario your licence application asks you if you currently or previously had substance use issues and you have to provide relevant details and medical notes.

[zxcccxz 82]

Not sure if you're planning on applying to UofC, but I think this would be a great experience to discuss in your Top 10 if you did. As a current student, I can tell you first-hand that they love these sort of "overcoming adversity" unique stories. As people have already mentioned though, it's up to your comfort level whether you want to disclose something like this. My experience (at UofC) is that they're very supportive and non-judgemental about this sort of thing, and I don't think it would adversely affect you at all. But I'm unfamiliar with other schools, so I wouldn't necessarily recommend that you include this in all of your applications.

[ellorie 609]

I don't mean to judge anybody who has replied - but I feel like the longer you go on in medicine (i.e. once you get to residency) the more you start to realise how much stigma there really is, and just how awful some clinical environments can be.

I feel like the people advocating for disclosure and talking about how helpful it will be to spill all of this are largely earlier in their careers.

And I am like really early career myself in the grand scheme of things as a very new staff - but I have seen and heard (and experienced) some stuff that maybe applicants and preclerks have not.  Maybe the majority of the time it works out and the majority of people are non-judgmental and understanding - but those times it doesn't - those will burn you HARD and you'll never see it coming.  Medical schools talk a big game about valuing diversity and life experience and being compassionate and holistic but it can be a whole other thing on the ground.  And even IF most of them mean it, there will always be those people who haven't caught up, and all it takes is some bad luck for one of them to be reading your file.  Boots on the ground, things can be pretty ugly out there.

[JohnGrisham 1,698]

34 minutes ago, ellorie said:

I don't mean to judge anybody who has replied - but I feel like the longer you go on in medicine (i.e. once you get to residency) the more you start to realise how much stigma there really is, and just how awful some clinical environments can be.

I feel like the people advocating for disclosure and talking about how helpful it will be to spill all of this are largely earlier in their careers.

And I am like really early career myself in the grand scheme of things as a very new staff - but I have seen and heard (and experienced) some stuff that maybe applicants and preclerks have not.  Maybe the majority of the time it works out and the majority of people are non-judgmental and understanding - but those times it doesn't - those will burn you HARD and you'll never see it coming.  Medical schools talk a big game about valuing diversity and life experience and being compassionate and holistic but it can be a whole other thing on the ground.  And even IF most of them mean it, there will always be those people who haven't caught up, and all it takes is some bad luck for one of them to be reading your file.  Boots on the ground, things can be pretty ugly out there.

100% would not directly disclose it at this point in time - opens up too much potential bias for unnecessary potential gain.

For OP focus on your volunteering with addicitons and how its inspired you - keep your personal experiences  out of it. Focus it on enlightenment, and how you want to provide better care for future patients.

Again, do NOT include it in your medical school application. Seen colleagues get burned(slightly) as residents for less.

"You don't have to say anything until you have already matched to residency (assuming you don't go around telling people)."     I agree with this.  Doesn't matter how supportive or "with the times" some programs seem, at the end of the day all trainees are replaceable, and it takes one backwards thinking administrator to throw a wrench at you, and cause unnecessary burden.

[JohnGrisham 1,698]

1 hour ago, zxcccxz said:

Not sure if you're planning on applying to UofC, but I think this would be a great experience to discuss in your Top 10 if you did. As a current student, I can tell you first-hand that they love these sort of "overcoming adversity" unique stories. As people have already mentioned though, it's up to your comfort level whether you want to disclose something like this. My experience (at UofC) is that they're very supportive and non-judgemental about this sort of thing, and I don't think it would adversely affect you at all. But I'm unfamiliar with other schools, so I wouldn't necessarily recommend that you include this in all of your applications.

Disagree completely. UofC is a great medical school in their admissions process - but I personally know a colleague who had issues in a related realm, and much like any other medical school - they gave them a hard time and  big run around...that would seem contrary to their public face that most see. 

General rule: Be smart, be safe, get support for yourself when you need it - don't hide anything from your close care providers, but schools/residency programs/colleges aren't looking out for you and will cover their own when needed. They are there for the public, and you 2nd. Always take care of yourself first.   As you say, you got support and are clean now - great keep it that way by being proactive with appropriate medical/therapeutic support. But don't go around telling people unnecessarily. 

[helpmeplz 9]

48 minutes ago, ellorie said:

I don't mean to judge anybody who has replied - but I feel like the longer you go on in medicine (i.e. once you get to residency) the more you start to realise how much stigma there really is, and just how awful some clinical environments can be.

I feel like the people advocating for disclosure and talking about how helpful it will be to spill all of this are largely earlier in their careers.

And I am like really early career myself in the grand scheme of things as a very new staff - but I have seen and heard (and experienced) some stuff that maybe applicants and preclerks have not.  Maybe the majority of the time it works out and the majority of people are non-judgmental and understanding - but those times it doesn't - those will burn you HARD and you'll never see it coming.  Medical schools talk a big game about valuing diversity and life experience and being compassionate and holistic but it can be a whole other thing on the ground.  And even IF most of them mean it, there will always be those people who haven't caught up, and all it takes is some bad luck for one of them to be reading your file.  Boots on the ground, things can be pretty ugly out there.

This. Even I'm a fetus compared to you guys (I've just started med school this year haha), but I'm starting to see some things that are making me real skeptical... it's almost as if everyone, be it applicants, 1st year students, older students, staff, teachers, etc., is trying hard to pretend that they're perfect and invulnerable, and that the medical world is an absolute utopia where everyone within it is morally "perfect" (in the sense of they are motivated by nothing else than motivation, hopes and dreams of caring for humankind (I know that this might be people's main motivation of choosing medicine, but their only motivation? I doubt is exactly the case)).

I wish people could just get off their (unconscious) moral high horse, and be a bit... "realer" with each other sometimes. I mean, we're going to become doctors, but before that, we're also human.

[JohnGrisham 1,698]

4 hours ago, bearded frog said:

You're not gonna be an anesthesiologist, as unfair as that is. You might have to go through various monitoring programs etc. You have to disclose it on all your licensing applications.

This isn't accurate in my province - and in my past experience on different addictions services...theres not an uncommon amount of physicians on special monitoring programs with colleges across Canada, and yes, some are anesthesiologists.

[zxcccxz 82]

12 minutes ago, JohnGrisham said:

Disagree completely. UofC is a great medical school in their admissions process - but I personally know a colleague who had issues in a related realm, and much like any other medical school - they gave them a hard time and  big run around...that would seem contrary to their public face that most see. 

General rule: Be smart, be safe, get support for yourself when you need it - don't hide anything from your close care providers, but schools/residency programs/colleges aren't looking out for you and will cover their own when needed. They are there for the public, and you 2nd. Always take care of yourself first.   As you say, you got support and are clean now - great keep it that way by being proactive with appropriate medical/therapeutic support. But don't go around telling people unnecessarily. 

I know somebody who got into UofC when one of their Top 10 experiences talked about them cheating on their boyfriend (I felt this was kind of ridiculous, as it bascially shows nothing but poor character but they must've really sold it as a "learning experience" I guess). So I guess, maybe in my mind, beating a serious addiction had a lot more redeeming qualities than that. But I guess you're right. If you're a strong candidate otherwise, there's no reason to take the risk of getting a reviewer or committee member who will look unfavourably on this experience. Medicine isn't immune to the stigma. 

[ellorie 609]

This is my suggested approach to having any kind of mental health condition in this field: keep your head down, your mouth shut, and play your cards close to your chest.

Trust the people who are bound to you by confidentiality (i.e. your own care team).  Find people you can trust as a priority, especially if you need to move at any point - if you no longer need specialist care, find a good family doctor and develop a relationship so that you have a point of contact, and so that you have somewhere to go if things hit the fan (as they always can, and more than ever with the stress of medical training).  You don't want to be stuck needing a letter for the College and having to try to get it from someone who barely knows you.

Figure out which institutions/organizations function to protect/help you and which ones do not.  The ones whose priority is something other than you, do NOT lie to them or conceal things from them that you are required to disclose - but do not give them more than the minimum they ask for, when they ask for it.  This includes your medical school, your residency program, your hospital, and your supervisors as a whole, and ESPECIALLY your provincial College.  Understand what they are entitled to know, when they are entitled to know it, and do not give them more.  Be professional and honest in your interactions with them at all times but do not give them anything they do not require.

Some organizations will exist for the primary purpose of helping you - this can include the residents' union (though they often have little power), student support/disability services/resident wellness (these are a slight grey zone so you have to feel it out a bit), or the provincial physician health program.  Trust them cautiously and reach out for help/support/accommodations early if you need them, because getting support early and staying on track is way better than having a relapse or an episode and having it affect patient care.  But do not tell them your whole life story.  Tell them what they need to know to help you.  Always start by sharing the minimum, and then if it goes well, you can always say more later.  But you cannot unsay things.  You want them to see you as: proactive, cooperative, seeking care appropriately, keeping patient care/safety in mind, and being professional.  Show/tell them how you are being these things despite whatever blooper you are asking for help with and they will be far more likely to help you and protect your ability to work/keep you working.  These are things that these organizations have told me that they want to see, after I have engaged with them, and seeing those things from me caused them to be helpful and protective of my career.  I have had some bloopers that I have had to ask for help with and I have never been taken off work because I have always prioritized patient safety and showed everyone that I was handling my stuff responsibly and with attention to my professional responsibilities.

When it comes to supervisors, you will need mentors who you can trust.  Your mentors will not necessarily (or even probably) be mentors who are assigned to you or your primary supervisors.  Develop these relationships slowly.  I have been burned here.  Feel people out and get to know them before you disclose anything.  Listen to how they talk about patients, how they talk about colleagues, and watch how they relate to you.  Show them you are a smart and capable doctor so that they already know that about you before you tell them anything.  I have two amazing mentors who know the deep details of my business, that I could call at any time, in any state, and be totally honest, and they have been invaluable in advocating for me, supporting me, and helping me navigate residency, but this emerged over a period of several years - I did not really develop this level of trust with them until PGY4-5.  These are largely people who supervised me at some point.  There is a broader circle of people who know the broad shape of various aspects of my business but not the details or the full picture, maybe another 3-4, and those relationships are great and helpful too - but the number of people I trust implicitly is very small. 

I got burned very badly by one supervisor as a result of disclosing something that in retrospect I should not have trusted that supervisor with, and had another concurrent supervisor tell me (after finding out about it through the hospital gossip mill, as almost the entire department did, which was a whole other horrifying chapter): "this is my advice to you: you think your supervisors are there to help you but they are not.  They are there to judge you.  Show them what they want to see."

I say this not because I agree with it (I think it's a despicable thing to say to a resident who just got burned as badly as I did) but because some staff will operate this way and you want to find out who those are and avoid them like the plague in terms of being open or vulnerable or asking for help. 

This incident was the thing that primarily solidified my strategy above, and happened mid-residency.  I wish I had applied this strategy much sooner in residency because it would have saved me a lot of heartache and also hassle.

You might make a mistake.  Hopefully you have been judicious and disclosed only a little.  If so, you correct course and move on.  I had some blips (small and also big) and course corrected and it was fine.  The key to course correcting is being proactive, doing damage control, and extracting yourself as quickly and cleanly as possible.  There is no need to catastrophize and think that your medical career will be some kind of lonely hell where you never get to be yourself and everyone is awful to you and one misstep will end your career.  You just need to be smart and cautious and adjust as needed.

As I said in my earlier posts, none of this is insurmountable.  As long as you keep in control of your disclosures at key decision points (medical school admission, residency match, license application, finding a job) you can wobble a little bit in other areas.

Most people in medicine are not frankly malignant and most do want to help and support you.  They just also may have their own unconscious biases and competing priorities that may not be in your interests, and a few will be frankly malignant and it can be hard to know who those are going in (though you will figure it out fairly quickly if you pay attention).

There are wonderful people in medicine and overall the culture is changing.  People with these kinds of challenges going into the field is extremely valuable in changing the landscape because the more people there are out there, the more mentorship there is for others behind us, and the more we can change things to make it better for every generation of medical trainees and doctors.  But in my mind there is no reason to expose yourself to unnecessary risk when there are other ways to accomplish the same thing.  Trust the people that have shown themselves to be trustworthy and let them help you, but don't throw your information out into the winds with no control over where it sticks.  I have done this.  Sometimes it was fine.  Sometimes it ended with a lot of tears and a big mess that I had to run around cleaning up.

This is my two cents as a somewhat, but not overly, salty person at the end of training and the beginning of real life.

 

[MDplz1997 0]

Thank you all for answering my initial post.. means a lot. Ive carefully read all of your input. I think my initial gut feeling was to also keep it under wraps... I suppose my only big worry is the three year gap on my timeline after high school where I flunked out of a professional career... broke my shoulder, got addicted to pain meds. I am not sure what to write for that time or how to account for it on my applications. Any suggestions for this?

 

It has been very interesting reading all of the above, amazing to get the perspectives of people working in the field. Thanks again. 

[ellorie 609]

Since it was before university, they may not ask.  If you do want to mention it, you could say you were recovering from a sports injury?  It sounds like you were, it was just complicated.  If you do well in university with no gaps that will speak more strongly than anything you might say.