Quoted: Mental health history and residency/rotation applications

Doodledog

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Question:

I am a medical student with a mental health history, though fortunately it has been quite mild during medical school. There are no particular incidents that I need to explain, although I would probably have gotten higher grades during my first two years if I had gotten the help I needed sooner (I never failed a course, but got mediocre grades).

My question is probably a fairly common one, though I could not find it in the forums. There are many people with mental health issues whose problems do not adversely affect their work, at least to any meaningful extent. But many hospitals (whether for residencies or rotations) want to know your medical history, including your mental health history. They specifically ask about common disorders like depression, anxiety, etc. -- and not whether it is a disease that will affect your performance, just whether you have it or not. And they request your medical records, some of which may have that information. So what is one to do in these situations?

On those occasions where I've already had to fill out such forms but I knew that my actual records would not be sent, I chose to say "no." I simply have no confidence in the respective administrator actually keeping this information secret, particularly at a small community hospital where everyone on staff knows each other. And, if I was doing a residency somewhere (and would therefore be around long enough to get to know everyone), I would have the same concerns.

(As far as my physical health goes, I'm an open book. It doesn't bother me in the slightest.)

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This is a difficult situation. You obviously want to keep your medical history private, which is totally reasonable. Hospitals have a need to know some of this information also -- they don't want someone with active TB coughing around the hospital, nor do they want someone with a history of injection drug use to have easy access to IV narcotics. Balancing these two needs is difficult.

Ideally, it would work like this: You're hired by the hospital to do a job. In the hiring process, the only question that is asked is whether you're able to perform the functions of the position with or without a reasonable accommodation. Once you're hired, you may be asked to undergo a pre-employment physical. That care provider would review your history, and make an assessment as to whether you're able to work or not. The physician you see (usually in occ med) would be required by law to keep your medical information private from your employer. Anyone who talks with someone else / peeks at your record would be guilty of a HIPPA violation.

There is no reason why this same setup can't work at any institution. In fact, if an institution was so small that this didn't seem feasible, it would always be possible to have employees seen by some doc outside the institution.

Unfortunately, some programs may try to merge the two functions, and have the same people running the program collecting the health information. IMHO, this is simply wrong. When it happens, you'll need to decide what to do about it. I expect it may be illegal for them to ask these types of questions as part of an employment process. It's also illegal for them to require that you release your medical records to them (again, it would be OK if you were releasing your records to someone other than your employer who then screens them, and reports only that you can/cannot work). But making a big stink about it isn't going to end well for you.

The rules for students are probably totally different, since they are not covered by employee law. I don't know.
 
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