How do I know if medical school is a good environment for me?

November 20, 2007 10:29 PM

Med school is considering kicking me out - what should I do?

I am a first year student doctor. The medical school administration is seriously having doubts about allowing me to continue medical school. I have generally been doing very well academically. The major concerns the administration have include the fact that I failed one test, and my psychiatrist informed the school that I missed two psychiatric appointments (I had previously given my psychiatrist permission to converse with the school to verify that I was attending regular psychiatric appointments). I can truly say that I failed my test because I didn't study for it while I was in the middle of changing psychotherapeutic medications, and I missed the psychiatric appointments because of normal human error. Now I'm working very hard to prevent myself from making these mistakes in the future. More importantly, I can see myself as eventually becoming a good physician, and if I were to be kicked out of medical school, I have no idea what I would do with my life. The administration is questioning whether medical school is the right environment for me right now. I think it is. What should I do?

posted by anonymous to education (15 comments total)

Is there an ombudsman or something like that for students to discuss these types of issues outside of your psychiatrist? Surely this is a concern that many students have had. What has your psychiatrist said to you about your fitness for med school? Is he/she willing to go to bat for you? What has happened to make you think that this is what is on the admins mind? Have they given you any requirements to fulfill to prove to them that you are ready for the challenge? And are you ready/capable to fulfill those?

I know you cannot answer these questions directly here, but perhaps food for thought. I'm rooting for you.
posted by thebrokedown at 11:29 PM on November 20, 2007

I say this as kindly as possible and from experience: missing two psychiatric appointments is a sign that not all is well with you.

It sounds like you have a lot on your plate right now -- you might not be serving yourself or your patients best in your current situation. Have you considered withdrawing for a semester or two? Maybe if you did that, the school would let you return without issue (whereas if you're kicked out maybe you'd have a hard time convincing them you're fit for returning later).
posted by loiseau at 11:34 PM on November 20, 2007 [1 favorite]

Wait, so you're doing academically well, but they want to kick you out for failing one test?

Sounds like they may have an ADA compliance issue. I'd be shocked if medical schools were allowed to discriminate against people with mental illness.
posted by InnocentBystander at 12:34 AM on November 21, 2007

I think we may be missing some context here. The school has already been following the poster's psychiatric treatment -- it seems to me that this is not coming out of the blue.
posted by loiseau at 1:43 AM on November 21, 2007

Some things to consider: if there is nothing else to your story, you should be able to continue if you speak to your treating psychiatrist and the dean honestly about continuing with your treatment plan.

Consider for yourself your life further down the line. You will have a very stressful life for a while to come, it starts to get worse after first year and probably peaks during residency. You will hurt your colleagues and patients if you fail in your responsibilities as you go on. That being said, there are many physicians who function with treated mental illnesses.

Another consideration is that you will likely have to reveal your illness and treatment to credentialing and licensing boards in the future. You will certainly want to show a pattern of stability.

Good luck!
posted by objdoc at 1:56 AM on November 21, 2007

Sounds like they may have an ADA compliance issue. I'd be shocked if medical schools were allowed to discriminate against people with mental illness.

ADA compliance doesn't absolve the person from the obligation to seek medical care. Choosing to miss two appointments would not help the situation.
posted by Blazecock Pileon at 2:11 AM on November 21, 2007

I had several classmates during medical school who had personal issues and had to take time off (usually a year). There has to be some type of student advocacy office at your medical school (Student Affairs maybe?) who should be able to help you plan out your course of action. I guarantee that you are not the first person in the history of your school to have issues.

Your medical school probably does not want to kick you out. That reflects poorly upon them because they accepted you in the first place. My experience was that the school would bend over backwards to ensure that you graduated so they could maintain a near 100% graduation rate.
posted by i_am_a_Jedi at 5:32 AM on November 21, 2007

I totally agree that your med school does not want to kick you out, and they're not going to discriminate against you solely for having a mental health issue (particularly if that issue is exacerbated by med school related stress).

They are however going to discriminate against you if they think you are non-compliant with your psychiatrist's advice and treatment. Not showing up for appointments could indicate to them a lack of insight, and a future risk to patient safety. One of my medical school colleagues was struck off the medical register (i.e. after graduation) essentially for failing to accept that he had a mental illness that required ongoing management. That alone made him a risk to patients.

You sound sure that medical school and doctoring is right for you, so you need to demonstrate that commitment to the med school administration, by showing up for your psych appointments no matter what. I agree with objdoc that if you're honest and contrite now about the problems you've been having, you won't be kicked out.
posted by roofus at 5:52 AM on November 21, 2007

I'd be shocked if medical schools were allowed to discriminate against people with mental illness.

Maybe they're not, but medical boards are. If you have significant problems that need to be addressed, perhaps a leave of absence is in your best interest right now (and the interests of your future patients). You could return to medical school when you have your psychiatric issues fully addressed. This seems to me to be a better alternative then fighting the wisdom of those in the business of educating physicians only to find out that they're right and that you've spent a lot of time/money and may end up not being able to practice anyway.

Best of luck.
posted by scblackman at 6:52 AM on November 21, 2007

It might require more research than I have time for right now but I think that with your history of mental illness you will not be able to practice medicine in most states (assuming you are in the US).

I think that while applying for your license (after graduating and obtaining a residency) your mental health history is taken into consideration. While your school may fall under some ADA guidelines the governing body that approves your medical license does not.

Perhaps the school knows this and is trying to wash you out now?
posted by remthewanderer at 7:00 AM on November 21, 2007

I can't tell whether you're asking how to force the school to retain you as a student or whether you're asking what you should really do.

Everywhere I've been - med school, residency, fellowships - I've seen maybe a 2 or 3% psych washout rate per year. People who've made all the previous cuts - smart, accomplished people - get up to the next level and can't handle with the stress. Some of them had psychotic breaks; some of them got very depressed and have to take a leave of absence; some of them have the wisdom to remove themselves from the environment before these catastrophes happen.

If you want to stay in med school: Right now you've made two mistakes with regard to continuing in med school: you failed one exam and you waived your patient's right to privacy. You need to correct both these mistakes if you want to proceed. First contact your therapist and make it clear that you revoke your permission to discuss your mental health with anyone else. Secondly, contact your dean of students and offer to make up the failed work. You'll need to make good on this offer while keeping up with all the other classes you're taking.

I have to tell you that I think you're probably wrong about a couple of things you said in your question. Most importantly, if you're finding the first year of med school stressful enough to decompensate your mental illness, I doubt you will ever make it through a decent residency. The first year of medical school was difficult work for me, but it was the happiest year of my life because I was doing the work I wanted to do. Most docs I know who weren't under severe financial pressure enjoyed med school on the whole; only a few found it intolerably stressful, and most of those were either constantly struggling with money troubles or felt bad about being away from their kids for such long periods of time (or both, as in the guy whose wife dumped him for another guy and took the kid away to boot.)

Also, medical school is never the only thing you can do with your life. In fact, it's one of the the more difficult choices you can make with your life, and you have to be making that choice again and again, every morning when the alarm goes off at 4:30 AM.

InnocentBystander: I'd be shocked if medical schools were allowed to discriminate against people with mental illness.

Shocking, isn't it! Why can't we have people with schizophrenia, unable to discriminate reality from fantasy; or homicidal maniacs taking care of your mother when she gets ill, InnocentBystander!? It's an abuse of human rights - the fundamental human right to be a doctor!

How this is actually accomplished: the mental illness makes you fail your class or not show up on time for rounds. The med school then kicks you out for failing your class or not showing up on time for rounds. Sounds like the O.P. is nearing that threshold.
posted by ikkyu2 at 9:53 AM on November 21, 2007 [1 favorite]

Oh, and here's a tip:

I can truly say that I failed my test because..
I missed the psychiatric appointments because..

Let's walk a little further down the road of time, shall we?

I can truly say that I prescribed the wrong medication because..
The only reason I removed the wrong kidney was because..
I committed a preventable medical error, causing my patient's untimely death, because..

When talking to your med school staff, think carefully before you decide to offer an excuse for what you did. It is a habit that doctors look very poorly on when it relates to other docs' professional behavior.
posted by ikkyu2 at 9:58 AM on November 21, 2007

Think about why you want to stay in medical school. You say you can't imagine doing anything else. But surely there are other things that would allow you to use your talents and skills to help people (or whatever aspect of medicine you especially like). The first thing is to remind yourself that IF you had to leave med school, there would be other excellent options for you. Don't let yourself get trapped into thinking that this is the only thing you can do -- it isn't.

The next thing is to find out exactly what the school wants to do. Be sure you are not going on second-hand info or speculation. Be sure you are asking what your options are, at each point. Can you take a leave of absence for a year? If the workload or other stresses are too much right now, that might be a good idea -- you would have some time to get your head together without falling further behind.

The school is pushing the panic button -- think about why, from their perspective. Do they have evidence of other behaviors/history of yours that might be contributing to this decision, beyond what you've included here? Try to be honest with yourself about this. Are their concerns justified, or are they really misconstruing something? Talk to your psychiatrist about it. What would have to change before the school would feel good about you staying in the program?

Did you miss psych appointments because your psychiatrist isn't a good fit for you? If so, you can try talking to another psychiatrist.
posted by LobsterMitten at 10:18 AM on November 21, 2007

Now I'm working very hard to prevent myself from making these mistakes in the future. More importantly, I can see myself as eventually becoming a good physician

Do you have an adviser? Make sure you have a plan for how to cope with the stresses of med school, and get your adviser to advocate for you. You have a shrink; get him/her to work with you on a good plan to make sure you don't miss appts. Don't be in denial about the significance of missing appts, but also don't be bullied; grad school is hard, and missing appts isn't surprising. The key is to be able to show them you have made workable plans to resolve the problems, and are implementing the plans. Good luck.
posted by theora55 at 11:14 AM on November 21, 2007

Have you thought about transferring over into an affiliated Epidemiology and Public Health program, if med school is NOT a good environment for you but you still want to work in medicine?
posted by sock it to me monkey at 1:27 PM on November 21, 2007