Wayfaring MD

I am a family medicine resident who likes to highlight the hilarious in medicine as I write about patients, medical school, residency, medical missions, and whatever else strikes my fancy.



Disclaimer:
HIPAA is for reals, folks. All of my "patient stories" have been changed to protect patient privacy. I will change any or all identifiers, including age, location, race/ethnicity, sex, medical history, and quotes. Also, I am an anonymous internet person. Why should you trust an anonymous internet person to give you medical advice? Don't ask me, ask your doctor!
Wayfaring MD followers
Recent Tweets @WayfaringMD
Posts tagged "depression"
Asker Anonymous Asks:
Can you be a doctor still if you developed depression and BPD in med school? I'm scared to get help in case I'm kicked out...
wayfaringmd wayfaringmd Said:

Yes. 

Your diagnosis is technically your business alone. But if your school notices that your work is being affected by your illness, they may ask you to take some time off to get better before you start back. 

Please get help. NOT getting help will do much more damage to your schoolwork and career than actually getting help. 

What are your thoughts on medical school admittance and whether or not a history of mental illness will have an impact? - krissybehind

"Mental illness" is a pretty broad category, like "genetic disease." It really depends on what type of mental illness we’re talking about, and more importantly whether it is well treated or not. It also depends on what you choose to disclose, since most med school physicals are done after your initial acceptance.

3789 3790 3791 3792 3793 3794 3795 3797

Depression and anxiety are SO common. If the applicant has good insight into their condition and is getting good treatment and has appropriate coping skills, they shouldn’t get in the way of med school admittance. On the other hand, a person with multiple recent suicide attempts may be a bit too much of a gamble for a medical school. 

x x x x x x x x x 4691 x x x x x x x x x 4691

ADHD and OCD are also pretty common. We all know some med students with these, and they tend to do fine with treatment. 

image

Other conditions like schizophrenia, mania, unstable bipolar disorder, active addictions, and a few personality disorders (like antisocial, paranoid, or schizotypal) may prevent admission if they are not really well controlled. Those disorders can be pretty incompatible with the amount of stress med school puts on people.  

image

This is one of the reasons why most schools require students to go through a physical with their personal doctor prior to the start of school. This, of course, would be after your “acceptance,” but if the doctor were to find something physical or mental that was serious enough to keep you out of medical school, there is a possibility that your admission could be put on hold. I’ve never heard of it happening before, but I’m sure it does. 

Hey Wayfaring! I was in class today and noticed that a girl I'm barely acquaintances with seemed to have what looked to me to be scars from cutting herself. How do you recommend I deal with the situation?
wayfaringmd wayfaringmd Said:

That’s pretty heavy stuff. 

Be her friend. Get to know her. Nobody has too many friends. If you get to know her well enough, you can ask her about her scars.

If you do choose to ask her about her scars before really getting to know her, do it in private. You don’t want to put her on the spot or embarrass her. But she may not receive questions from a stranger very openly. 

If you are concerned that she is hurting herself or is seriously depressed, report it to your school. I’m sure there’s someone in administration you can report to. I’d start maybe with your professor in the class. They may know who to direct you to. 

Remember also that you can’t fix her issues. These scars may be old and dealt with already. She may have already gotten treatment and moved on. But she may need some help. Your job is to point her in the direction of that help and be a friend, not take her problems on yourself. 

Asker vst2 Asks:
You mentioned that you wake up and read the Bible for strength. What passages or verses keep you going or do you turn to in times of despair?
wayfaringmd wayfaringmd Said:

Great question! 

When I’m down on myself or my circumstances, I tend to think about God’s promise to sustain his followers and work for their good. I also like to review his character and the names of God to remind myself what God should be in my life. So here are some good ones for you that come to mind. 

  • Psalm 3:1-5 ”I cried to the Lord…and he heard me…for he sustains me”
  • Exodus 14:11-14 ”the Lord will fight for you, and you have only to be silent”
  • 2 Chronicles 20:17 ”you will not need to fight in this battle…see the salvation of the Lord on your behalf”
  • Matthew 6:31-34 , Luke 12:22-31 “therefore do not be anxious for tomorrow, for tomorrow will be anxious for itself” (that’s your whole today’s pancakes/tomorrow’s pancakes concept)
  • Isaiah 30:18-19 ”he will surely be gracious to you at the sound of your cry”
  • Psalm 56:11 ”In God I trust…what can man do to me?”
  • Job 1:20-21 ”the Lord gave, and the Lord has taken away. Blessed be the name of the Lord.”
  • Romans 8:28  “God works for the good of those who love him…”
  • Hebrews 12:11-13 ”for the moment all discipline seems painful rather than pleasant…but later it yields the peaceful fruit of righteousness”
  • 2 Corinthians 9:8 ”having all sufficiency in all things in all times”
  • Isaiah 53 ”surely he has borne our griefs, and carried our sorrows” 
  • Psalm 40 ”as for me, I am poor and needy, but the Lord takes thought for me”
  • 2 Chronicles 15:3-4 ”when in their distress they…sought him, he was found by them”
  • Psalm 36:5-6 ”your love, O Lord, extends to the heavens”
  • Psalm 30 “you have turned my mourning to dancing”
  • Luke 18:27 ”what is impossible with man is not impossible with God”
  • Luke 11:9-13 ”ask and it will be given to you, seek and you shall find”
Asker Anonymous Asks:
Can you give any advice on getting an adult family member to seek help for depression when they have a huge stigma against mental health problems? The person in question's quality of life is going downhill, but they think that counselors/psychologists/psychiatrists are quacks, and that most mental illnesses don't actually exist.
wayfaringmd wayfaringmd Said:

Convincing someone that they need help when they don’t see that they have a problem is tough. Might I suggest you try a bit of motivational interviewing, as we do when we are trying to convince smokers or alcoholics to quit? 

You say this person’s quality of life is going downhill. Engage them in a conversation about it. Ask them what they think is causing that decline, or if they even recognize the decline. If they don’t recognize it, suggest it to them and let them know what you and other loved ones have observed. Let them know that you care about them and just want to see them live a better life. Usually with some nudging people are able to come up with some reasons.

Find out what this person is doing to help work on these issues. Encourage them to think about how effective those methods have been thus far. What do they think they are missing? Maybe they will see that their efforts haven’t been enough and that they could use some more help. This is the part where you ask them to let you help them.  

Acknowledge the fact that depression, or this issue, whatever you wanna call it, is likely multifactorial. This person doesn’t believe in mental illness? Ok, don’t fight it. But maybe they do understand that social stressors or physical issues can cause some change in emotions. And depression can also be considered a physical issue. Explain to them that some people exhibit problems with sleep, sex, concentration, and energy when they are dealing with emotional stress or depression. Ultimately, the brain (an actual physical thing!) is where emotions come from. Changes in the chemical makeup of the brain can change emotions much in the same way that changes in blood chemistry can show up as liver disease, diabetes, kidney disease, etc. 

If this person had diabetes, would they want it to be treated? Probably so. So why not treat another medical problem that could also zap his energy (and potentially his life)?

You can’t force someone to get help that they don’t want or think that they need. But you can at least introduce the idea to them that they have a problem. It may take ten conversations before they begin to budge. In the meantime, let them know you are concerned about them and offer to help in any way you can.  You may be the only counselor this person ever sees. 

Pediatrician phone call: Hey Dr. Wayfaring, I have a patient of yours here in the Peds ER. 

Me: Ok, who is it?

Pediatrician: Sally Teenager. She brought her baby here for a cold. But Sally’s also here as a patient. With postpartum depression. In the peds ER. 

Me: mmmkay, is she suicidal? 

Pediatrician: I don’t think so, but um… I’m not well equipped to deal with post partum depression… because I’m a pediatrician. 

Me: oh…. yeah. Well set her up to see me tomorrow then. And make sure she’s not suicidal! 

Hi WMD. How do you approach patients who are seeking treatment for self harm? Is it something you see often? Have you seen instances where the fact that a patient self-injures has affected the way they were treated or the attitude of medical staff towards them? How do you handle it? - anon

I see self-harm occasionally. So far, it’s always been in teenagers. When patients are seeking help for it, I generally start them on medication or refer them to a counselor. 

Yes, self-harm probably does affect the way some patients are seen. I know many doctors hear “cutting” and automatically label the patient as having borderline personality disorder. While self-mutilation is a symptom of the BPD, not all cutters are borderline. Some docs hear cutting and roll their eyes, excusing it away as “teenage drama.” 

In my experience, many people self-harm because they don’t know any other way to cope with or express their feelings. So my job as their doctor is to provide them with better ways to cope.

*Soapbox*

I think to some small degree, the publicity that some celebrity cutters have gotten has led to an increase in the activity in teenagers. Cutting has become so visible in the media and online that when a person gets depressed and doesn’t know where to turn for help, it suddenly becomes an option in their mind.

 ”This is what people do when they’re depressed.”
"Maybe this will help me feel something other than numbness."
"I just need an outlet." 

Unfortunately, depression is a self-perpetuating process. The more one dwells on the funk, the nastier it gets. People get depressed, do or think about things that disgust them, then feel guilty about it, and then get more depressed.

The solution is to break the loop. See a doctor. Start a medication to help you get out of the loop of funk. Talk to a counselor and figure out ways to deal with your oppressive thoughts and actions.  I see so many people that stay entrenched in depression simply because they’re too afraid or embarrassed to ask for help. How many times do I have to say it? Do something. 

So I have a question. Does being treated for depression while in medical school affect your ability to get into a residency program? I was told that there’s a spot on the ERAS application or something where they ask you if you’ve been treated for depression. - anon

I know that there was a question about it on my state medical license application, but I can’t remember about ERAS. I think there was. I tried to look it up, but I didn’t find anything. Maybe someone who has filled it out more recently than me can remember?

I believe the question is worded in a way to ask if you have any medical or psychiatric diagnosis that would affect your ability to take care of patients. My state, like many others, can limit a physician’s practice if they report a psychiatric condition on their license. Now this is usually investigated heavily, and state boards work more on treatment and rehabilitation so they can keep doctors in practice, rather than kick them out.

As for residency programs, it’s probably the same deal. I would imagine that if you clicked “yes” on the question, it would ask for an addendum to your application explaining your answer. I’m honestly not sure how it would affect getting into residency. 

Asker Anonymous Asks:
Hi WMD! I was just wondering about your advice regarding students with depression. I know you've written in the past about how it's best to take a break to get your head together...but... have you known someone who has got through med school regardless of depression/anxiety/suicidal thoughts? How did they manage it?? Sometimes it just seems (and sometimes it is) impossible to get myself out of bed and to school but I really don't want to take time off :( thank you always for posting <3
wayfaringmd wayfaringmd Said:

The one person I know who was suicidal during med school took time off, but I do know several people who dealt with pretty severe anxiety in med school. Those folks mostly got professional counseling or medication to get through. If you’re to the point where you can’t get out of bed, you need help, friend. I know that the idea of taking time off sounds bad and scary, but so does failing school because you can’t get out of bed. Seriously, find a counselor, a doctor, something. 

Asker Anonymous Asks:
Were you taught any particular ways to encourage patients who are having a tough time coping with ongoing illness and might appear to be depressed? Is this something that you think is your responsibility to notice/question or does it fall outside your duty (and in the hands of perhaps a psychologist)?
wayfaringmd wayfaringmd Said:

We don’t have any set technique that we learn in med school. We’re just taught to be aware that your patient may have issues beyond the physical. But in general I would encourage patients to talk about their difficulties coping and would encourage them to seek counseling of some sort, whether formally in a series of visits with me or a trained counselor, or informally through a pastor or friend. 

It is absolutely my responsibility as a doctor to notice a patient’s change in mood and worsening depression. Mental illness affects physical health and well being. Plus, I’d add that the majority of patients suffering with mental illness do not seek help from a psychologist or psychiatrist first. They usually go to their family doctor about it. And many patients either don’t realize that they’re depressed, or they are unwilling to recognize it in themselves. That’s when we family docs, who have the benefit of continuity of care and know our patients well, can step in and be a big part of helping a patient heal physically and mentally. 

Dr. C: How can you know the difference between depression and burnout in residency?

JB: By how you act when you’re on vacation. 

I am a senior in high school and I want to become a doctor, but medical school seems… Tiresome and depressing. I feel like once I get there I’ll be so isolated and alone that I will give up. How does one handle that? It just seems so daunting to me. But medicine is my passion and I don’t want to give it up! -scienceofthes0ul

Well friend, you have judged medical school correctly…sort of. It absolutely can be tiresome and depressing, and it is at times (and residency moreso). But the cool thing is that when you’re tired and depressed, most of your friends are probably feeling the same thing. 

image

That doesn’t sound very comforting, but it kind of is. You will be surrounded by people who are just as miserable as you are, and they can empathize with you and you can use each other to get through. It’s funny, I spent less time with my friends in med school than I did with friends in undergrad, but I was much closer to my med school friends, and I think it’s because of this miserable dynamic. 

image

Take my best good friend, for example. We somehow managed to get every 3rd year rotation together, which was a godsend. She kept me sane, for real. And during our 4th year when we parted ways for much of the year, we still called each other almost daily to share crazy patient stories, catch up, and commiserate. 

image

But just in case you’re not lucky enough to find a best good friend in med school, here are some tips to avoid isolation, depression, and burnout. 

Read More

Yet another picture tagged with #drugs and #depression and #bipolar to shock and gain attention, and yet these are birth control pills. Last I checked, Yaz was not an effective treatment for bipolar disorder. 

Yet another picture tagged with #drugs and #depression and #bipolar to shock and gain attention, and yet these are birth control pills. Last I checked, Yaz was not an effective treatment for bipolar disorder. 

Today my pastor’s sermon was on depression, and while the overall message was very good, I got a little bent out of shape about one comment. He talked briefly about some folks he knew who had attempted or committed suicide, and he said “and these weren’t single people. They had families and stuff to live for”.

Good to be told I have nothing to live for. 

wayfaringmd:

Can you give me tips on dealing with depression? I’m a second year med student (on a international university, so is second year of six) who really loves medicine, especially surgery, but feels that does not have what it takes to be successful, to be a good doctor. I’m constantly thinking, “I’m not good enough, not that smart, I don’t have the abilities…” :S (can you please answer this on anon?)

I once told my mentor (and imo the best freaking doctor in the history of ever) that I didn’t feel like I was smart enough to be a doctor. This was like late in my fourth year of medical school, so I should have felt more confident, right?

Her (very wise) response? 

“I wake up every day and think I’m not smart enough for this job. That’s what keeps me reading and learning.”

image

The point is, none of us feel good enough, smart enough, compassionate enough, competent enough, etc, at least at some point in time, if not all the time. The people who claim they do have everything under control are the ones most in danger of hurting someone because of their arrogance. Shoot, I have the “I’m not smart enough to be a doctor” thoughts at least weekly, and I’m already a doctor. 

image

Read More