Monday, October 04, 2010

I Have Bipolar Disorder. Can I be a Doctor?


Ah, one of our readers asked this.

It's one of those questions to which there is no real answer. Being a doctor takes a long time, it requires reliability, diligence, and a willingness to learn things you may not want to learn (organic chem anyone????) and do things you may not want to do. It requires endurance and passion. You need to be tolerant of many things: arrogant supervisors, irritable colleagues, sick people who may not be charming and who may, in their distress, be down-right nasty. You have to tolerate a militaristic order and be willing to work with a system that may be very difficult, wrong, and demand your obedience in ways that may be uncomfortable. Oh, I am so happy to no longer be a medical student or a resident in training.

So can you do it with bipolar disorder? Can you do it with diabetes? Can you do it with attention deficit problems? Can you do it if you're disorganized or ugly?

The question assumes there is one bipolar disorder, that for everyone it has the same course and the same prognosis. Some people have an episode a few times in a life, and between episodes, their mood is stable, their emotions gentle. Others cycle from one mood to another, feeling the whole bipolar thing most minutes of most days. Some patients with bipolar disorder are in and out of the hospital, behave in impulsive and criminal ways when ill, and can't hold any job. Some do fine with medications and therapy, while others have refractory conditions that defy the most creative of cocktails and the best of therapists, even with their total compliance. And some people become doctors and then get bipolar disorder.


So, maybe.

What do we think Kay Jamison would say?

32 comments:

Anonymous said...

It all depends on the severity>

Cyclothymia? sure.
Bipolar II, mild? Sure.

Severe bipolar I? Sorry but I doubt it. Medical school takes 4 years, residency another 4. The likelihood of a severe episode in that frame of time is pretty great.
Plus it will be extremely hard to perform (study and function) on anything but minimal medication, and a person with severe bipolar often takes multiple antipsychotics and antiepileptics which tax energy motivation and the capacity to remember/learn.

I guess it depends on the severity of illness, how likely it will be that a severe episode will hit you in the next 8 years, and how much medication you require to maintain decent control of moods. You can get through school with mild and moderate mood episodes (i know, I did it) but a severe episode is going to knock you on your ass obviously.

Anonymous said...

I am a 4th year psychiatry resident, and I have bipolar I. I had a manic episode at age 15, and again, at age 19. Both were serious enough that I was hospitalized during the former episode and arrested during the latter. Since the second episode, I have remained on mood stabilizers and have been okay. I am fortunate to have never plunged into the darkness of a deep depression, but occasional bouts of minor depressive symptoms have plagued me.

With sleep hygiene being such an imortant part of bipolar management, med school and residency can have deleterious effects on health. During med school, I was as careful as I could be about maintaining adequate sleep rhythms. In residency, I was worried about overnight call, but I made it through without any major effect. I was open with my residency director about my situation, and he encouraged me to come to him if I needed support in any way. I am lucky to have a supportive wife and family who have helped me keep an eye on myself throughout the travails of medical training.

So is it doable? Yes, but as the previous post said, you need to assess your situation. Also, be realistic about what specialty you go into. Surgery probably isn't a viable option. Anything with shift work, like emergency med, also probably is not a good idea.

Provigilant said...

Prior to the use of antidepressants, there were people who were stabilized and maintained on lithium only, and who weren't destabilized by some of the drugs used today to treat the illness. No matter the severity of their episodes, they were able to continue with their education and careers. Those with milder forms of illness would have difficulty, given the amount of time spent in depressive phases.

Anonymous said...

Well, Bipolar I has never been an impediment to my ability to practice law (except for that 3-week hospitalization for mania with psychotic features). Clearly, medicine is a more demanding field and one must endure the punsihing course of medical school and residency, but anyone who is stable and on minimally-sedating medication, with a history of periods of mood stability (YES, WE DO EXIST) ought to do just fine. And what about unipolar depression? Can't you make a case that that's just as disabling? We don't secondguess alcoholics or drug addicts when they are starting down a career path--society looks the other way. Why should a young adult with bipolar disorder have to put up with such scrutiny?

In the Pink said...

I have Bipolar type 1 and was hoping to go to medical school. In my third year at college I totally broke down and failed Chemistry. I retook it and got an A but it proved to be to difficult for me. I still had chem 2 and organic chem to do and my mind just felt like it was melting on all the meds I had to take. I wish I were a success story but I am not.

Anonymous said...

KRJ is not a doctor ,though.
I have known doctors with bipolar as well as many other professionals. I have also known doctors without bipolar but who were nasty and heartless and incompetent. Your diagnosis is not the issue. Your competency is.

Katie said...

You know what? Diabetes is not the same as bipolar disorder. Disorganized is not the same as bipolar disorder. And ugly is certainly not the same as bipolar disorder.

I get that you're trying to make a point. But you are seriously minimizing the truth and intent behind the question. And I think you know it.

Ladyk73 said...

I started reading shrink rap when I was just struggling with two hospitalizations a few years ago. Three weeks after my 2nd hospitalization I started grad school. My Psychiatrist wanted to fire me from her practice because I was TOO sick and she wanted me in day treatment. I got support from the disability office of the school. I got accomodations to had in papers late. I used these accomodations a handful of times. I think I was submitted things late no more so than any other student trying to balance other life obligations.
I worked towards a Master's in Social Work. I went to a very clinical/therapy based school. I did reveal my diagnosis to my field supervisors. It was hard, but it was an appropriate thing to do. I got a 4.0 my last semester.
I have my MSW. My mom died the same week I graduated. So I have delayed getting my license. But I do work in the field. BUT, I work as a "peer specialist"
I have a master's degree in social work. But I have to answer to non-clinical people. I am so fustrated. Soon I hope to take and pass my test.... and get a real job...

:P

So yes. You can. Just be careful on who you reveal your diagnosis. People who work in mental health are Sometimes the people who will most likely to prejudge you. Stigma from practioner peers is very very prevalant.

Anonymous said...

Why not? These people did.



http://pn.psychiatryonline.org/content/36/14/11.full



Mental illness occurs in all facets of society and some doctors (and medical students) are mentally ill just a some doctors have other illnesses just as some teachers or brick layers have mental illness or other illnesses. We all have challenges of some kind and these can give those who wish to be caregivers unique strengths and capacity for empathy.



I heard Suzanne Vogel-Scibilia, former NAMI president and bipolar since the age of 15, speak about this and she told of actively experiencing her mental illness and seeing a person that she didn’t know whether they were real or not during training/working on a ward. Fortunately she was able to channel her difficulties (jumping in a fountain one day, being a caring doctor the next). She also found ways for her and her patients to stay safe. She was, in a way, bright, unique and maybe someone you’d consider a little eccentric. I would say she was delightful in her eccentricities—a true joy to listen to and someone who loved knowledge, had a great sense of humor about herself, life and her illness. Part of her charm is that she didn’t see her illness as something horrible…just something which made her have certain quirks or tendencies—some of them even good perhaps.



My suggestion: If you want to be a doctor—whether or not you have a mental illness—try and be one. What do you have to lose? If it doesn’t work out you can always become a lawyer and sue a doctor. OK, I was really kidding there.



Elbee

Anonymous said...

In my state you will have to answer if you have been treated for bipolar disorder, etc when you get your medical license. So, if you've got that label or diagnosis, and you're honest about it, you very well could be screwed.

Dinah said...

Katie,
Didn't mean to be flippant but there is no yes or no answer. The illness expresses itself differently in different people and people deal with it differently. Some people with bipolar disorder can become doctors, and some people without bipolar disorder can't.

I just bought
Just like someone without mental illness
by Mark Vonnegut, M.D.

Anonymous said...

Thank you for this post!

I'm starting medicine next year and I am determined to manage my mental illness as best I can so that I'm able to cope with the demands of school and life as a doctor. I've been through a lot to get to this point that I'm well enough to even attempt this, so I'm beating away the self-doubt and just trusting that I can do this. I know it will be harder for me than for others that aren't dealing with mental health issues, but it will make my achievements that much sweeter for me personally.

Hopefully 12 months from now I am still looking at things just as positively. It is going to be an awesome adventure that is hopefully not interrupted by the demons of mental illness.

betsy yates said...

Can you be a doctor and NOT be bipolar?

Anonymous said...

I don't know what the person asking the question wrote. When I read the post title though, that's not at all how I interpreted the question. I assumed they wanted to know if the diagnosis would need to be disclosed and if that would exclude them from being admitted to medical school, residency, etc.

That's why the comparison with diabetes always annoys me at least. Stigma is not insignificant. I have no idea if anyone asks about psych histories and what they do with that information if they do. I think it's a legitimate (and answerable) question.

Also, Kay Jamison (aside from not being a doctor) had quite an extensive support system. How much can someone (reasonably) count on being able to have that in a healthcare setting?

Dinah said...

Oh, my, I completely missed the question here! I'm not aware of anything specific on a med school application that ask about psychiatric or medical disorders--- maybe the med student readers would know? It would seem tremendously discriminatory, many illnesses are disabling, not just bipolar disorder, but major depression can be disabling, schizophrenia, panic attacks, OCD...and Diabetes can be tremendously troublesome...med student holding the heart during a long surgery passes out from hypoglycemia....what about seizure disorder? Or colitis (sorry, I gotta run now)...

Licensing boards do ask if you have a mental illness that interferes with your ability to practice. My guess is that most doctors who see psychiatrists check off the "no" box.

class of 2015??? said...

As a current medical school applicant, I can add that most (all?) medical schools have you sign off that you meet what they call "technical standards." It's a pretty long list of things like motor function sufficient to perform a physical exam. There's also a mental health one along the lines of has the emotional stability to fully use intellectual capabilities and can function under physically and mentally stressful workloads.

Here's an example:
http://www.einstein.yu.edu/admissions/page.aspx?id=9058

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Anonymous said...

Just a niggle: actually, Kay Redfield Jamison *is* a doctor (PHD, not MD), and a Professor of Psychiatry to boot. So I think the story of her life and career is definitely relevant to this post.

I know students (medical, psychology, nursing and other fields) with psychiatric disorders, and like Dinah said, it really depends on a multitude of factors, not just the degree being pursued - e.g. the severity of the disorder, how well it is managed, and the kind of academic support in place.

drmichi said...

I am a doctor.
I want to specialize in surgery.
I have been bipo for as long as I can remember. I had a serious breakdown during my 3rd year.
I was booked off and went back to work.

I am a really good doctor.
My bipolar has made it really hard. I was booked off again. I missed shifts because I couldn't look after my patient - I was not mentally capable and because I have severe psychosomatic symptoms, I was physically not capable either.

I had to disclose to my consultants and HOD when I had tp be admitted. Since then most of them have little faith or respect in me.

I have put every effort possible into getting better and my improvement is truly incredible.
I am an even better doctor. My clinical skills are better than my peers. I work harder than them and my patients improve except for the those with fatal injuries.
My soul is a healer, but haven't had teaching. I just care for my patients and it helps them too.
I will never become a doctor who doesn't care and treats only physical problems, so I take on a lot of emotional stress. I also have the joy when they get better and the honour of thank you's.

I work in a specialized trauma unit. My patients are the most severely injured. At times I am resuscitating up to 9 patients in a resource limited environment. It is extremely busy. I always stay in control and save patients on the brink of dying.

I do many night shifts. my schedule has absolutely no normal routine.
We know that sleep is one of the most crucial elements of managing bipolar. I have no sleep pattern at all and have to rely on meds to rest. sometimes I have only 6 hours off between night shifts, so I can't use meds.
Somehow I don't make mistakes.

It is incredibly hard. I have to do my job whatever the mood. It is terrifying to not know how what state I will be in. I feel better at work. I do everything for my patients, but I am suffering.
My state of mind out of work is uncontrollable, I barely function and ,my quality of life is non-existant. I have little left for me and I end up neglecting me.

I am leaving my trauma department due to my bipolar. I think the problem is the night shifts.
I may not be able to become the great surgeon I have the potential to be. If it means I will not be stable, I cannot risk the possibility of mismanaging patients. and I can't live my life perpetually unstable and alone.

You can't look after anyone if you don't look after yourself.

I'm very well when working only during the day, but I have to give up my dream of being a surgeon beacuse of the effect sleep disturbance has.

People who are bipolar can be great doctors (maybe not if it is severe.) The limiting factors must be carefully considered, for your own health and your patients. I may not be a surgeon, but I am a good doc - that is what is rewarding.

Anonymous said...

Hi

I am a second year resident in General Surgery and suffer from bipolar disorder. I had only a single episode in my life (about 2 years ago) and I succeeded in completing my medical doctorate.

I am doing extremely well in residency and do not feel it has affected my cognition or my resiliency towards difficult patients, attendings, collegues...

I think if you want to become a medical student, you need to have excellent grades and a passion for the field.

Anonymous said...

I would tell anyone with this disorder who is considering becoming a physician to think carefully and be honest about their individual strengths and weaknesses, as well as what type of work they are interested in doing before choosing a career path. This is the same advice I would give to any college student.

The issues faced by peoples with bipolar disorder are as diverse as the issues faced by all people.

Anonymous said...

I am a physician with bipolar disorder. I was only diagnosed after I had been in practice some years. I was in a surgical residency but left 1 1/2 years shy of finishing...this was due to children, not bipolar. But I certainly noticed the effects of sleep deprivation on my moods, and I had my suspicions of the diagnosis before then. Now, I have a full time practice, nasty divorce proceedings, and nasty teenagers. Most important of all, I have a supportive psychiatrist who follows me closely, and has kept me from being admitted several times. So, as many have commented, you can be a doctor and be bipolar...everyone is different, and you just don't know until you try!

Anonymous said...

I started my job after taking a 6 wk research course, during which I became progressively withdrawn and down. I failed the statistics class just because I couldn't summon the energy to finish the final exam (I did 2/3 of it). I have the ideal job in my old department where I know everyone and the hospital and people are familiar, my schedule is just what I want, although it's an academic institution there is no pressure to do research or get grants as I have a purely clinical position. I do have 4 weeks on service each year where I do that blasted home phone call 24/7 this time from residents staffing consults, and those weeks totally screw me up for about a month after (partly the sleep dep, partly because I have to reduce my seroquel dose to be able to wake up at night). I have chronically low self confidence but am told repeatedly how much people think of me, that I have a gift for interacting with children, etc. I have made a few important diagnoses in the past couple years that other people have missed. Nevertheless, and I'm sure other depressed people can understand, I think I am the worst person in the world.

Anyway the depression that started just before my job began never let up. It became chronic, waxing and waning in no pattern. I've been on a ton of meds, been told by well-meaning people that I'm on too many meds. I spoke with a successful bipolar doctor at another local hospital (who I met through her book about hypergraphia), she referred me to a trusted colleague, who said I was "NOS" and didn't offer me and my doctor any concrete specific advice (just a very long list of med options, some of which we had not heard of!!!). That was a year ago. Since then I have been limping along. The time I spend with my patients is the only bright spot in this whole mess. When I am with the kids, there is a point to kmy existence, and in fact most importantly I forget about myself because it is all about them. I can't concentrate for too long, have low energy,constant migraines, blah blah. I got so epicallly behind on my clinic notes that 1 month ago I was taken aside and given 2 months to finish them, without clnics. I am not suspended, I'm still getting paid, everyone wants me back, etc. But this sent me into a downward spiral. To me this is failure, no matter now irrational that seems. I spent the first month crying and not sleeping and not getting notes done, of course. Now I have begun to get some intruding manic type symptoms. I did get some notes done, though! Anyway my brain is only getting worse. My doctor and the psych at our office of clinician support want me to take a leave of absence . We are going to discuss it today. I think at this point I have to or I won't get better. But I don't know if I can come back and do the same thing or not. My mother always tells me, "no one is indispensable" and she's right. But I am pretty sub specialized, one of probably only 50 or so people in the country who do what I do. That doesn't mean anybody actually needs me, especially if I am going to go crazy every 5 minutes. I don't know what else I would do for a living if I didn't do this. It seems to me my life would be worthless if I could not do my job. The spectre of utter failure would haunt me wherever I went. And I would think of my little patients from time to time and weep. But they deserve better than me.

Anyway this was too long. I just wanted to put this in because someone suggested that a bipolar person could just "try and see" how med school and residency went, but I would not advise it. I had no way of knowing ahead of time, but if you have that benefit, try to spare yourself the suffering. There are other ways to help people.

Anonymous said...

Part II

I started my job after taking a 6 wk research course, during which I became progressively withdrawn and down. I failed the statistics class just because I couldn't summon the energy to finish the final exam (I did 2/3 of it). I have the ideal job in my old department where I know everyone and the hospital and people are familiar, my schedule is just what I want, although it's an academic institution there is no pressure to do research or get grants as I have a purely clinical position. I do have 4 weeks on service each year where I do that blasted home phone call 24/7 this time from residents staffing consults, and those weeks totally screw me up for about a month after (partly the sleep dep, partly because I have to reduce my seroquel dose to be able to wake up at night). I have chronically low self confidence but am told repeatedly how much people think of me, that I have a gift for interacting with children, etc. I have made a few important diagnoses in the past couple years that other people have missed. Nevertheless, and I'm sure other depressed people can understand, I think I am the worst person in the world.

Anyway the depression that started just before my job began never let up. It became chronic, waxing and waning in no pattern. I've been on a ton of meds, been told by well-meaning people that I'm on too many meds. I spoke with a successful bipolar doctor at another local hospital (who I met through her book about hypergraphia), she referred me to a trusted colleague, who said I was "NOS" and didn't offer me and my doctor any concrete specific advice (just a very long list of med options, some of which we had not heard of!!!). That was a year ago. Since then I have been limping along. The time I spend with my patients is the only bright spot in this whole mess. When I am with the kids, there is a point to kmy existence, and in fact most importantly I forget about myself because it is all about them. I can't concentrate for too long, have low energy,constant migraines, blah blah. I got so epicallly behind on my clinic notes that 1 month ago I was taken aside and given 2 months to finish them, without clnics. I am not suspended, I'm still getting paid, everyone wants me back, etc. But this sent me into a downward spiral. To me this is failure, no matter now irrational that seems. I spent the first month crying and not sleeping and not getting notes done, of course. Now I have begun to get some intruding manic type symptoms. I did get some notes done, though! Anyway my brain is only getting worse. My doctor and the psych at our office of clinician support want me to take a leave of absence . We are going to discuss it today. I think at this point I have to or I won't get better. But I don't know if I can come back and do the same thing or not. My mother always tells me, "no one is indispensable" and she's right. But I am pretty sub specialized, one of probably only 50 or so people in the country who do what I do. That doesn't mean anybody actually needs me, especially if I am going to go crazy every 5 minutes. I don't know what else I would do for a living if I didn't do this. It seems to me my life would be worthless if I could not do my job. The spectre of utter failure would haunt me wherever I went. And I would think of my little patients from time to time and weep. But they deserve better than me.

Anyway this was too long. I just wanted to put this in because someone suggested that a bipolar person could just "try and see" how med school and residency went, but I would not advise it. I had no way of knowing ahead of time, but if you have that benefit, try to spare yourself the suffering. There are other ways to help people.

Anonymous said...

Maybe try veterinary school - not so stressful, voluntary residencies so 4 or 5 yrs total, few overnighters and you get to pet some great animals. I was diagnosed Bipo 1 18m ago at 61 after a very stressful time. Two weeks later survived a 7 day self-induced coma.
Gaduated at 41 after yrs of failures but it would have been tougher on the drugs still VMD is a Dr - so go for it.

Anonymous said...

Depends. Many clinicians explain Bipolar Disorder as a SPECTRUM.

Three months after I graduated with a PhD in Molecular Genetics and was starting my first after grad school job as a postdoctoral research fellow, I "seized." My diagnosis was changed from garden variety depression to a bipolar spectrum disorder (BPII). I was put on massive doses of drugs to be stabilized. Unfortunately, I spiraled down and lost my academic future in science (and how many years does it take to get a PhD?).

Almost three years later, I am about to begin an accelerated bachelor of science in nursing program. I am concerned about maintaining optimal mental health. Adding another wrinkle, my husband and I would like to try to conceive (my age requires us to try, now or never).

This diagnosis trounced my self-confidence. Bipolar does not go away. I must remain forever vigilant. And there is a tremendous amount of stigma about mental illness. I am still in mourning over my obliterated science career and this diagnosis that hangs like a loose noose around my neck.

Anonymous said...

I am sure the above poster can find something to do with her old degree. Good luck with everything. I think we test ourselves with taking on too much. Set ourselves up for disappointment. I am going for an advance degree but I have to not go for the most competitive.

Emily Vaccaro said...

I have a similar question. I am a senior in high school and have been considering studying psychology in college to become a clinical psychologist. The problem is, I have a history of depression and anxiety, and I still have some bad days (especially when it comes to college). Is this a realistic option for me?

Emily Vaccaro said...

I have a similar question. I am a senior in high school and have been considering studying psychology in college to become a clinical psychologist. The problem is, I have a history of depression and anxiety, and I still have some bad days (especially when it comes to college). Is this a realistic option for me?

Anonymous said...

I just read this and it gives me great hope. I have been involuntarily hospitalized once and hospitalized thrice during the first year I have had Bp 1, two were due to medication reactions tho, one when i was diagnosed, and one when I needed my meds changed.. Im a straight A college student on the pre-med track and this gives me hope that one day I may be a doctor, preferably a psychiatrist, too, so no one hurts like I have hurt. I thought my involuntary committment would bar me from being licensed or something.

Anonymous said...

Hi, I am currently training to be a psychiatrist and was diagnosed with Bipolar2 about 14 months ago during a severe depressive phase. Currently I have my employers asking my treating psychiatrist and psychologist whether I am well enough to re-enter training ie. 'suitable' also the concern is that if I get unwell and fail training that I will sue them for pushing me... What rot! I am finding being a doctor with a mental illness, that is not an acceptable one like 'burn out', is isolating. I would like to meet with peers to share stories and support each other but I have not found any groups in my corner of Australia. It's like mental illness amongst doctors is an embarrassment and we have to be hidden away lest the ideal of the superhuman doctor is tarnished by this. I would suggest to others thinking of doing med to have a really good think about it- We eat our under performers or ship 'em out to sea....

Anonymous said...

M
Well if your medication effectively controls your symptoms then delving into medicine to become a doctor would be reasonable and possible. That is if that's your passion. However, you must understand bipolar disorder is a unique experience for each patient and everyone lies somewhere on the functionality spectrum. You can be extremely high functioning, moderately high functioning, moderate in function, moderately low functioning or extremely low functioning. Furthermore, it's important to note that functioning has to do with 3 factors. First, your intrinsic innate nature. Are you high functioning naturally before your onset of illness? Secondly, the bipolar disorder can effect functioning even if medicated. Some of the ways bipolar effects functioning is by residual negative mood and mild cognitive impairment. Lastly, we all know medication side effects can negatively affect overall functioning