Dear Pamela,

Question for you in regards to disclosure about mental illness. In every job that I have applied for, as part of the credentialing process, there are questions about felonies, treatment for drug/alcohol abuse and mental illness. Why are mental health questions still allowed to be on there? I have had postpartum anxiety/depression three times now, and I feel like it is none of their damn business. So I have lied about it on my applications. Also, I feel like these question could contribute to doctors not seeking help, especially for problems that could require a mental health hospitalization. I would be so interested if there were a survey out there or a study looking at whether these questions have an adverse effect on doctors and medical students presenting (or not) for care they may desperately need. If somebody answers that question as a no, but lies, are these places able to access medical records to find out if somebody is truthful? How much weight does that question even have? Do we as docs worry too much about mental health questions unnecessarily?

Sincerely,

Concerned Physician

Dear Concerned Physician,

Mental health questions on job applications are more than just an invasion of privacy. These questions are against the law. According to the Americans with Disabilities Act — a law enacted by the U.S. Congress in 1990 — employers are prevented from discrimination based on mental or physical health. It’s illegal to ask applicants disability-related questions. Furthermore, accommodations must be provided for employees with medical conditions. Case closed.

Yet on physician insurance credentialing, state board licensing, and employment applications, mental health questions persist. In addition, these personal health questions are grouped with questions on criminality (such as felonies and DUIs) which would suggest that a doctor who seeks mental health support is committing a crime, further stigmatizing those who need support — not punishment.

Why are there no questions about diabetes, stroke, or other physical conditions that could potentially impair a physician’s ability to care for patients? Why is the singular focus on mental health? And why are these questions allowed to be on there at all when they are against the law? Medical boards exist to protect the public. Employment applications protect the needs of employers. Insurance credentialing applications protect the needs of insurance companies. So who’s protecting doctors? Nobody.

These illegal questions have remained unchallenged by medical students and physicians for far too long. Do we really need a survey to prove these questions have a detrimental effect on doctors and medical students who may delay/avoid care?

It’s none of their damn business if you’ve had postpartum depression. I agree. If you are not impaired, and your physician has released you to work, then you shouldn’t need anyone else’s permission or approval to do your job.

Those who tell the truth about seeking mental health care have suffered delays in licensure and ridiculous levels of added scrutiny. A physician friend of mine had a 6-month delay in obtaining her state license when she revealed that she had sought counseling during a divorce ages ago. The board mandated that she provide her counseling records. But her counselor had retired. So they forced her to get a psychiatric evaluation before declaring her safe to practice in the state. Doesn’t everyone need therapy during a divorce? Why the hell is it anyone else’s business?

This is exactly why a friend of mine, an excellent psychiatrist, drives 200 miles out of town, pay cash, and use a fake name to receive mental health care.

Some doctors do lie on applications. Can the board, insurance companies, and employers gain access to your medical records? Not unless your records are easily accessible on an electronic medical record system, and they can find out who provided your care. Though I’m no legal expert, I believe they can still subpoena your records. So do docs worry too much about these questions? I believe concerns are justified. Physicians have faced discrimination and major career ramifications by revealing the truth.

Fear of seeking treatment due to these antiquated, punitive, and illegal questions leads to increased physician depression, anxiety, substance abuse — and ultimately may result in suicide. I know of several medical students who have died by suicide for fear of seeking mental health care that would be disclosed on their official school records and in future applications for residencies, hospital privileges, state licensure, and insurance credentialing.

We enter medicine with our mental health on par with or better than our peers, yet anxiety, depression, substance abuse, and suicide are all occupational hazards of our profession. Here’s why. We’re steeped in a profession full of human drama, suffering, and death. Yet we have no on-the-job emotional support then we’re punished if we seek mental health care. How can we care for others if we can’t get the care we need as human beings — without fear, stigma, and discrimination?

Seeking mental health care is the responsible thing to do for one’s own health, and I believe regular mental health support makes one a better doctor. In fact, I believe all medical students and doctors require mental health care to be well-adjusted human beings. We should be far more concerned about physicians who don’t receive mental health care.

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. She is the author of Physician Suicide Letters — Answered and Pet Goats and Pap Smears. Watch her TEDx talk, How to Get Naked with Your Doctor. She hosts the physician retreat, Live Your Dream, to help her colleagues heal from grief and reclaim their lives and careers.

Image credit:Pamela Wible