Friday, November 04, 2011

Tell Me.... an Ethical Dilemma



Sam is young man is applying for a summer program, a real resume builder.  Among other things, the application asks if he has been treated for a psychiatric disorder.  In fact, he's seen a therapist and he's felt anxious at times.  His internist gave him some Lexapro samples and he feels better.  The symptoms of his problems have been limited to his own subjective distress.  His anxiety is not something that has disabled him, in fact he has not missed a day of school in 3 years -- and then for the flu-- he sees his therapist on the weekends, and no one would know he's been uncomfortable unless he told them.  He's never been in a hospital, he's ultra-reliable, and he has great grades and extracurriculars.  Any way you look at it, Sam is an energetic guy on the road to success.


What should he write on the form?  It's a yes/no check box, no questions or place to clarify, so if he says yes, well, that could mean he has some subjective anxiety, or it could mean he has attention deficit problems, or it could mean he has been hospitalized 6 times after becoming violent, or has a severe mental illness.  He's worried that his anxiety will throw him into a subset of applicants that the committee would rather not deal with: why choose someone for a project who has a mental illness if another equally qualified applicant is available without this issue to address?


Sam's mother say he should check "yes."  He has been in treatment and he has a diagnosis and he takes a medicine.  He has a psychiatric disorder and he needs to be honest. 


Sam's father says that the question defies the spirit of what the committee wants to know.  They want to know, Dad presumes,  if there will be issues or problems or things they might need to accommodate, and there is no reason to believe that Sam's problem will interfere with his ability to negotiate life in a competitive or stressful environment.  Sam, he contends, does not belong in the same category as someone who has attempted suicide, been hospitalized, missed work, or behaved in a disruptive or dysfunctional manner. If anything, Sam's anxiety drives him to focus and achieve and to be very conscientious.  He's not ill, his father says, he's just more anxious on a spectrum of normal anxiety.


I want to know why forms get to ask such questions and put people in the awkward situation of having to answer something that is none of anyone's business versus being dishonest.  It seems that if someone wants to know this, it might be asked in terms of "Do you have any health issues that might require any special accommodation?"  Is there a limit to what random forms can ask and whether you're behaving unethically if you choose not to answer their questions or answer it less then completely?  Sam tried leaving the question blank, but the computer wouldn't let him submit the form without checking all the boxes first.  Can they ask if you have deviant sexual fantasies?  If you've ever committed a crime (regardless of whether you've been charged or convicted)?  If you say provocative things on your blog?

44 comments:

Anonymous said...

"Under the ADA, you are not required to disclose your psychiatric disability unless you wish to request accommodations in the workplace. By the same token, a potential employer is not allowed to ask whether you have a disability during the hiring process. They may, however, make a job offer conditional on a medical examination. This medical examination must be required of all job candidates, not just those suspected of having a disability."
http://socialanxietydisorder.about.com/od/sadandworkschool/a/disclosure.htm
If Sam is not asking for accommodations, there is nothing unethical about saying no to a question that has no business being asked. How many people would be out of a job if they had to fess up to cheating to their spouse?

Anonymous said...

no need to disclose - issue sounds relatively mild with no demonstrated interference in his ability to function - he should not be penalized for choosing healthy ways of coping with anxiety (medical care, therapy) instead of self medicating with regular use of THC or ETOH....which would not necessarily raise any red flags, given the 'normal' range of behaviors in his age cohort.

Anonymous said...

If this is for a government clearance, he should check yes. If they do a background investigation and find out he lied on the form, that is serious (trying to hide something -even if minor) and could affect his ability to receive a clearance in the future.

For the private sector- why would they be asking a question that is so vague and opens them up to a lawsuit under ADA?

Anonymous said...

Oh how I have struggled with this one!
I have been applying for jobs for months in this crappy economy (Background - Bipolar disorder, husband left/gave up on marriage 6 months ago, and I have primarily been a SAHM to three kids for years). There have been several jobs that I have spent a ton of time applying online, only to find at the end of the app. that there would be a drug test - more specifically concerning mental health issues ( which I do have) and substance abuse problems ( which I don't have) The stuff that falls under "protected information." And they want you to sign that waiver to release that info... What a nightmare. Then the panic arises and you think of the lithium, lamictal, seroquel and other PRN drugs running through your veins/brain that help you function.... It is so frustrating and it has kept me from applying for several jobs that I would have otherwise qualified for. I don't want people knowing THAT stuff. Nope, they either get it or they don't, and you don't want to end up in the hands of someone that doesn't get mood disorders. No thank you!

Anonymous said...

Difficult question to answer...

If it is for a job that requires government clearance and you know that background/medical checks will be done at a later date, then by all means be truthful and check yes. Not worth the ramifications of being found "dishonest" later on.

I'm curious why a private sector job would ask this, and what the legal jargon entails, can you opt out of the question (not sign the disclaimer)?

Then there is the exact wording of the question - have you ever been "diagnosed" with a psychiatric disorder? This could get fuzzy, yes I take psych drugs but have I ever been diagnosed? Not entirely sure.

For example, I currently take Ritalin prescribed by my campus health center. I also took Ritalin in elementary school for several years prescribed by my pediatrician. I have never had psych testing for ADHD. I was prescribed medication based on my own subjective complaints and history of doing well on the drug. I don't know what is written in my chart and if there is an actual axis dx. Could I truthfully answer that- No I have never been "diagnosed" with a psych disorder?

It seems this argument might apply to cases of mild attention problems, anxiety, depression, etc where the client might not meet full DSM diagnostic criteria (Sam's anxiety does not cause problems functioning in daily life and therefore he would not meet DSM criteria?) but none the less seeks medication and the medication proves to be beneficial.

This probably also depends on the physician and their level of comfort prescribing medications to individuals that do not met full diagnostic criteria.

If you don't meet DSM criteria, then "legally" do you have a diagnosis?

Interesting topic...

Anonymous said...

No frickin' way should anyone ever admit to that on a job application. As the first poster notes, under the ADA you only need ti disclose if you want accommodations. If you aren't seeking accommodations, don't every disclose. While there are laws against discrimination, it still happens. Others will question your competence if you disclose having some sort of psychiatric disability, mood disorder etc. Don't do it.

Still Dreaming said...

where I live, it's illegal to ask that! I can't believe it's legal anywhere. Wow....
The only time they can ask is on optional employment equity declarations and even then, it's just "do you consider yourself to be a person with a disability?". Strange that that's even a legal question.

Nicola said...

In most jurisdictions, it's either illegal (i) to ask for that information, or (ii) to discriminate on the basis of it once you have it. Since the employer has no right to the information, Sam has no ethical duty to provide it. That one's an easy one.

rob lindeman said...

It's not a dilemma. Check'no'. It's nobody's business but yours.

PDFdoc said...

I struggle with that dilemma every year as I re-apply for privileges at three hospitals. Similar question, but worded such that it asks if we have any condition that may impair our ability to deliver medical care. I suppose that bipolar falls under this heading, but I always answer no. I have enough checks in place (colleagues, psychiatrist, friends) that this hasn't been an issue in 20 years of practice. The lithium tremor gives me some grief in the OR, but I've learned to work around that.

I similar question was on my medical school application...I had to have a physical done by my family physician, and there was a list of questions, including "have you ever suffered from seizures". I had temporal lobe epilepsy, but had been seizure free for 3 years, and in any case temporal lobe epilepsy does not include all of the drama of grand mal seizures. My family physician simply answered no.

I am generally honest to a fault, but in situations like this, I think that common sense and judgement should weigh in.

Anonymous said...

Note that the blog post said Sam is applying for a "summer program," not necessarily employment. It's impossible to say if the question is legal without more information on the nature of the summer program. In some cases, it may be legally justified as a business necessity. For example, if it entailed travel to a third world country where medical assistance might not be readily available. I'm not saying it's right, just that it might be legal. (I learned that what's right and what's legal are often two different things 30 years ago, on my first day of law school.)

Anonymous said...

My guess is it's a liability issue for the summer program. I answered "yes" to the same question for a summer program some 15 years ago out of honesty - and regret it to this day. I was 17, dealing with depression, had meds and a therapist, still quite high achieving and successful and all that other stuff. It was a paper application and I detailed under the yes by saying the issue was under control and under the treatment of a physician. Prior to being accepted I had to go through rounds of intrusive questions from slews of people, ranging all the way up to the director of the program. The directors also then insisted on separate and additional conversations and documentation from teachers, employers, supervisors, etc. In the end, I was permitted to attend the program, but the humiliation and trauma I went through in the process leading up to it is still clear in my mind. Never have I checked a "yes" in those boxes since. There absolutely is discrimination in the world and mental illness absolutely falls into that category. It's not a question of what should/shouldn't be, it's a simple question of what is.
The only time I check a "yes" on those boxes now is on a medical form FOR another doctor (ie a new internist, or a dentist - anyone who actually might need to know what drugs are in my body.)

Jane said...

I think the last poster made a really good point about what kind of program this is. What if Sam is applying to a program that takes place overseas and there would be limited access to medications or psychiatric help. Then it would be relevant for them to know (if only to make absolutely certain that he won't potentially need accommodations that they can't provide.)He's fine now with his Lexapro and his weekend therapy sessions. But how will he do if the therapist gets cut out and the Lexapro stops working in, say, Bolivia.

Jane said...

However, I would hope that kind of questioning would be illegal (just because of it's pointlessness) if Sam were applying to a summer program where he would have obvious access to medical care and can handle his disability quickly and efficiently on his own. It's leaving the country, and the program having to provide medical care, that I could see as being the only relevant reason to ask for something that mild.

Anonymous said...

Sam could miss his therapist and the Lexapro might stop working in Bolivia are not goo enough reasons to have him write yes. Sam's friend, Aldo might fall out of a tree and break his neck on the same program. Usually participants have to sign a waiver if they are going somewhere without good medical care. Even if Sam were staying at home,where he has access to his therapist and his Lexapro, nothing guarantees that his Lexapro will stop working at the same time that his therapist gets run over by a truck and dies.
Sam probably would not need either the therapist or the Lexapro if he did not feel so much pressure to build his resume, especially since he already has great grades and ECs. Sam, take the summer and go do something you really love to do. One more EC on your resume is not going to set you apart from the hordes of kids who have already gone to volunteer overseas as part of some rite of passage that we as a society have created for young ,well off, high achievers.

Dinah said...

Ugh, blogger ate my very long response.

Dinah said...

Sam is applying for a competitive summer program, not a job, and I think there was some travel to remote places.

If he misses his therapist (or his mom???) he will miss them. He plans to bring enough Lexapro with him, plus some extra doses in case he spills a few down the drain. He is aware that the pills could get stolen/lost/eaten by natives, and that he might not be able to replenish them immediately, and he says he is willing to risk the return of his subjective anxiety as well as any other discomfort that may be involved. He's more concerned that these things will happen to his friend Roger who has asthma.

Sam may get anxious, or he may get a headache, or he may twist his ankle and slow the whole group down. Just by being alive, we are all at risk or illness or injury.

Sam submits his therapist"s statements for reimbursement by his health insurance. In order to do this, the statements must have a diagnosis, and Sam's diagnosis is Anxiety Disorder, Not otherwise specified. He's in therapy, he's on medication, and his treatment is financed by a health insurance company: by definition, he has a psychiatric disorder (what ever that may mean....).

The question remains, is it wrong for Sam to lie on the form and check the "no" box? Isn't it wrong to lie?

I'm enjoying all your great answers!

PDFdoc said...

Everywhere we turn in life, there are black and white rules, when nothing is as simple as that.

For instance, in our province, we are not allowed to drive and use the cell phone. Makes total sense in the city, but, if I'm driving down a deserted 4 lane highway 60 miles out of town, and the hospital calls, why should I stop to answer the phone? Because the law says so?

We also have graduated licensing now to drive a car. It takes about 2 years of driving to be fully licensed. For city kids, no biggie, they just take the bus. For rural kids, it interferes with after school activities such as sports and jobs. I had my driver's licence 2 days after turning 16, which immensely helped in getting me to and from jobs. No accidents. I understand that rules have to be black and white, but does the interpretation have to be black and white? One sees this in daily life - again on the driving theme, many of us may have been stopped for speeding. How many times has the police officer lowered the offence, or given only a warning. He/she used judegement and common sense.

Aside from judgement and common sense, it is a matter of risk assessment. If someone has had psychotic episodes requiring hospitalization, perhaps this is something to know about, as would grand mal seizures. But everyone involved in the process should be able to use common sense. Yes, I know that it isn't common anymore.

In Sam's case, he should answer no, as the likelihood of his anxiety causing impairment the would effect others is trivial. It may not be the law, but it is what is right. All of the previous arguments are spot on!

Sunny CA said...

When I applied to the Peace Corps in 1972 there was a question like that on the form, which I answered "yes" to just because I had used on-campus counseling services and was being scrupulously honest. I was going through normal college-age angst and love problems at the time, not depression. I am positive that "yes" got my application thrown in the trash and I regretted my honesty. If I had it to do over again, I would definitely NOT say yes. Also, I omit my psych history from ALL questionnaires, even those of new doctors. Why does a GYN need to know psych history?

jesse said...

Dinah is asking whether it is wrong to lie. The question is posed as ethics, not law, not practicality, not being smart. Is one required to give an ethical answer to an unethical question, or, better, if a man is held up at gunpoint and asked if he has any money, is it wrong for him to lie and say he does not?

We could presume for the purpose of the question as ethics that there would not be any consequence for a "yes" answer than the possibility of being turned down, while a "no" might lead to being accepted.

But even in terms of ethics one needs to look carefully at the question: It asks if he "has been treated for a psychiatric disorder." What does that mean? I have no idea. The use of that term in the DSM does not mean it used that way by the entity requesting an answer. If a person sees a psychiatrist one time for anxiety, and is given an SSRI, does that mean he has a disorder? It could certainly be both honest and wise, given the information about the applicant Dinah gave us and that it is for a summer internship, for him to answer "no."

One clearly ethical option that the applicant might consider would be to write to the entity offering the internship and inquire about the question. The answer to this inquiry could help the prospective applicant decide whether he wanted to complete the application. If he were applying for an internship in a law firm, asking the meaning of the question and to what it referred might show him to be just the kind of applicant the firm wanted!

Anonymous said...

Oh Dinah, sometimes you seem so intelligent and sometimes you seem almost willfully the opposite.

I'm the anon who responded "yes" out of honesty on a summer program 17 years ago and to this day wishes he said "no."

It's absolutely not a question of if lying is "wrong." It's an issue of what the point of the question is. Yes, the summer program is likely asking for liability purposes. But by answering yes, Sam runs the absolutely real risk of the program saying, we don't want to have a risk like that on our program. Sam may be saying he is under care and his anxiety, but at the end of the day, when he checks yes, he becomes a 17 year old with a medical (or worse - psychiatric) disability and the program can absolutely decide that's a troubled minor and a liability it doesn't want. And truthfully? Do you blame them - a program in, say Bolivia, with limited access to mental health professionals is surely a high risk for increased anxiety. Why would you, a private prestigious summer program, pick Sam when he is potentially a major liability?

As far as purpose of question and lying being wrong....Try thinking of it this way - is it wrong for a psychiatrist to lie about a diagnosis in order for his patient to obtain insurance reimbursement? Of course not - and I bet you do it all the time as well, same as virtually all mental health clinicians who submit billing - whether to insurances or to patients who then submit for out of network benefits.

Anonymous said...

This is a very interesting topic.

I absolutely believe Sam should remain mum. I agree with many of the posters that stigma against mental illness remains virulent.

I am infuriated that it is quite possible Sam is upper middle class. I am extrapolating this based on the fact that he is applying to prestigious summer program and in order for him to be competitive, his family most likely had the funds to encourage Sam to participate in opportunities to make him stand out.

I further believe, that wealthier families have money to find doctors and therapists if anything psychological is amiss.
Why should Sam (and his parents) be punished for being proactive and self-aware in their prevention and treatment of mental illness?

Jane said...

"Sam probably would not need either the therapist or the Lexapro if he did not feel so much pressure to build his resume, especially since he already has great grades and ECs. Sam, take the summer and go do something you really love to do. One more EC on your resume is not going to set you apart from the hordes of kids who have already gone to volunteer overseas as part of some rite of passage that we as a society have created for young ,well off, high achievers."

Lol Anon! Why do kids get treated like this? We can't let them be 17 year old kids anymore. We need to overschedule all the creativity and happiness out of them. I agree with you. I think Sam should get off the Lexapro and just do what makes him happy. Maybe he should buy a drum set, start a band over the summer, become a local rock star, and put that on his college resume. Maybe he'll even get some groupies in his hometown with his playing.

I don't know that this is a moral question. I think it's more like an abstract reasoning question. Why are they asking? Jesse made a good point that the people in charge of the program might even be impressed with that question. If the reason is irrelevant to his situation then he can abstract that he doesn't need to put down yes.

If they can accommodate his friend Roger's asthma, they can probably accommodate Lexapro (at least I hope so...). The program probably has a plan for Roger. If Roger has trouble breathing, the people in charge of the program are aware of his asthma and can line him up with an inhaler in case he loses his, etc. If Sam loses the Lexapro, maybe they can locate the nearest third world pharmacy and get it for him before he starts having withdrawal symptoms.

My point about cutting out the therapist was to say that the reason his condition is so mild is perhaps because he is in regular therapy and takes meds. Not because he would miss the therapist. If Sam starts falling apart overseas the people in charge of the program may understand why and try to accommodate. If they plan ahead for asthma then they should be willing to plan ahead for this. Its better than Sam not telling them about the Lexapro, the Lexapro gets eaten by wild boars, he goes into withdrawal, and nobody has any clue why. Or even worse, he gets injured, they take him to a makeshift hospital while unconscious that is staffed by doctors who know no borders, and is then injected with a drug that interacts with Lexapro.

I maintain that Sam may be better served by creating a rock band and scoring some groupies all before he turns 18. He worries too much. If that program doesn't want to accommodate his anxiety, then at least every rock star/artist understands anxiety and having an "artist's temperament." He'll probably even have more fun.

Reminds me of Freaks and Geeks. The main character is an overachiever who starts hanging out with slackers (freaks) instead of other geeks, because she realizes there is more to life than trying to be a perfect student.

Anonymous said...

The question is probably thrown in there upon advice of their risk management dept. It seems particularly common for employers to do this when the job involves working with children/teens. Personally, I don't think they expect people to answer it honestly. I think they are just trying to protect themselves if they hire someone, things go bad, and they get sued.

I saw an application for a church preschool that had the question, "Have you ever been a victim of sexual abuse?" What do you suppose they were driving at? If I've been sexually abused I'm therefore a pedophile? Is that what they were trying to say? The question is offensive and none of their business. As we all know most people who have been victimized don't turn around and victimize others. I suppose this question was the work of that church's attorneys who were paying close attention to what has occurred with the Catholic Church.

Anonymous said...

Freud would have had to answer yes.

Anonymous said...

From the Peace Corps website:

"Because of the nature of the countries in which Peace Corps serves, the scope of medical care available in those countries, and the conditions under which Volunteers live and work, the Peace Corps may not be able to accommodate certain medical or psychiatric conditions.

"Stable conditions, in addition to medication regimes (both medical and psychiatric), can be appropriate for Peace Corps service and are considered during the pre-service evaluation. Recent changes in these conditions or medication regimes (both medical and psychiatric) are evaluated on an individual basis and may require a period of proven stability prior to Peace Corps service.

"Peace Corps assesses each applicant individually. The medical assessment process will likely require more time for applicants with extensive health histories. This assessment usually requires more communication between the applicant and the Office of Medical Services and often involves the need for additional information and medical tests.

The website goes on to state:

"After individually assessing each applicant, Peace Corps is typically unable to reasonably accommodate applicants with the following conditions."

The list of conditions includes Bipolar Disorder I, complex mental health conditions with multiple diagnoses, major Depression – recurrent, psychosis, psychiatric hospitalization within 1 year and schizophrenia as conditions that can't be accomodated. The list of medical conditions that can't be accomodated is much longer.

The attorney in me wants to tell Sam to answer the question "yes." The formerly misdiagnosed and now undiagnosed bipolar in me wants to tell Sam to answer the question "no."

He runs the risk of getting thrown out of the program if he answers "no" and his Lexapro use is then discovered. And, how is lying and trying to cover up his use of Lexapro going to affect his anxiety? I think he should find a different program that does not require this information. I'd probably think differently if he was not using a medication whose use he'd have to try to conceal.

Anonymous said...

One last thought from the attorney. If Sam is a minor, and this summer program is for high schoolers, it's highly likely that any use of prescription medication will be supervised--that is to say it will remain in the custody of, and be dispensed by, adult supervisors. If this is the case, it will make stealth use of Lexapro that much more difficult.

Dinah said...

Sam is not a child. I don't recall the details of the program.

I do believe that if he checked off no and his Lexapro was discovered, he could say that he felt the spirit of the question was about risk or illness, and that since he has never had difficulties functioning, even without medication, that he didn't think this was what they were asking.

The question about whether the respondent has been sexually abused is horrible and terribly violating with no relevance to anything. It's actually so outrageous that I would hope that people who had not been victimized would not answer it on the principal that it's wrong to ask it.

The criteria for disorders that are listed as Not Otherwise Specified and some of the Adjustment disorders are so broad and vague, that patients generally meet them and there is no issue that it's "lying." These patients often have other diagnoses, but those don't 'count' so there is no point in disclosing them on insurance forms.

For the record, Sam checked "yes."

Anonymous said...

So Sam checked "Yes."
What happened? Did the program accept him? Did he have to have his MD explain his medical condition? Was he humiliated? What happens to his "private" medical record once the summer program has documentation?

Dr. Psychobabble said...

I don't think the question should even be asked, unless it's to require special accommodations or because there is a need to know the full medical history for some reason.

The real question is why should Sam have to consider potential stigmatization from answering "yes?" Of course, he shouldn't. But of course, those are not the times we be 'a livin' in.

Also, I don't think that lying is "always wrong." Sometimes it's adaptation.

Anonymous said...

I think checking yes was the right thing. I do believe that times are changing. If he checks yes, then they will have to find very substantial grounds to discriminate/use the diagnosis against him, which it doesn't sound like they would have in this case.

Unlike previous posters, I have checked 'yes' and still been hired. Had I checked no, at some point my clearance would have been revoked, if it would have been issued at all. Checking yes may have delayed the issuance- and I know that my psych provided info because I gave him the form and fax number- but the info went through a medical committee, not the actual investigator. I know what my psych wrote, and if anything, that makes the whole treatment side of things that much better- I know he's got my back as long as I am doing what I need to do to stay healthy.

If Sam thinks that the question was asked and is unnecessary to the employment (sorry, but it is very relevant to Peace Corp given the conditions and support available) then he could even take it a step further and ask them why they are asking, and whether they have turned anyone down on that basis and had any lawsuits filed as a result. ;)

Anonymous said...

Dinah: As I'm sure you know, the NOS diagnoses include a specification that the diagnosed does not meet criteria for other disorders. That means that if you record an NOS because of insurance or stigma or whatever other reason when the person DOES meet criteria for a non-NOS dx, then yes, yes you are lying, because the person by definition does not have the anxiety, or depression, or personality disorder NOS that you have recorded.

Do I think that's necessarily wrong? Not necessarily at all. Just making the point that it is actually a pretty good parallel.

If Sam's going on a summer program and still existing under a "never missed a day of school" clause, he's likely still a minor. Even if not a "child" by psychology/psychiatry treatment standards, legally, he is still a minor.

I also think Sam's a bad example for this question, because he clearly has incredibly minor anxiety that does not really affect his life substantially.

Anonymous said...

Anon above,

There are lots of Sams in universities everywhere who never miss a day of school and go on resume building trips. Many of these Sams still depend on their Mom and Dad to fund the trips and school too but they are not necessarily legally minors.
About lying. Dinah, if a patient asked if they were boring you, and they were, would you say yes?

Anonymous said...

Anon above,

You're right, but those sams in universities don't refer to classes as "not missing a day of school in three years" or call non-academic "extracurriculars." They're also less likely to see an internist because a)that's not what university health center doctors get called and b)a university health center dr would likely have made the referral to the campus psychiatrist rather then give out lexapro samples. And they also aren't dependent on weekend-only shrink appointments to prevent anyone from knowing because university schedules are infinitely more flexible.

That said, I still think Sam should have written no. I just think the summer program gets a little more leeway as far as trying to prevent any preventable chaos or trauma from taking place on their program. It's a program that will be taking responsibility for his health and safety, so that gives them presumed leeway to ask about it.

That said, I still think Sam should have said no. If he's relatively sure he can handle himself for 6 weeks, then fine, it's no one's business. If he's not, then that's a separate story.

Liz said...

great discussion of all the issues involved with these kind of sticky situations.

http://pocketshrink.blogspot.com

Anonymous said...

"You're right, but those sams in universities don't refer to classes as "not missing a day of school in three years" or call non-academic "extracurriculars." They're also less likely to see an internist because a)that's not what university health center doctors get called and b)a university health center dr would likely have made the referral to the campus psychiatrist rather then give out lexapro samples. And they also aren't dependent on weekend-only shrink appointments to prevent anyone from knowing because university schedules are infinitely more flexible."
You are right for wherever you are but,
it is more likely that an adult-parent, shrink or other would call miss day of school. I still call it that because every September my kids go off to school and I can't stop myself to say wait up, that kid is missing a day of classes, not school. We actually do call it school. Where we are, non academics are called ECs, short for extra curriculars. University students who are still covered under a parents health plan and who stay in the country, would have access to any sort of doctor and would not be restricted to the uni health service. The Sams who went to school a few hours away come back home for their non emergency medical and dental. Our Sams are legally adults at a younger age than Sams who live elsewhere. Many Sams would need a weekend appointment since many majors/ programs are very intensive, involving about 35 hours of in class/lab time, aside from self study time.
Sam, ya shoulda ticked NO

Anonymous said...

It's kind of ironic that this post is written by the same blogger who wrote on April 11, 2011:

"What has perplexed me, however, is the claim that the (diagnostic) label itself is what causes the problem. I've been practicing for a long time, and I'm not aware that anyone has ever had a problem because of a diagnostic label I've stuck on an insurance form."

Diagnosic labels can, and do, have lasting consequences.

Anonymous said...

Anon, It's different when you are talking patients as opposed to your own or you friend's kid.

Dinah said...

There's no irony here.
I absolutely believe there is stigma and discrimination associated with psychiatric diagnoses.
I'm not aware that anyone has ever had problems because of code that has been submitted to a health insurance company for reimbursement. A health insurance form is different from a job application. The only reason I can see to ask such a question is to allow for discrimination, otherwise it seems it would suffice to say that the program can't accommodate people with certain health issues, and to then ask specific questions to those who have been accepted. Putting a yes/no option to mental illness has no place on an application. Why isn't there a yes/no option to Do you have a recurrent gastrointestinal disorder? Or do you have asthma? Or do you have migraine headaches? Or have you had cancer?
The repercussions of a psychiatric diagnosis may be much greater when all information is shared with everyone via electronic records in huge clouds accessible by all. I still believe some of the biggest discriminators are medical professionals who are quick to attribute physical symptoms to psychological problems.

Anonymous said...

Those diagnoses do affect insurability.

Jane said...

"Why isn't there a yes/no option to Do you have a recurrent gastrointestinal disorder? Or do you have asthma? Or do you have migraine headaches? Or have you had cancer?"

I didn't read that into the post. I figured the summer program was asking about the patients overall health and probably did include questions about asthma, etc. It probably asked if there had ever been broken bones or surgery as well. If the only health question is a mental one, then it shouldn't be asked at all...unless there is some info I'm missing.

Sarebear said...
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withallmyheart said...

If I continue to hide my chronic and severe mental illness, I clothe myself daily in shame and regret. I refuse to do this. I am more than my diagnosis, of course, but I cannot deny how schizoaffective disorder has been the filter through which I have always seen the world. I have been blessed with treatment, with medicines, with wonderful psychiatrists who have helped Me to keep me alive.
My choice, therefore, is not to ascribe to Don't Ask, Don't Tell. I *will* tell, because I am who I am. I *will* tell because if I can do a job well, that is independent of my illness. I *will* tell, because this is the way in which SHAME and STIGMA will be overturned. ~~I will share what it is to live with mental illness, I will tell people how I live "in" mental illness, I will share my victories, I will share Hope and Light. I choose to be OUT about my psychiatric illness. I have come too far to shroud myself now in darkness..........

Psychology Scientist said...

Firstly I feel that the question has been posed primely due to a lack of understanding on part of the employer about mental illness. Psychiatric disorder can be disabling as well as fairly manageable on a day to day scale. It is essential that companies hiring professionals as well as every kind of organization or institution in the world should understand the basics of what mental illness actually is. Once that becomes a reality I am sure people will know better questions to ask on a form. Also it is essential to make certain questions optional. It should not be mandatory for the candidates to answer everything on a form, even an online form. I hope people behave with more sensitivity when it comes to designing forms and choosing the kind of questions that needs to be put forth in front of eligible candidates.