Apr 21, 2021
Omar Sultan Haque, MD, PhD, talks with Lorenzo Norris, MD, about
the need for medical schools to become responsive to physicians,
medical students, and residents with mental disabilities.
Dr. Haque is a
physician, social scientist, and philosopher who is affiliated with
the department of global health and social medicine at Harvard
Medical School, Boston. He disclosed founding Dignity Brain Health,
a clinic that seeks to provide clinical care for patients
struggling with major depressive disorder. Dr. Haque also serves as
medical director of Dignity Brain Health.
Dr.
Norris is associate dean of student affairs and administration
at George Washington University, Washington. He has no
disclosures.
Take-home points
- Dr. Haque and colleagues recently published a perspective piece
in the New England Journal of Medicine about the “double stigma”
against mental disabilities, which the authors define as
“psychiatric, psychological, learning, and developmental disorders
that impair functioning,” including common diagnoses, such as
attention deficit disorder and major depressive disorder.
- Physicians and physicians-in-training, such as students and
residents, face major challenges in disclosing mental disabilities,
from fear of discrimination during the admissions process to stigma
throughout training and licensure.
- Medical leave is often the only suggested solution to an
exacerbation of a disability, and this response is likely to
instill fear in trainees, because taking leave will require future
disclosure and worsen the double stigma. Reasonable accommodations
could improve functioning and allow trainees to remain enrolled and
on their desired academic path.
- Dr. Haque recommends that medical schools and training programs
have trained disability service providers (DSP) with specialized
understanding of medical education and curricula who do not have
conflicts of interest – as sometimes happens when they participate
in other roles, such as serving as deans or professors within a
medical school.
- A continued challenge to disability disclosures are questions
on medical licensing applications and renewals about past or
current diagnoses or treatment for mental disabilities. Dr. Haque
reminds listeners that, according to the American Disabilities Act,
these questions about past and current diagnoses are illegal if the
answers to those questions do not affect physicians’ current
functioning.
Summary
- Dr. Haque’s article offers several recommendations for medical
schools, training programs, and licensing boards aimed at
addressing the burden of the double stigma against mental
disabilities within the culture of medical training and
practice.
- Medical schools should clearly communicate that applicants with
disabilities are welcome as part of a larger commitment to
diversity, and individuals with mental disabilities should be
admitted and allowed to complete training.
- Universities should hire medical school–specific disability
service providers who understand medical education and are
committed to parity for individuals with physical and mental
disabilities.
- Policies related to mental disabilities should be clearly
publicized so that students and trainees know what to expect if
they disclose a disability, and should create reasonable
accommodations for those with mental disabilities instead of
promoting medical leave as the only option.
- Faculty members and administrators could publicly describe
their own protected time for therapy and highlight the professional
successes of people who were able to disclose their condition and
get reasonable accommodations.
- The Federation of State Medical Boards should enforce the
ADA-based legal standard that questions about mental disabilities
should be asked and answered only if they address current
functional impairments that affect a physician’s ability to
practice medicine safely.
References
Haque OS et al. N Engl J Med.
2021 Mar 11;384:888-9.
Wimsatt LA et al.
Am J Prevent Med. 2015 Nov. 49(5):703-14.
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Show notes by Jacqueline Posada, MD, associate producer of the
Psychcast; assistant clinical professor in the department of
psychiatry and behavioral sciences at George Washington University,
Washington; and staff physician at George Washington Medical
Faculty Associates, also in Washington. Dr. Posada has no conflicts
of interest.
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