Managing Bipolar During Medical Training
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Q:  Managing Bipolar During Medical Training

Do you have any advice on how to manage Bipolar II during medical training, considering that the lifestyle is almost directly opposite of the lifestyle you recommend for managing bipolar?

Dear Dr. F'
First thought:  Until recently this recently has not been an issue since most trainees would not have dared to raise the question, so I hope we could think of this as a sign of progress.  Not so much progress though that if you were able to arrange to avoid having to take up-all-night call coverage, that your colleagues would necessarily be understanding, if they thereby had to shoulder more of the load -- I fear, as surely you've considered as well. 

Secondly, as you've probably also learned there is the Americans with Disabilities Act and it has been invoked in situations like this such that your employer is supposed to make "reasonable accomodations" for the compromises forced upon you by the illness. I haven't surfed around lately to see if there's anything new on the ADA in a mental health context.  If you haven't been there, the Bazelon Center for Mental Health Law has some resources starting with an overview page on preventing discrimination in the workplace and thence to the ADA's applicability to mental health issues. 

Adding these two thoughts together: you might be able to arrange not to have sleep-disrupting night call, e.g. by citing the recommendations against it you can find in Miklowitz's Bipolar Disorder Survival Guide based on the Social Rhythm Therapy research which his group has incorporated into their most recent major publication on this topic (i.e. that's the paper you'd probably want to cite; look closely at the components of the treatment re: "rhythm" and sleep).  But you'd probably want to arrange some tit-for-tat deal with colleagues whereby you took something off of their plate while adding more call to theirs, requiring perhaps more years of training to allow you enough time to do this without having to be doing a good portion of the work at night, as is the usual expectation.  As you are surely acutely aware, since everybody hates night call, figuring out what you can trade for that won't be easy.  Perhaps your residency director could brainstorm with you on that.  However, I must admit the general idea still seems very unusual, though logical (to me anyway), such that the very idea of walking in to propose such a thing you should probably regard as rather radical.  You're welcome to say it was my idea, not yours!  

Dr. Phelps

Published February, 2005


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