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!
Published February, 2005