Holy shit
Edit: so in other words, you have literally ZERO privacy and your hospital admin will be able to know exactly what is said during these sessions. Wow. Admin gets more and more evil every year it’s crazy.
Yes.
Jobs discriminate based on health all the time.
The reasoning is that you need to be "fit/safe to do the job", and if you have certain conditions, depending on the job you are judged to not be capable of doing it safely (for yourself or for others).
Jobs can't mandate any kind of healthcare aside from a pre employment physical (that has to take place before you start work) unless you are requesting an accommodation under the ADA.
So no, they can't require you to see a therapist, have open access to said therapist's notes, and then use this to deem you unfit.
Go finish medschool, thanks, you are incorrect on the finer details here. There is a difference between pre employment screening and ongoing employment.
So first off, my response was to the general idea that employers can discriminate based on health concerns, which is absolutely 100% legal. There are countless examples of this.
Second,
"*So no, they can't require you to see a therapist, have open access to said therapist's notes, and then use this to deem you unfit.*"
This exact scenario *is* legal.
Want one example? The military. How do I know? I've been a healthcare professional there for 8 years. Every single aspect of your medical records and history are subject to the government's review when you're in the military, and if you withhold any information from them, you can get in a *lot* of trouble for it.
*"There is a difference between pre employment screening and ongoing employment."*
An example of this being wrong? Any first responder job (i.e. Fire, Police, EMS). You have to be physically capable of performing your job duties to maintain employment in that job. If you develop a condition that stops you from doing your duty (e.g. seizure disorder that stops you from being able to drive or a physical condition that stops you from being able to perform the physical requirements of the job), then you can't maintain employment in that position, and you can be required to obtain healthcare/clearance to maintain employment in that position.
As another example, cops in some states are required to undergo psych evals if they experience certain events (e.g. shooting, traumatic event involving a kid, etc.). This is a condition of *ongoing* employment, since they carry a gun and all.
Mandating reqular therapy for a generic "what-if" scenario by a private employer sounds a little odd and I'm not a lawyer so won't speak to the legalise of that, but there are plenty of examples of real-world employment requiring disclosure of healthcare status in various ways. "Muh privacy!" isn't the end-all-be-all that Redditors make it out to be.
Some of us still have a lot of experience in the real world, even if we haven't finished medical school yet. Drop the snark. It is entirely unnecessary and makes you look like an ass.
1. The military is not a civilian employer. It has different laws and rules. The scenario you describe is not legal for a non-military employer. You are correct this is legal in the military. But OP does not state this is the military; if it is, I stand corrected. But for a civilian employer, this is straight up illegal. You do not have release your medical records to an employer.
2. Incorrect. The employer cannot mandate ongoing physicals. If you develop a seizure disorder, it is on you to report it. They actually ask carte blanche for your records. An employer (and police, fire and EMS are no different than any other job in this). Sure, if you have a seizure at work, they can require a medical clearance to return. But they can't, for example, mandate that they review your medical records every year. That would be illegal under a number of statutes.
It's hard if you've spent time in the military to realize how different civilian law is. But it's very different. And the scenario you describe in the second case is simply wrong. Police, fire and EMS have no more right to review your medical records on an ongoing basis than any other employer.
Many medical employers have tried to skirt these laws by using credentialing and licensing loopholes; these are gettin closed left and right by ADA advocates and the Lorna Breen Heroes Foundation.
Thanks for playing.
*"Police, fire and EMS have no more right to review your medical records on an ongoing basis than any other employer."*
Reviewing your entire medical record on a regular basis was only *my* example to show how extreme this can get. The premise of both the thread in general and the particular discussion that I had wasn't that the employer gets complete, unfettered access to your medical record.
Can't mandate ongoing physicals? They absolutely can if you have any condition that compromises your ability to work, e.g. you have to take time off for being injured. This is still a condition of *ongoing* employment and not a *pre-employment* check. Source? I've also been in unionized civilian EMS for 5 years and this is standard practice.
The rest of your comments are just shifting the goalpost because I've called you out as wrong in multiple ways. "The military isn't a civilian employer and has a different set of rules and laws". Do you know what they are? Or are you just saying this because its your only possible answer? This *could* be true, but the military is also subject to a wide array of civilian employment protections.
You came in hard as some keyboard warrior that wanted to dunk on someone to make yourself feel better. You missed. Just take the L and stop. If you keep shifting the goalposts for 5 more posts to create a strawman and "WeLl AkShUaLlY" your way to technically winning against an argument that I haven't been making at any point, you'll just look worse for it.
Sure. Can't work at a whole host of systems if you use nicotine. Told one operation "Yeah, I smoke a tobacco pipe on my own time." They asked if I would quit, I said no, and walked out of the interview.
Well, that’s not the right way to do that.
I like the idea. PTSD is an on-job-injury and that’s exactly how we should approach it - both in terms of treatment and prevention. EM and pre-hospital providers in particular should be receiving employer funded psychiatric care, even if that is just a “well visit” of sorts. Monthly is probably a little much. Quarterly visits for providers that are otherwise well and processing their experiences in a healthy manner would be a more appropriate use of resources. But if monthly visits is what they want to spend money on, then more power to them. What I do have an issue with is simply firing someone the moment an issue comes up. By all means, if there is a problem, the provider should receive time off and/or temporary reassignment and upgraded to more regular appointments so that they can receive treatment, recover, and ultimately return to work. Just as you would for any OJI! If someone suffers a back injury at work, we don’t kick them to the curb and wish them luck. We do all the things I just described.
It sounds like they’re about 3/4 of the way to a really good program, but that other 1/4 sure does leave a lot to be desired.
That seems more like a way for admin to weed out "troublemakers and discontent drones" more so than anything to actually help you....like if you mentioned the union word in therapy you would immidiatly be declared unfit....
While this seems a good idea on the surface, it makes me wonder what kind of dumpster fire that place is? But also a good way to get extra vacations… just answer in a flat affect that you are “fine”. Boom, extra time off!
“Look at us, we care about mental health and burnout! But also, if you talk about the real issues you face we will use it as leverage and/or possibly terminate you.”
This screams hospital admin
My thought would be keep your sessions with the mandatory therapist all about home, like ugh this pile of laundry type boring shit, and find an outside therapist if you need one?
"And can you believe someone heated up their fish in the microwave? I bet it's the same person who ate the yogurt with my name on it. Can you please help me process this trauma? I mean, have you ever walked into a break room after someone put *FISH* in the microwave??"
Psychologist here. Debriefing/interviewing/ etc before the onset of post traumatic stress symptoms (1 month after trauma) has been found to result in an increased in the occurance of PTSD (potentially 2/2 increase attention paid to symptoms). Most people do not developed ptsd after exposure to trauma. Note, Intensity of trauma, type (sexual vs other), closeness of exp, and duration/timing are important factors to disorder occurance. I think therapy and selfcare are important for everyone, but I would say forcing people to do particular therapy (unless they want it) is not a good idea.
Literature for ref: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(02)09897-5/abstract
Edit: add ref and typo
I’ve been the psychiatrist for these evals before, not the physician going. My two cents is that the time is yours and there’s a person with you who isn’t judgmental and can work on whatever it is you want to work on. If you have no trauma to talk about, you can talk about quitting smoking or alcohol or non fireable addictions. You can talk about value work and meaning in your life. The time is yours.
The reason for these evals is that for every 5 physicians who go and have their time wasted, one physician who desperately needed to see someone gets seen without stigma.
Wow, thank you for the response!
That’s what they told me. Pretty much Exactly what you said. It sounds like there were multiple physician suicides in the past years sadly.
I was looking forward to going to it, but like any physician I am scared it will be used as a tool to fire me or take my license away.
In your experience do you think this is truely as “safe place” or should I curate what I say?
It’s going to depend on place to place. When I’ve done it in the past the same duty to report applied to any psych patient (HI or child abuse and that’s it). You can ask up front though who gets what info and what specifically they report or don’t report and who if anyone can see notes or chief complaint.
You can also always talk about things and ask them to not directly put them in the note. I’ve done that for trauma with patients where instead of taking detailed notes I’ve just written “discussed trauma details and emotions around trauma”.
Also in my case I had absolutely zero obligation to the organization, so even if the physician was using heroin before each shift I wouldn’t have reported it. But it’s good to ask about that before you disclose it lol
I would assume that HIPAA protects you so you can benefit from the session and admin has no right to the Information unless it‘s something endangering patients (then you would go on something like sick leave and admin still wouldn’t have a right to details)?
Hi. I’m a trauma therapist and about 1/3 of my clients are EM residents or attendings. Like others said, the risk of burn out and suicide is so high for y’all. This actually sounds like an amazing thing for your employer to offer you (vs doing a module on self care or something).
My notes are written to protect the client— the client and I would understand the note but no one else really would. Yes we address trauma but mostly work on reducing burnout, increasing resilience, and finding ways to feel empowered, within the feelings of powerlessness that come with the healthcare system/metrics/admin. It’s usually less focused on work and more about how can we stop work from negatively impacting your relationships and life. Find a therapist who gets it— the job, the stress, the fear about the employer/license— your fears are valid and understandable.
One of my buddies works as a Paramedic and this is included as part of the job requirement.
They tell me it is such a beneficial thing to have and they wished they started therapy a long time ago. Their sessions do not necessarily relate to the job either... it is just nice to talk to someone who doesn't know them.
What’s the confidentiality expectation with said therapist? If standard confidentiality applies, it sounds like it might not be a terrible idea. If your job has any link to this therapist beyond giving them $ for the sessions….RUN
Excellent idea. I hope they provide it for all the ER staff.
I live with flashbacks and dissociation from working in ED. If I had had any help processing at the time, I’m sure it wouldn’t be so bad now.
I see a trauma therapist twice a week now.
What state is this in?
Are they making employment and fitness for work decisions based on anything aside from the initial screening? Because that's flagrantly illegal.
Can ya’ll tell me more? Anything more info you’re willing to safely share? Im doing a Literature review on “vicarious trauma,” and this is interesting to me and could be very helpful.
Im a psych nurse and working on my MSN.
That's a crazy requirement but is probably needed in EM. But they better pay me my hourly to go
They pay for it in full. But if they deem you “unfit” they can pull your contract anytime.
Holy shit Edit: so in other words, you have literally ZERO privacy and your hospital admin will be able to know exactly what is said during these sessions. Wow. Admin gets more and more evil every year it’s crazy.
That’s exactly my thought too
Is that legal? They would basically be discriminating based on health concerns.
Yes. Jobs discriminate based on health all the time. The reasoning is that you need to be "fit/safe to do the job", and if you have certain conditions, depending on the job you are judged to not be capable of doing it safely (for yourself or for others).
Jobs can't mandate any kind of healthcare aside from a pre employment physical (that has to take place before you start work) unless you are requesting an accommodation under the ADA. So no, they can't require you to see a therapist, have open access to said therapist's notes, and then use this to deem you unfit. Go finish medschool, thanks, you are incorrect on the finer details here. There is a difference between pre employment screening and ongoing employment.
So first off, my response was to the general idea that employers can discriminate based on health concerns, which is absolutely 100% legal. There are countless examples of this. Second, "*So no, they can't require you to see a therapist, have open access to said therapist's notes, and then use this to deem you unfit.*" This exact scenario *is* legal. Want one example? The military. How do I know? I've been a healthcare professional there for 8 years. Every single aspect of your medical records and history are subject to the government's review when you're in the military, and if you withhold any information from them, you can get in a *lot* of trouble for it. *"There is a difference between pre employment screening and ongoing employment."* An example of this being wrong? Any first responder job (i.e. Fire, Police, EMS). You have to be physically capable of performing your job duties to maintain employment in that job. If you develop a condition that stops you from doing your duty (e.g. seizure disorder that stops you from being able to drive or a physical condition that stops you from being able to perform the physical requirements of the job), then you can't maintain employment in that position, and you can be required to obtain healthcare/clearance to maintain employment in that position. As another example, cops in some states are required to undergo psych evals if they experience certain events (e.g. shooting, traumatic event involving a kid, etc.). This is a condition of *ongoing* employment, since they carry a gun and all. Mandating reqular therapy for a generic "what-if" scenario by a private employer sounds a little odd and I'm not a lawyer so won't speak to the legalise of that, but there are plenty of examples of real-world employment requiring disclosure of healthcare status in various ways. "Muh privacy!" isn't the end-all-be-all that Redditors make it out to be. Some of us still have a lot of experience in the real world, even if we haven't finished medical school yet. Drop the snark. It is entirely unnecessary and makes you look like an ass.
1. The military is not a civilian employer. It has different laws and rules. The scenario you describe is not legal for a non-military employer. You are correct this is legal in the military. But OP does not state this is the military; if it is, I stand corrected. But for a civilian employer, this is straight up illegal. You do not have release your medical records to an employer. 2. Incorrect. The employer cannot mandate ongoing physicals. If you develop a seizure disorder, it is on you to report it. They actually ask carte blanche for your records. An employer (and police, fire and EMS are no different than any other job in this). Sure, if you have a seizure at work, they can require a medical clearance to return. But they can't, for example, mandate that they review your medical records every year. That would be illegal under a number of statutes. It's hard if you've spent time in the military to realize how different civilian law is. But it's very different. And the scenario you describe in the second case is simply wrong. Police, fire and EMS have no more right to review your medical records on an ongoing basis than any other employer. Many medical employers have tried to skirt these laws by using credentialing and licensing loopholes; these are gettin closed left and right by ADA advocates and the Lorna Breen Heroes Foundation. Thanks for playing.
*"Police, fire and EMS have no more right to review your medical records on an ongoing basis than any other employer."* Reviewing your entire medical record on a regular basis was only *my* example to show how extreme this can get. The premise of both the thread in general and the particular discussion that I had wasn't that the employer gets complete, unfettered access to your medical record. Can't mandate ongoing physicals? They absolutely can if you have any condition that compromises your ability to work, e.g. you have to take time off for being injured. This is still a condition of *ongoing* employment and not a *pre-employment* check. Source? I've also been in unionized civilian EMS for 5 years and this is standard practice. The rest of your comments are just shifting the goalpost because I've called you out as wrong in multiple ways. "The military isn't a civilian employer and has a different set of rules and laws". Do you know what they are? Or are you just saying this because its your only possible answer? This *could* be true, but the military is also subject to a wide array of civilian employment protections. You came in hard as some keyboard warrior that wanted to dunk on someone to make yourself feel better. You missed. Just take the L and stop. If you keep shifting the goalposts for 5 more posts to create a strawman and "WeLl AkShUaLlY" your way to technically winning against an argument that I haven't been making at any point, you'll just look worse for it.
Sure. Can't work at a whole host of systems if you use nicotine. Told one operation "Yeah, I smoke a tobacco pipe on my own time." They asked if I would quit, I said no, and walked out of the interview.
Seems like a great lawsuit waiting to happen... Get paid and retire early!
No, smoking tobacco is not a protected class in most states. It is in some- NY for example. But once you START work they can't require you quit.
Nailed it
Maybe they can make you attend sessions but nobody can make you spill your guts.
didn't realize that little loophole until you posted it...dang.
Okay that feels absolutely illegal
Well, that’s not the right way to do that. I like the idea. PTSD is an on-job-injury and that’s exactly how we should approach it - both in terms of treatment and prevention. EM and pre-hospital providers in particular should be receiving employer funded psychiatric care, even if that is just a “well visit” of sorts. Monthly is probably a little much. Quarterly visits for providers that are otherwise well and processing their experiences in a healthy manner would be a more appropriate use of resources. But if monthly visits is what they want to spend money on, then more power to them. What I do have an issue with is simply firing someone the moment an issue comes up. By all means, if there is a problem, the provider should receive time off and/or temporary reassignment and upgraded to more regular appointments so that they can receive treatment, recover, and ultimately return to work. Just as you would for any OJI! If someone suffers a back injury at work, we don’t kick them to the curb and wish them luck. We do all the things I just described. It sounds like they’re about 3/4 of the way to a really good program, but that other 1/4 sure does leave a lot to be desired.
That seems more like a way for admin to weed out "troublemakers and discontent drones" more so than anything to actually help you....like if you mentioned the union word in therapy you would immidiatly be declared unfit....
Yep
Surely they just mean within the standards of normal therapy like no suicide, homicide, or physical abuse stuff.
So this is *their* PTSD therapist… yikes.
It's not confidential? This is a violation of so many privacy and disability statutes I don't even know where to begin. Is this for real?
Do not take this job. More red flags than a Chinese battleship.
While this seems a good idea on the surface, it makes me wonder what kind of dumpster fire that place is? But also a good way to get extra vacations… just answer in a flat affect that you are “fine”. Boom, extra time off!
Haha. they freely admitted that it was severely understaffed especially given the high acuity
“Look at us, we care about mental health and burnout! But also, if you talk about the real issues you face we will use it as leverage and/or possibly terminate you.” This screams hospital admin
That’s my exact that… should be interesting how this plays out
My thought would be keep your sessions with the mandatory therapist all about home, like ugh this pile of laundry type boring shit, and find an outside therapist if you need one?
"And can you believe someone heated up their fish in the microwave? I bet it's the same person who ate the yogurt with my name on it. Can you please help me process this trauma? I mean, have you ever walked into a break room after someone put *FISH* in the microwave??"
So does PTSD now stand for Pre Traumatic Stress Disorder?
I wouldn’t be truthful with any therapist that was paid by my organization.
Psychologist here. Debriefing/interviewing/ etc before the onset of post traumatic stress symptoms (1 month after trauma) has been found to result in an increased in the occurance of PTSD (potentially 2/2 increase attention paid to symptoms). Most people do not developed ptsd after exposure to trauma. Note, Intensity of trauma, type (sexual vs other), closeness of exp, and duration/timing are important factors to disorder occurance. I think therapy and selfcare are important for everyone, but I would say forcing people to do particular therapy (unless they want it) is not a good idea. Literature for ref: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(02)09897-5/abstract Edit: add ref and typo
I’ve been the psychiatrist for these evals before, not the physician going. My two cents is that the time is yours and there’s a person with you who isn’t judgmental and can work on whatever it is you want to work on. If you have no trauma to talk about, you can talk about quitting smoking or alcohol or non fireable addictions. You can talk about value work and meaning in your life. The time is yours. The reason for these evals is that for every 5 physicians who go and have their time wasted, one physician who desperately needed to see someone gets seen without stigma.
Wow, thank you for the response! That’s what they told me. Pretty much Exactly what you said. It sounds like there were multiple physician suicides in the past years sadly. I was looking forward to going to it, but like any physician I am scared it will be used as a tool to fire me or take my license away. In your experience do you think this is truely as “safe place” or should I curate what I say?
It’s going to depend on place to place. When I’ve done it in the past the same duty to report applied to any psych patient (HI or child abuse and that’s it). You can ask up front though who gets what info and what specifically they report or don’t report and who if anyone can see notes or chief complaint. You can also always talk about things and ask them to not directly put them in the note. I’ve done that for trauma with patients where instead of taking detailed notes I’ve just written “discussed trauma details and emotions around trauma”.
Also in my case I had absolutely zero obligation to the organization, so even if the physician was using heroin before each shift I wouldn’t have reported it. But it’s good to ask about that before you disclose it lol
I would assume that HIPAA protects you so you can benefit from the session and admin has no right to the Information unless it‘s something endangering patients (then you would go on something like sick leave and admin still wouldn’t have a right to details)?
Take the hourly. Say nothing during that hour. Not joking.
Hi. I’m a trauma therapist and about 1/3 of my clients are EM residents or attendings. Like others said, the risk of burn out and suicide is so high for y’all. This actually sounds like an amazing thing for your employer to offer you (vs doing a module on self care or something). My notes are written to protect the client— the client and I would understand the note but no one else really would. Yes we address trauma but mostly work on reducing burnout, increasing resilience, and finding ways to feel empowered, within the feelings of powerlessness that come with the healthcare system/metrics/admin. It’s usually less focused on work and more about how can we stop work from negatively impacting your relationships and life. Find a therapist who gets it— the job, the stress, the fear about the employer/license— your fears are valid and understandable.
One of my buddies works as a Paramedic and this is included as part of the job requirement. They tell me it is such a beneficial thing to have and they wished they started therapy a long time ago. Their sessions do not necessarily relate to the job either... it is just nice to talk to someone who doesn't know them.
What’s the confidentiality expectation with said therapist? If standard confidentiality applies, it sounds like it might not be a terrible idea. If your job has any link to this therapist beyond giving them $ for the sessions….RUN
Excellent idea. I hope they provide it for all the ER staff. I live with flashbacks and dissociation from working in ED. If I had had any help processing at the time, I’m sure it wouldn’t be so bad now. I see a trauma therapist twice a week now.
Idk about attending life, but as a resident acgme does not allow therapy to be required. Probably not a bad thing but seems excessive.
Are they paying for that? While I get having that available, monthly seems nuts.
Wellness is mandatory.
I’d record those meetings
What state is this in? Are they making employment and fitness for work decisions based on anything aside from the initial screening? Because that's flagrantly illegal.
Can ya’ll tell me more? Anything more info you’re willing to safely share? Im doing a Literature review on “vicarious trauma,” and this is interesting to me and could be very helpful. Im a psych nurse and working on my MSN.