In episode 319, I received a question from a listener worried about seeking help for their mental health through fear of losing their job. In this post, I offer my thoughts on the situation and highlight some factors to consider.
Hi Dr Duff, A close friend of mine is going through some serious personal family issues. My friend really wants to find a therapist to help them work through this time in their life, but is concerned that even asking to see a psychologist may result in losing their job, and any ability to work in their chosen career again. My friend works in an industry that requires regular medical fitness evaluations, which include reviews of all of their medical records. Although these personal issues are not work related in any way, my friend is not willing to take the chance that they may never work again just for seeking some help through a tough moment in their personal life. Assuming my friend is capable of paying out of pocket, do you know of any resources they may be able to utilize in a situation such as this? Thanks.
========== Background Info (just in case it helps): My friend is a pilot. Recently the FAA has been cracking down on all sorts of medical things. For instance, pilots taking over the counter Tylenol. The fear being, if a pilot has something going on that would result in them wanting to take Tylenol, then they may have a problem that would make them unsafe to fly. Etc. Since getting grounded for medical reasons would result in the inability to ever fly again, and since the education for pilots often cost $125k or more, my friend is incredibly afraid of doing anything that may jeopardize their ability to continue to fly.
This is a very good question and a bit complex. I want to start by saying that I am not an expert in this particular field. There are industries that have their own styles and protocols, which are different from what you see elsewhere. Therefore, when in doubt, I think that the best course is to find someone with the exact knowledge that you need. For example, if there is an attorney that specializes in aviation law for pilots, you may be able to consult with them to get the specific guidelines.
In general, you healthcare privacy information is protected by the HIPAA law, but there are certainly organizations that have the right to ask for a medical review, such as the military or the FAA when there is the possibility that specific medical issues could interfere with the ability to safely perform job functions. People are sometimes motivated to keep things from these organizations or lie, but you need to be careful about that. I recently had someone that I saw for neuropsych testing that lied about having any history of attentional issues, but they had taken ADHD medication in school, so the part of the military that they were a part of found out and suspended them and required them to get a third party evaluation. So, you definitely do need to be careful about these things.
However, it’s also important to not be overly paranoid when you don’t have a reason to be. There are some issues that are points of contention when it comes to specific licensing and there are some issues that are not. Same goes for medications. In most cases, you can find a list of these requirements on the website for a given organization. You can also look at what is involved in their assessment process if they do a fitness for duty evaluation. You want to be really careful about lying, distorting the truth, or being overly guarded. Even on some of the measures that you might be administered in a fitness for duty evaluation, there are validity scales that can often tell when someone is being unrealistically defensive or attempting to portray themselves in a specific way. If your friend has marital issues or family issues they are working through, there is a good chance that this would not be of concern to a medical reviewer. They are trying to understand whether this would impact your friend’s ability to do their job appropriately.
When working with a therapist, it is certainly okay to let them know the type of scrutiny you are under. As therapists, we are required to keep notes, but they do not have to be exceptionally detailed. It’s not like we need to keep a full log of what is discussed in therapy. Our progress notes are part of the medical record and those can actually be fairly minimal. More extensive notes can be taken in our process notes, which are more like personal therapy notes that we keep. Those are not part of your record. An organization like the FAA can ask for progress notes, diagnoses, and procedure codes. If someone has a diagnosis code reflecting adjustment issues or family issues that would probably not be of major concern. That’s just my guess though. I understand this is someone’s livelihood that we are talking about. Most organizations also have an appeal process if you feel like you were wrongly rejected.
One thing that your friend may also consider if they are just simply unwilling to take any step that could potentially compromise their career would be to go outside of the medical/psychiatric field. There are a lot of people out there that function as coaches. They don’t provide a clinical service, but are able to help with advice, planning, and strategizing. Since they are not operating as a healthcare provider, most likely the potential employer would have no knowledge or right to the information that is provided in these coaching sessions.
So just some things to think about. I really would advise them to gather more info from people within the field that they can ask frank questions to before making their own decisions. The last thing I’ll say is that there are sometimes good reasons for denying someone a license or grounding them. The point here isn’t to work the system. We are just wanting a just and fair evaluation of your friend. If it turns out that these issues are so significant that they are not in a place that they could fly safely, the right answer is actually for them to not fly. These are lives we are talking about. Money is horrible and inconvenient, but safety is the first priority. Hopefully this helps!
You can listen to this on Episode 319 of the podcast!
Thank you for the great question!
If you know someone else who might benefit from this, please do share it with them. Send them a link or shoot over a screenshot, and share it on social media to show your support – you never know who needs to hear this type of information.
Got a topic or a guest you’d like to appear on the show? Or interested in having Duff answer a question on the podcast? Please get in touch! Email Duff and maybe you’ll hear it on a future episode!
Want to help out the show and Duff the Psych?
- Subscribe to the podcast on iTunes.
- Leave a podcast review on iTunes. These reviews really help Duff reach potential listeners, and he appreciates every one!
- Share the show on Facebook or Twitter.
- You can also buy Duff a cup of coffee, which helps fuel the energy that goes straight back into creating more content for YOU!