Disability while doing rotations

[Dr^2]

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I've been diagnosed with Rheumatoid Arthritis (sucks, I know...)
It's relatively under control, but I still have difficulty with lots of things normal people don't even think about.

I'm concerned that I'm going to bomb my rotations, especially the physically demanding ones like surgery. I'll be fine AFTER med school, as I'm going to choose a physically un-demanding specialty and will spend most of my time doing research.

Does anyone have any experience with similar cases? Thanks for any insight even if it's not what I want to hear 🙂 😍

 

[njbmd]

I've been diagnosed with Rheumatoid Arthritis (sucks, I know...)
It's relatively under control, but I still have difficulty with lots of things normal people don't even think about.

I'm concerned that I'm going to bomb my rotations, especially the physically demanding ones like surgery. I'll be fine AFTER med school, as I'm going to choose a physically un-demanding specialty and will spend most of my time doing research.

Does anyone have any experience with similar cases? Thanks for any insight even if it's not what I want to hear 🙂 😍

This information needs to be shared with your Dean of Students so that it can be shared with your rotation coordinators. If they know that you may have periods of waxing and waning in terms of your diagnosis then they can do things that can assist you or make accommodations for you when necessary. Make a list of things that you might have difficulty with when you share this information with your Dean.

Medical students often have a wide variety of physical abilities and most can be easily accommodated if things are planned out before hand. Don't be afraid to share this info with your school administration who can pave the way for you and they can make sure that you are not "marked down" because you couldn't physically keep up.

 

[PeepshowJohnny]

Surgery will give you great grades if you can prove you can handle the thinking aspects of the field (pre and post op management, reasons for surgery etc.). You don't need to be a procedural wiz.

 

[Twitch]

Have you talked to your doc about TNF alpha inhibitors? The literature indicates great success with them and the ability to live virtually symptom free. The bad part is that the drugs aren't cheap, though most insurance co's will cover them.

 

[SocialistMD]

Have you talked to your doc about TNF alpha inhibitors? The literature indicates great success with them and the ability to live virtually symptom free. The bad part is that the drugs aren't cheap, though most insurance co's will cover them.

Not to be a complete ***, but don't you think a fellow med student has done a ton of reading about the current and potential therapies for his/her condition?

To the OP, make it known to the powers that be of your school. That said, don't let it become an excuse to get out of doing things you don't want to do. I graduated with a guy who had at least four bouts of "prostatitis" during third year (along with the death of 2 aunts); it never seemed to be a problem during the first two years and it must have gone away during fourth year. I don't know what he was doing with his social life and I guess most people would never question a 25-year old claiming to have prostatitis, but when you see him out later that night at a bar and your buddy is stuck in the hospital taking call for him; well, that isn't cool.

 

[Dr^2]

Thanks for the responses everyone!

I was getting really worried, especially since my lab PI seemed to think I was essentially doomed!! He even suggested that I not go back to med school for the 3rd year, which is just 😱

I'll be sure to clearly communicate with everyone when the time comes -- and work extra hard so I'm not a dead weight in the team!!

Have you talked to your doc about TNF alpha inhibitors? The literature indicates great success with them and the ability to live virtually symptom free.

True! TNF alpha inhibitors are the reason I'm kinda glad I have RA instead of some other awful autoimmune disease like MS or lupus 😳 However, I've decided that I'm going to give the less dangerous DMARDS a chance to work their magic first... I'm glad the TNF's are there if I need them 🙂

 

[Twitch]

Thanks for the responses everyone!

I was getting really worried, especially since my lab PI seemed to think I was essentially doomed!! He even suggested that I not go back to med school for the 3rd year, which is just 😱

I'll be sure to clearly communicate with everyone when the time comes -- and work extra hard so I'm not a dead weight in the team!!



True! TNF alpha inhibitors are the reason I'm kinda glad I have RA instead of some other awful autoimmune disease like MS or lupus 😳 However, I've decided that I'm going to give the less dangerous DMARDS a chance to work their magic first... I'm glad the TNF's are there if I need them 🙂

I'm glad you feel this way. A number of RA patients I've spoken to lead painless and asymptomatic lives with the newer generation of drugs in the market. As you already know (and encouragement almost always helps, in my book) the likelihood of one of the RA drugs not alleviating your symptoms is exceedingly small, esp with the newer FDA indication for Rituxan to add to the mix. So you're pretty well covered if and when you need it.

Also I'd encourage you not to think of yourself as dead weight or corner yourself in a particular field because of RA. IMHO, we need more doctors like you who can truly relate to patients in pain and suffering and provide empathy to a much greater degree than others. You bring a unique value proposition to the table. Instead of looking @ RA as something that'll hold you back, I'd look at it as something that gives you more of reason to do what you're doing - making a difference in the lives of others.

 

[mjl1717]

I'm glad you feel this way. A number of RA patients I've spoken to lead painless and asymptomatic lives with the newer generation of drugs in the market. As you already know (and encouragement almost always helps, in my book) the likelihood of one of the RA drugs not alleviating your symptoms is exceedingly small, esp with the newer FDA indication for Rituxan to add to the mix. So you're pretty well covered if and when you need it.

Also I'd encourage you not to think of yourself as dead weight or corner yourself in a particular field because of RA. IMHO, we need more doctors like you who can truly relate to patients in pain and suffering and provide empathy to a much greater degree than others. You bring a unique value proposition to the table. Instead of looking @ RA as something that'll hold you back, I'd look at it as something that gives you more of reason to do what you're doing - making a difference in the lives of others.

1) Im in no way discounting RA.. Cold water fish oils have dual role in being cardioprotective and also aid lubrication and decrease crepitus.. (Any oil except flaxseed for that matter)

2) Also localized treatable prostatitis and moderate to severe multisystemic RA which affects mobility appear to me to be on opposite ends of the morbidity spectrum..

3)Last-unfortunately and I hate say this.. Many docs treat disease more conscientiously when they personally experience disease. This is meant as a general statement..

 

[SocialistMD]

Also localized treatable prostatitis and moderate to severe multisystemic RA which affects mobility appear to me to be on opposite ends of the morbidity spectrum..

I think you completely missed my point because you don't understand the subtext. The guy with prostatitis didn't have prostatitis (or, if he did, he had it once); he was using it as an excuse to get out of taking call. My point was one should not use any medical condition as an excuse to get out of doing work, as one will not only be robbing one's self of an education, but will also create more work for the rest of the team.

 

[Allerian1004]

I completely understand how you feel. I don't have RA, I have lupus with a significant amount of polyarthritis and I know that surgery is going to suck for me. And like you, I know I will not be choosing a physically demanding specialty (yeah rheumatology!) And, I wish we had TNF alpha inhibitors. I get lovely drugs like prednisone and cellcept. And unfortunately rituxan is only being used for severe systemic lupus i.e. kidney or CNS involvement. Can someone please discover a prednisone like drug with no side effects! And, I am afraid of talking to my Dean. I know mine is supposed to be very nice.

 

[Ashers]

I completely understand how you feel. I don't have RA, I have lupus with a significant amount of polyarthritis and I know that surgery is going to suck for me. And like you, I know I will not be choosing a physically demanding specialty (yeah rheumatology!) And, I wish we had TNF alpha inhibitors. I get lovely drugs like prednisone and cellcept. And unfortunately rituxan is only being used for severe systemic lupus i.e. kidney or CNS involvement. Can someone please discover a prednisone like drug with no side effects! And, I am afraid of talking to my Dean. I know mine is supposed to be very nice.

Most of the rotations at our school have a pre-rotation form, and it usually asks if you have some illness that affects your work.

However, even using that, it's still prone to human error. I mentioned my medical issue (Raynaud's where I can't hold a soda can out of the fridge without pain) one time to not be in 1 surgical rotation (CT surg, where the student's job is the hold the heart covered in ice), and that's the one I was put in. It ended up being OK where the head of CT spoke with the cardiac guys, and they just "survived" without a med student holding the heart. Sometimes I wonder how hospitals without med students work. 😉

 

[SoCuteMD]

I've been diagnosed with Rheumatoid Arthritis (sucks, I know...)
It's relatively under control, but I still have difficulty with lots of things normal people don't even think about.

I'm concerned that I'm going to bomb my rotations, especially the physically demanding ones like surgery. I'll be fine AFTER med school, as I'm going to choose a physically un-demanding specialty and will spend most of my time doing research.

Does anyone have any experience with similar cases? Thanks for any insight even if it's not what I want to hear 🙂 😍

I think you should talk to your dean. I would also add that the physically demanding parts of surgery did not involve fine motor coordination - they involved hours (upon hours) of standing. There may even be an attending or two at your institution who sits during surgery. My site was very time-intensive and so I rarely got the chance to sit down during the day. At other sites where my friends rotated, they occasionally found themselves with a few hours to nap or read during their long days. So talk with the people ahead of you if you have several different choices for location.

Also ask about which services have shorter/less demanding hours so that you might be able to find a way to be assigned to one of those services for at least part of your rotation. For example - there is one service at one of our hospitals that is JUST the chairman's service, BUT the chair takes vacation for most of December, and students are still assigned to his service. They don't scrub much (which sucks for them if they are interested in surgery and trying to get a chairman's letter) but they don't stand in the OR all day.

What I found on my surgery rotation was that my "technical skills" were limited to cutting the tails of suture (ha!) and retracting. A lot more of my evaluations came from how I answered pimp questions and what attendings thought of my assessment and plan.

 

[praying4MD]

Sorry to hear about your diagnosis.

Having had significant medical issues in the recent past (and currently) I know firsthand it SUCKS.

First, TAKE A DEEP BREATH. It will get better and you will be ok.
2 - Don't believe everything you read on the internet. This freaked me out when I was sick (you think I'd know better being a doctor, but when you're the one who is the patient facing some grim chances, you will find that you will believe almost anything.)
3 - Allow yourself to be a patient and not a doctor.
4 - Fourth, tell your faculty - you will be surprised at how understanding some will be and appalled at how callous others will be. Expect both.
5 - Take the time you need, but do not abuse this privilege.
6 - Take time for yourself for things to sink in.
7 - I purposely saved this one for last so as not to appear callous myself -- don't feel sorry for yourself - people pick up on this and hate it (even when you have every right to feel sorry for yourself.) There is a chick with Treacher-Collins Syndrome in my residency program - whenever I feel tired or annoyed with life, she is who I think about -- pretty amazing how far she's come really. And I've never heard her complain about needing a special stethoscope or how others may have a hard time understanding her with a speech impediment. She is pretty awesome if you ask me - and when I was sick, people said the same about me -- that is what you want to be known as, not as the self-pity resident. Trust me on this one.

Good luck and I wish you the best of health. Only people who have truly had health issues can understand the toll it takes on your mind and on your body... FOREVER -- Sorry you have to go through this, but, Cliche as it sounds, you will be a better doctor for this - I guarantee that. It has done wonders for me to become a better doctor (although, I would have preferred not to get sick in the first place too.) 😉