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How are absences viewed during 3rd year?

Discussion in 'Clinical Rotations' started by GrammCracker, Dec 12, 2008.

  1. GrammCracker

    GrammCracker New Member
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    I have a bad feeling that they will be greatly frowned upon, but I just wanted to ask.

    I'm currently a 2nd year and I'm on a medication where I'm required to make an appointment with my doctor once a month so I can have some blood-testing done and pick up some more medication from him.

    Is this going to be feasible during 3rd year?
     
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  3. mercaptovizadeh

    mercaptovizadeh ἀλώπηξ
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    It ought to be. It's your health in question. And people have lives outside of clerkships. Explain the situation without going into detail regarding the medication/blood test if it is something you prefer keeping private. If they want documentation, get that from the doctor. Talk to the clerkship director and relevant attending early about this.
     
  4. Scaredshizzles

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    If the medication is accutane, I wouldn't tell people that. :)
     
  5. SLUser11

    SLUser11 CRS
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    I think you'll be fine. These appointments won't cause true "absences," but rather an hour or two away from the action. You should schedule the appointments for the mid-to-late afternoon. Then, mention in the simplest way possible to your resident (or attending if there isn't a resident) that you have a doctor's appointment for blood work. If they say no, then go to your clerkship director.


    What residents and staff don't like are students who schedule these appointments for 8am, or somehow disappear for 5 hours for such an appointment, because it shows poor insight, and possibly some lazy or manipulative intent.


    Calling in sick is a whole other beast. The rule of thumb is that you go to work unless you are actively throwing up or can't leave the bathroom for more than 5-10 minutes due to diarrhea. Smaller ailments with requests for absence will likely draw negative attention. Colds, migraines, etc will get you very little sympathy.

    This calloused approach to sick days is the result of the resident system, where one house officer's absence leads to a large amount of work being transferred to someone else's shoulders. Most hard workers decide to "grin and bear it" when they feel sort of sick. They then expect the same out of their med students, who are training to do the same.

    The histrionic outcry from students when this has been discussed in the past is "I darest not step into the hospital, lest I spread germs to my patients!" The simple response to this is that, first of all, we don't believe your intentions are so pure, and second of all, if they are, then wear a mask, and some gloves, and wash your hands. Your patients will be just fine.


    In my experience as a med student, those people calling in sick were usually just hungover, and couldn't get up at 5am. But my point is that it doesn't matter whether your reason for calling in sick is legitimate or not....it will be interpreted as weak and lazy. Welcome to the unfair world of medicine.
     
  6. hooperg

    hooperg Just some guy
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    My money's on Clozapine (Clozaril). :)

    Unfortunately, by and large preceptors do not like absences, but some are more understanding than others. Do what you have to do (within honor and reason) and if they still give you grief, **** em', they're temporary inconveniences.
     
  7. njbmd

    njbmd Guest
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    Let your clerkship director know of your health needs. When (and if) a question comes up, he/she will deflect the criticism for you. You might also ask if you should share this information with your senior resident. The reason I say ask the clerkship director is because you want to tell your resident that Dr. X (the clerkship director) told me to let you know that I would be absent on Day X, Y and Z. Other than that, you should be fine but minimally, your clerkship director needs to know about your absences in advance of you starting. Often when these types of situations come up, the Dean will notify the clerkship directors of the special needs (absence for monitoring)of students as the go through clinicals. In this way, problems are avoided up front.
     
  8. Droopy Snoopy

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    Shouldn't be a problem as far as rotations go. You're brand new every month, so one preceptor doesn't know or care that you've been absent in other rotations. Your groupmates shouldn't care either considering it's your health, and especially if you make an effort to pick up as much slack as possible. Try and schedule your appt at 3pm for example, missing only a couple of hours instead of a whole day.
     
  9. Doctor Bagel

    Doctor Bagel so cheap and juicy
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    Exactly what I was going to say. At most you'll have to miss work 2 times on one rotation, which will not earn you a reputation as a slacker. Afternoon is always better because medicine in general seems very am oriented. You'll often have lectures and other less critical stuff in the afternoon, so it's possible no one will even notice you're gone.
     
  10. 45408

    45408 aw buddy
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    I'd much rather throw up or have diarrhea than have a migraine. I threw up at the hospital and only went home after repeated insisting from my resident that I should leave early. If I had a migraine, I'd be informing the resident that I'm going to have to leave early. The only time I ever had to leave work because I was sick was because of a migraine. They can be bad, bad news. My vision gets blurry, I'll barf, I get photophobic, and I have a crushing headache on top of it. I wouldn't blow someone off because they get a migraine. Fortunately, I haven't had one in >2.5 years.


    For the OP - a lot of my rotations have lecture days or afternoons. It probably wouldn't be a big deal if you went then.
     
  11. SLUser11

    SLUser11 CRS
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    I absolutely agree, but you're missing the point. It doesn't matter how legitimate your complaint is, it will make you appear weak. If you are going to blame someone, blame the students that came before you that took days off for "migraines" that were FOS.

    As a third year, you already know from taking histories from your patients exactly how subjective someone's "migraines" can be. The legitimate ones, like you described that have emesis, etc, are dwarfed by the self-diagnosed or over-played ones, so many residents tend to be skeptical.

    I'm not giving my personal approach to students, just my experience, mostly as a med student and now as a resident. I feel that I am more accomodating than most.
     
  12. Law2Doc

    Law2Doc 5K+ Member
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    Agree -- if you can find out ahead of time so you aren't missing rounds or mandatory things, and you let the rotations know well ahead of time, a once a month appointment for a couple of hours is probably doable.

    Some places may make you make up the time. Some residents might get miffed if they end up having to do your work, and this may be reflected in evals if they are jerks, but that's something you deal with.
     
  13. mercaptovizadeh

    mercaptovizadeh ἀλώπηξ
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    I had migraines every other day as a kid. They are truly awful. Any noises, light, and even cold air made me nauseous and I frequently threw up. The only cure is sleeping it off. Unfortunately, migraine is a very internal condition, and even others who are migraine sufferers may be less than sympathetic unless they see you clutching your head and throwing up.
     
  14. eforest

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    Having a medical problem is hard because you can't necessarily plan WHEN you're going to have time free to go to the doctor. I've learned the tricks- in my Family Practice rotation- I asked to go to the doctor one afternoon and left a little early (they were easy going). For my internal medicine rotation, I did have to cancel an appointment last minute once because a preceptor session was switched. On surgery, where I knew that going to the doctor would not be looked upon kindly, I was a bit sneaky. We don't get post call days off like the residents- so I would wait until days when the chief (who was grading me) was post-call and tip toe away when I thought I wouldn't be missed. This was risky though, because had I been caught I would have been nailed for being unprofessional. (it was unprofessional)

    Basically, try to do what you have to do.
     
  15. BoneTwister

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    I know what you mean. I have had two really bad blackouts/migraines and they are aweful. Going blind for hours. They are so bad I wish I had normal migranes and their comfort. When people compliain of normal easy migraines I think to them "how lucky they are to have a comfortable condition"

    Oh well I just try to deal the best I can:sleep:
     
  16. BigRedBeta

    BigRedBeta Why am I in a handbasket?
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    You can always go to the visit post-call...

    This obviously isn't always an option as a student because you'll have plenty of rotations without call, but if you know your call schedule far enough in advance and your doctor isn't one of those that is booked for months on end, you can save a lot of hassle by going on your own time when everyone wants you gone.
     
  17. 45408

    45408 aw buddy
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    Dude, you've had two. TWO. You hardly have anything that classifies as a "condition." Some people have them daily, which is hardly an easy condition. A little perspective on your part would be nice.
     
  18. BoneTwister

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    Sounds like you have never had one. Otherwise you would not be be yelling at me. Would you be making fun of someone with the AIDS?? Probably not, then you shouldnt be making fun of my condition because I know what they are going through and it wasnt fun for either of us. And if you would be making fun of them , ill tell you now it is unprofessional so please stop. Thank you!:sleep:
     
  19. anon-y-mouse

    anon-y-mouse Senior Member
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    Umm, hello, the guy said he has had them before, so much so that he'd rather have other debilitating symptoms before he had a migraine, so I have no idea where you are coming from with that! Also, we as a society make fun of people with AIDS all the time - look at South Park / Jared the Subway guy. AIDS is hilarious. Just like cancer. ( :rolleyes: )

    Also, for the original poster, you should be fine as long as you let people know about your appointments as early as you can, and let the clerkship director know preferably before the clerkship starts. People are RIDICULOUSLY accommodating of people with extenuating circumstances who've given notice super far in advance. Also depends on the rotation slightly. I didn't really feel comfortable leaving during surgery, since I didn't want to miss out on anything, and it wasn't really consistent what time we'd get out on any particular day (surgery cancellations, etc.) -- nevertheless, my chief told me on the first day that they're totally cool with that sort of stuff.
     
  20. 45408

    45408 aw buddy
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    Sounds like you haven't read the thread. I've had 4-5 of them, and I've had loss of vision, nausea, vomiting, photophobia, and crushing head pain. And I'm still very grateful that I don't deal with even "mild" migraines on a daily basis.
     
  21. Tired

    Tired Fading away
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    Possibly.

    You don't have a condition. You had two headaches. Grow up.
     
  22. SoCuteMD

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    Dude, you pretty much lose all credibility when you complain about how everyone else's migraines are so much easier. Do you know what THEY are going through? No.

    Plus, you've had all of 2. Most of my migraneur friends end up with at least one blinding, photophobia and vomit inducing hammer to the head
    every couple months at the very least.
     
  23. QofQuimica

    QofQuimica Seriously, dude, I think you're overreacting....
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    For people who get migraines, it may be possible for you to cope with them on the wards, especially if you have the classic type with aura. That's the type that I have. I keep medication with me everywhere I go, and the trick is to take it as soon as the aura appears so that it's already in your system before the aura goes away and the headache starts. It also helps me to drink something caffeinated during the aura. I still get the headaches even with premedication and caffeine, but they're bearable. It reduces the nausea, and I haven't ever had to go home due to a migraine the entire time I've been in med school. The other thing is to try to avoid your known triggers if at all possible. Of course, if you have common migraines and don't get auras, this is not going to help you much. I don't really know what to suggest to those people except to try keeping meds with you and take them as soon as you realize you're getting a migraine. Also, be aware of your triggers.

    OP, one other possibility is to see if your doctor has weekend and/or evening hours. Even on call months, you won't have call every single weekend.
     
  24. 45408

    45408 aw buddy
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    And he got bant. Probably some repeat offender.
     
  25. Ashers

    Ashers Bacteria? Don't exist.
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    I didn't had problems asking off for medical/dental appointments last year. If I was going to miss clinic, I asked my site director if it was OK -- they had asked if I needed any specific time off. On other rotations, I took some time off during lecture where there was no attendance taken.

    On the subject of migraines, I get them all the time (minimum 3/week). I've never had to take any time off for them in my life (since I was 7). They're pretty much an annoying routine, and sometimes, when they're bad (for me), I will walk around the hospital wearing sunglasses. I just wish my insurance would approve more medication.
     
  26. MJB

    MJB Senior Member
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    This might be a good place to ask about having kids during 3rd, and possibly 4th year. More specifically, just becoming a parent....as I don't think I'll be having any kids (after all, I don't plan to become a "man having a baby" like the "dude" that Oprah keeps fawning over), but my wife might.

    Is it even possible to be able to attend some doc appointments with a spouse when you are expecting? How about being able to be there for the birth and a couple days after?
     
  27. Tired

    Tired Fading away
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    You could probably work out some visits here and there, even easier if it's in the same facility you're rotating at.

    I'm sure most rotations would be fine with you being there for the birth.

    But what the hell do you need to be there "a couple days after" for?
     
  28. MJB

    MJB Senior Member
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    Thought the wife might appreciate it. :)
     
  29. dilated

    dilated Fought Law; Law Won
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    This is why it's not worth it to play the third year game. Apparently we're supposed to be constantly worried about whether we look "weak". I can tell there's a pattern of weakness in you - you seem like the type that needs food daily. And probably has to go to the bathroom... MORE THAN ONCE PER DAY! :eek:

    As I tell the firsties: obliterate step 1, publish some papers, and just enjoy third year being yourself and not giving a crap if you're perceived as "weak" by some bagged out resident or attending for things like unavoidable health problems. High passes will set us free.
     
  30. Law2Doc

    Law2Doc 5K+ Member
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    I don't know if it's an issue of being perceived weak -- it's a culture thing. If you are running around doing things for residents and rounding for 4 hours a day, etc, you very well might miss a few meals. The more savvy 3rd years quickly learn to carry power bars and other portable foods in the inside pocket of their white coat, because you might not always get to the cafeteria. You adapt to the culture.
    As for having to go to the bathroom, it's less about being weak and more about being disruptive. If you have to scrub out during a long surgery to hit the head, it means you can't be holding the retractor, have to scrub out, and then have to get re-gowned/re-gloved when you return. So that doesn't just involve you, and it's disruptive. So too if the team is rounding and you disappear to the restroom just as the attending turns to ask a med student level question. So you learn to never pass a bathroom when you have down time, even if you don't really have to go, because you might not get another opportunity for a while. Or you limit the amount of fluids you drink so you don't have to go as often. Again, I don't think the issue is being perceived as weak as much as the fact that everyone else on the team is doing X so it's disruptive if you do Y.
     
  31. Tired

    Tired Fading away
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    Rethink your priorities.
     
  32. MJB

    MJB Senior Member
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    No, thanks. Maybe when I'm the one being paid. ;)
     
  33. DonStracci

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    I have some medical issues as well that have required time off occasionally. I just always offer to take extra calls and that usually is fine, although one clerkship director was offended that i wouldnt tell her specifics of my illness. She wrote in my eval that i was 'secretive and unprofessional'. She had issues.
     

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