Hypothetical question about being kicked out

[Tristy]

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So, where do I start? I'll try to make it as short and to the point as I can.

I go to medschool in the east coast. Finished my first 2 years with flying colors despite all the drama in my life and health problems. I even pulled some honors here and there. I am possibly in the top of my class.

Now, last year, as some of you may remember, I was supossed to take Step 1 in June just like everybody else but my dad got very sick. So I had to jump on a plane to South America only to find out that he had died the morning I arrived. By this time I was on a personal LOA, which evolved into a medical LOA (I'll spare the details-but it's medical, NOT psychiatric leave) for the whole year.

So I come back and due to miscommunication between me and the school I ended up having to extend the leave but for one semester. So technically I should be able to begin the clinical curriculum on Jan 2010.

However, besides having to take (yes, still) Step 1 I have to be medically cleared and here lies the problem. I am on pain medication, for legitimate reasons, have been for over 2 years, it was what allowed me to finish my 2nd year and what prevents me from wanting to blow my brains out everyday. I am completely functional with the meds (yes, they're opiates), and when I am not on them I cannot even drag myself to the bathroom due to the pain. So, no addiction, no abuse.

But, the doctor that is supossed to clear me to go back has "reservations" (sp?) as to how these meds will affect my performance and she "doesn't feel comfortable clearing me and especially after what happened 1.5 months ago" (it is unclear what happened, I was found unconscious by my landlord, he called 911, and I spent about a week at the darn hospital.

While in the hospital I was told that my toxscreen was clear (duh!) except for narcotics (duh! my pain pills! and I told them that), so they pretty much had no idea what had happened. Some blame my benzo prescription, others blame the pain meds, but nobody really knows, which is pretty frustrating because this is adding to the problem of trying to go back to school.

So, could they hold me back and not let me start on the grounds that I'm on pain medication?? Sorry but to me that is ridiculous, what am I supossed to do with my life, sit at home, watch telenovelas and eat bomboms all day?

I mean, to me it seems that this doctor almost wants me to either 1) go back to school but no pain meds, so I risk going postal on myself from the pain, or 2) continue pain treatment but no school

Can they really do this? Am I going to need a lawyer? 🙁 It already sucks that not only I'm not graduating next year, or the year after, but on 2012...

If it wasn't for >60k debt that I have I would say fu&*t it all and I would go back to Argentina but I can't. And I'm even a good student!! Ahhhh, the ironies.....

Could I transfer to another school because of this situation?

Help? Please? I'm breaking my head thinking what to do about it....

 

[Tristy]

Anybody?

 

[Scaredshizzles]

So, where do I start? I'll try to make it as short and to the point as I can.

I go to medschool in the east coast. Finished my first 2 years with flying colors despite all the drama in my life and health problems. I even pulled some honors here and there. I am possibly in the top of my class.

Now, last year, as some of you may remember, I was supossed to take Step 1 in June just like everybody else but my dad got very sick. So I had to jump on a plane to South America only to find out that he had died the morning I arrived. By this time I was on a personal LOA, which evolved into a medical LOA (I'll spare the details-but it's medical, NOT psychiatric leave) for the whole year.

So I come back and due to miscommunication between me and the school I ended up having to extend the leave but for one semester. So technically I should be able to begin the clinical curriculum on Jan 2010.

However, besides having to take (yes, still) Step 1 I have to be medically cleared and here lies the problem. I am on pain medication, for legitimate reasons, have been for over 2 years, it was what allowed me to finish my 2nd year and what prevents me from wanting to blow my brains out everyday. I am completely functional with the meds (yes, they're opiates), and when I am not on them I cannot even drag myself to the bathroom due to the pain. So, no addiction, no abuse.

But, the doctor that is supossed to clear me to go back has "reservations" (sp?) as to how these meds will affect my performance and she "doesn't feel comfortable clearing me and especially after what happened 1.5 months ago" (it is unclear what happened, I was found unconscious by my landlord, he called 911, and I spent about a week at the darn hospital.

While in the hospital I was told that my toxscreen was clear (duh!) except for narcotics (duh! my pain pills! and I told them that), so they pretty much had no idea what had happened. Some blame my benzo prescription, others blame the pain meds, but nobody really knows, which is pretty frustrating because this is adding to the problem of trying to go back to school.

So, could they hold me back and not let me start on the grounds that I'm on pain medication?? Sorry but to me that is ridiculous, what am I supossed to do with my life, sit at home, watch telenovelas and eat bomboms all day?

I mean, to me it seems that this doctor almost wants me to either 1) go back to school but no pain meds, so I risk going postal on myself from the pain, or 2) continue pain treatment but no school

Can they really do this? Am I going to need a lawyer? 🙁 It already sucks that not only I'm not graduating next year, or the year after, but on 2012...

If it wasn't for >60k debt that I have I would say fu&*t it all and I would go back to Argentina but I can't. And I'm even a good student!! Ahhhh, the ironies.....

Could I transfer to another school because of this situation?

Help? Please? I'm breaking my head thinking what to do about it....

This is probably not helpful, but I think the reality of the matter is there is an unfair bias against opiate use. Have you ever tried any other pain medications, i.e. those for neuropathic pain (gabapentin (neurontin), pregabalin (lyrica)? In any case, I definitely would not give this up without a big time fight; start with getting a second opinion from a doctor who can confirm your need for the meds. It's not right for someone to be discriminated against because of any sort of health condition, if you give up the fight you're not just giving up on yourself, but also others in similar situations.

 

[SouthernSurgeon]

S
But, the doctor that is supossed to clear me to go back has "reservations" (sp?) as to how these meds will affect my performance and she "doesn't feel comfortable clearing me and especially after what happened 1.5 months ago" (it is unclear what happened, I was found unconscious by my landlord, he called 911, and I spent about a week at the darn hospital.

You seem to gloss over this very important issue. This episode suggests one of several things (medication overdose, inappropriate medication mixing, or a separate health issue). You point to this as the reason your doc won't clear you, and it is definitely a legitimate concern.

So, could they hold me back and not let me start on the grounds that I'm on pain medication??

Seems like that is what they are telling you. According to your post, the school won't let you back w/o medical clearance, and your doctor won't give you that clearance. Sorry, but this isn't "House" - opiates are heavy meds that affect your day to day function (esp when you have already blacked out or whatnot from them).

Can they really do this? Am I going to need a lawyer?

I'm no expert on whether they can or cannot - but bottom line is it seems that they ARE. You may need to contact a lawyer if only to better understand your rights/options. Going forward, you will likely need good solid documentation of your medical condition underlying the need for continued opiate use, as well as a doctor who is willing to clear you for duty in spite of that use (which your current doc doesn't seem willing to do).

This is not an issue that will just disappear when/if you get back into med school. Your residency applications will ask about any condition which will limit your ability to practice medicine; many residencies require drug testing prior to starting your intern year; this will need to be addressed for you to get a medical license; etc.

Could I transfer to another school because of this situation?

Doubtful

 

[Gabby]

At the risk of sounding unsympathetic, you blacked out and were found unconscious only a month and a half ago and no one knows why. Letting you handle patients may not be the safest thing in the world. There's liability to be concerned about. If I were you, I'd be more concerned about the reasons for your black out right now. If you're having an undiagnosed complication of your illness, you need to know and get it under control before beginning third year.

 

[Tristy]

I do take lyrica on top of everything else. I've also had injections, procedures, different treatment modalities done, that's why I was out for a year.

Just to clarify something, the doctor that is supossed to clear me is different from my pain doctor.

So from what you guys are saying I am pretty much screwed.

And to whoever said that this was not House, hello? I don't get intoxicated from the meds, try studying and taking finals while they're in your system. Not everybody gets impaired. But yes, there seem to be a definite opiophobia in this country.

Regarding my incident, I do understand that it needs to be cleared out as to what happened, but that, and the need of this meds to live and function shouldn't be grounds to dismiss me from school. Try living with pain 24/7 and having tried everything in the book for it.

But, seems like I am royally screwed.

 

[njbmd]

First of all, SDN is NOT the place to seek advice on this type of situation. You need to speak with the administration of your school, get documentation of your options and work with them to see what would be your next move. Here at SDN, we are only getting your side of the story, which is definitely not objective due to the duress that you seemed to be under. Anything that you read here is likely not going to be very useful as it's an opinion based on one side of a two-sided story.

Whether or not you need legal counsel can't be addressed on a public message board. If you feel like your rights have been violated, then you can present your case to a legal representative but here, again, anything that you read on this message board based on opinion of people who do not know the particulars of your specific situation.

Please take the time to contact your school, get everything that concerns your status in writing and negotiate directly with them. As for transferring, you need the support from your school and again, you will need to work with them before any other school would even touch your application.

I am sorry that your have had such a rough time with your medical education and the loss of your father but please work with your school, know your options and get legal advice if you feel that you need it. While SDN readers can offer an opinion, only the parties that are directly involved; who know all aspects of your situation, can give you informed advice that would be of use to you. Good luck.

 

[AlexMorph]

Not trying to be a jerk, OP, but you need to find a better crowd that actually knows your whole story so that they can give you meaningful advice. We are not capable based on the limited information present, as njbmd said above.

 

[RegularNihilist]

Given the amount of students and doctors writing on SDN, it is reasonable to believe that there will be someone familiar with the problem, who can give legal advice.

My sympathies to you for the whole ordeal, for your loss, for your pain condition, and on top of that, possible addiction and additional obstacles to get back in. When it rains, it pours.

PS: A COPD patient passing out due to CO2 narcosis, wouldn't be denied O2, the dosage would be adjusted. There is no substance abuse actually, there is only substance consumption with pleasurable and uncomfortable side effects.

 

[smq123]

Given the amount of students and doctors writing on SDN, it is reasonable to believe that there will be someone familiar with the problem, who can give legal advice.

Given the amount of students and doctors writing on SDN, it is reasonable to believe that there will be someone who would also be familiar with a medical problem that someone posted, and could theoretically give medical advice. However, since it's risky/dangerous to give medical advice over the phone, without laying eyes on the patient, that's a really really really bad idea. (Aside from the fact that it's a TOS violation.)

Similarly, I don't think it's a good idea to give someone legal advice over the internet. Unless you know the OP in person, you're really not well situated to comment on what she should do.

 

[cpants]

So, where do I start? I'll try to make it as short and to the point as I can.

I go to medschool in the east coast. Finished my first 2 years with flying colors despite all the drama in my life and health problems. I even pulled some honors here and there. I am possibly in the top of my class.

Now, last year, as some of you may remember, I was supossed to take Step 1 in June just like everybody else but my dad got very sick. So I had to jump on a plane to South America only to find out that he had died the morning I arrived. By this time I was on a personal LOA, which evolved into a medical LOA (I'll spare the details-but it's medical, NOT psychiatric leave) for the whole year.

So I come back and due to miscommunication between me and the school I ended up having to extend the leave but for one semester. So technically I should be able to begin the clinical curriculum on Jan 2010.

However, besides having to take (yes, still) Step 1 I have to be medically cleared and here lies the problem. I am on pain medication, for legitimate reasons, have been for over 2 years, it was what allowed me to finish my 2nd year and what prevents me from wanting to blow my brains out everyday. I am completely functional with the meds (yes, they're opiates), and when I am not on them I cannot even drag myself to the bathroom due to the pain. So, no addiction, no abuse.

But, the doctor that is supossed to clear me to go back has "reservations" (sp?) as to how these meds will affect my performance and she "doesn't feel comfortable clearing me and especially after what happened 1.5 months ago" (it is unclear what happened, I was found unconscious by my landlord, he called 911, and I spent about a week at the darn hospital.

While in the hospital I was told that my toxscreen was clear (duh!) except for narcotics (duh! my pain pills! and I told them that), so they pretty much had no idea what had happened. Some blame my benzo prescription, others blame the pain meds, but nobody really knows, which is pretty frustrating because this is adding to the problem of trying to go back to school.

So, could they hold me back and not let me start on the grounds that I'm on pain medication?? Sorry but to me that is ridiculous, what am I supossed to do with my life, sit at home, watch telenovelas and eat bomboms all day?

I mean, to me it seems that this doctor almost wants me to either 1) go back to school but no pain meds, so I risk going postal on myself from the pain, or 2) continue pain treatment but no school

Can they really do this? Am I going to need a lawyer? 🙁 It already sucks that not only I'm not graduating next year, or the year after, but on 2012...

If it wasn't for >60k debt that I have I would say fu&*t it all and I would go back to Argentina but I can't. And I'm even a good student!! Ahhhh, the ironies.....

Could I transfer to another school because of this situation?

Help? Please? I'm breaking my head thinking what to do about it....

Ok, so from what I gather, you feel you have a legitimate reason to be on opiates, but your school's doctor still has reservations. While it is true that many people have an unfair bias against opiate users, it is also true that you could be prescribed an inappropriate pain regimen and/or you could be abusing the drugs. Not knowing the origin of your pain and the details behind your "found unconscious" episode, it is impossible to judge whether or not your school's doctor's reservations are legitimate. It is, of course, possible to function as a physician while on a heavy opiate regimen for chronic pain. So my advice to you is to: A) make sure that you are on an apropriately titrated pain regimen for a legitimate diagnosis, B) get documentation of said diagnosis and pain regimen from the appropriate physicians including a pain specialist, C) initiate the appeal process to get medically cleared at school. Contact the administration to find out how to go about this. If they won't play ball or don't have a procedure in place, contact a lawyer.

 

[dotdash]

Your whole story seems worrisome to me. You don't seem to acknowledge the seriousness of the situation you are in. The doctor not clearing you to go back should be a big red flag -- for *you*, regardless of how your school takes it. Even if you force your way back into school at this point, you will run into more and bigger problems down the line. I agree with those who say you need more help than can be given on SDN.

And, frankly, the fact that you have Sylvia Plath as your avatar (that's right, yes?) worries me, too.

 

[cpants]

Your whole story seems worrisome to me. You don't seem to acknowledge the seriousness of the situation you are in. The doctor not clearing you to go back should be a big red flag -- for *you*, regardless of how your school takes it. Even if you force your way back into school at this point, you will run into more and bigger problems down the line. I agree with those who say you need more help than can be given on SDN.

And, frankly, the fact that you have Sylvia Plath as your avatar (that's right, yes?) worries me, too.

It's not necessarily a huge red flag. Many, if not most, physicians are not well educated on chronic pain and pain medications. The school's physician is going to err on the side of not clearing the patient for obvious reasons. If something were to happen, and the physician had cleared the student, it would look bad for said physician. However, it isn't acceptable to not medically clear a student just for "reservations", effectively putting his career on hold and jeopardizing the time and money already invested in a medical education. The doctor should state clear and definitive reasons why he feels the student is unable to continue medical school. Then the student should have an opportunity to contest those opinions. Chronic pain and/or chronic use of pain medication for a legitimate reason is not justification to hold someone out of medical school.

 

[Tiger26]

So, where do I start? I'll try to make it as short and to the point as I can.

I go to medschool in the east coast. Finished my first 2 years with flying colors despite all the drama in my life and health problems. I even pulled some honors here and there. I am possibly in the top of my class.

Now, last year, as some of you may remember, I was supossed to take Step 1 in June just like everybody else but my dad got very sick. So I had to jump on a plane to South America only to find out that he had died the morning I arrived. By this time I was on a personal LOA, which evolved into a medical LOA ( (1) I'll spare the details-but it's medical, NOT psychiatric leave) for the whole year.

So I come back and due to miscommunication between me and the school I ended up having to extend the leave but for one semester. So technically I should be able to begin the clinical curriculum on Jan 2010.

However, besides having to take (yes, still) Step 1 I have to be medically cleared and here lies the problem. I am on pain medication, for legitimate reasons, have been for over 2 years, (2) it was what allowed me to finish my 2nd year and what prevents me from wanting to blow my brains out everyday. I am completely functional with the meds (yes, they're opiates), and (3) when I am not on them I cannot even drag myself to the bathroom due to the pain. So, no addiction, no abuse.

But, the doctor that is supossed to clear me to go back has "reservations" (sp?) as to how these meds will affect my performance and she "doesn't feel comfortable clearing me and especially after what happened 1.5 months ago" ((4) it is unclear what happened, I was found unconscious by my landlord, he called 911, and I spent about a week at the darn hospital.

While in the hospital I was told that my toxscreen was clear (duh!) except for narcotics (duh! my pain pills! and I told them that), so they pretty much had no idea what had happened. Some blame my benzo prescription, others blame the pain meds, but nobody really knows, which is pretty frustrating because this is adding to the problem of trying to go back to school.

So, could they hold me back and not let me start on the grounds that I'm on pain medication?? Sorry but to me that is ridiculous, what am I supossed to do with my life, sit at home, watch telenovelas and eat bomboms all day?

I mean, to me it seems that this doctor almost wants me to either 1) go back to school but no pain meds, (5) so I risk going postal on myself from the pain, or 2) continue pain treatment but no school

Can they really do this? Am I going to need a lawyer? 🙁 It already sucks that not only I'm not graduating next year, or the year after, but on 2012...

If it wasn't for >60k debt that I have I would say fu&*t it all and I would go back to Argentina but I can't. And I'm even a good student!! Ahhhh, the ironies.....

Could I transfer to another school because of this situation?

Help? Please? I'm breaking my head thinking what to do about it....

(1) You repeatedly say you're tired of people not understanding chronic pain management, as if narcotics users are really just trying to fulfill an addiction. However, with this sentence, you demonstrate your ignorance by saying psychiatry isn't part of medicine. Hell, half of everything any specialty does is psychiatric--try getting people to take their meds for instance.

(2) This is really disturbing and if said aloud with even some degree of seriousness would get you emergency detention at a psych center

(3) Without pain meds, you say you couldn't even get to the bathroom, but then say your not addicted--I'm calling BS on this one--if the first statement is true, then the second is true as well.

(4) You were found unconscious by your landlord!!!!!!

(5) What happens when you're in a long case in the OR and can't re-up on pain meds--are you going to go 'postal' during surgery? What about if you're on call that night but forgot your meds at home--are you going to go 'postal' or leave your pts to go get your meds?


Honestly, forget being medically cleared right now--I think you need to get psychiatric clearance first, even if that makes me look like a dick for bringing it up

 

[muireinin]

(3) Without pain meds, you say you couldn't even get to the bathroom, but then say your not addicted--I'm calling BS on this one--if the first statement is true, then the second is true as well.

Physical dependence is not the same as addiction. I know that sounds weird, but our neuro class just went over this.

 

[cpants]

Physical dependence is not the same as addiction. I know that sounds weird, but our neuro class just went over this.

Very true.

 

[Non-TradTulsa]

I agree with all the other posters such as njbmd who have said that we're not qualified to give advice on your situation.

What I am thinking, however, as an older non-trad with years of experience in the business world, is this: while your rights may be getting a bit trampled, just remember that if you "cry havoc and let slip the dogs of war" - even if you win, it'll follow you for the rest of your medical career. Doctors do not like people who engage in litigation. Unfair? Yes. True? You bet.

I believe you absolutely when you say that your opiate/opioid doses are appropriate for your pain and that you don't become impaired. However, if I were the medical officer at your school, I would also have a great deal of hesitation over clearing you to go back to school only six weeks after an episode of unexplained syncope. Third year is incredibly stressful and incredibly physically demanding. You may feel like you're ready to go back - but you haven't experienced the demands of core rotations.

Nobody wants to put off graduation but, trust me - I turned 45 years old the first month of medical school. You have time. If you need to take a year off to keep your school happy, you may benefit in the long run to keep good relations with your school. Again, we don't know - and don't need to know - all of the exact details of your condition, but apparently you've been through quite an ordeal and one year off is not an unreasonable request.

Medical schools are entrusted by the public with educating doctors who are safe and competent to practice. You would have an extremely difficult time overcoming the deference to judgement that your school would receive in a legal action. Don't do it unless they actually dismiss you and you have very little left to lose.

 

[rysa4]

hey OP--

Agreed that there is missing info probably not appropriate for the forum. However, a few general comments:

1. Remain calm,rational, and clear headed in trying to deal with this.
2. Verify within yourself that you actually want to finish medical school.
3. have a polite sit down with your doctor ( the one who has clearance responsibilities). Identify her/his concerns specifically, and ask what steps he or she is looking for prior to giving clearance to proceed with your career.
4. Your use of the term "blowing my brains out" coupled with being found unconscious probably has led to an obvious concern. I don't know how to be any clearer than this. I am identifying a probable concern and not judging you or the situation.
5. Keep your medical school informed, after you get a good bead on where they are out.
6. Polite background legal assistance is a good idea; someone with licensure experience in handling "impaired" physicians is what you need. Visit a state capital near you, or wherever the state board is located.
7. Do number 6 before number 7 but not dilly dally.
8. keep your sh**t together. Or you will be out of the game.