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[deleted825474]

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[Lannister]

Do you take your dog into the room with you when you see standardized patients (or real patients, for that matter)? How do people react?

 

[Doctor Strange]

What accommodations are going to be put in place when you have to start clerkships? A dog can obviously not be in an operating room.

 

[mcloaf]

I find the lack of pictures of said service dog ITT deeply disturbing.

 

[Vitani]

What is the dog trained to do to mitigate your disability?

 

[Mr Roboto]

What happens if your patient is afraid of dogs?

 

[deleted825474]

Do you take your dog into the room with you when you see standardized patients (or real patients, for that matter)? How do people react?

Yes, I take him in the room with me when I have SP sessions. The SPs have been really welcoming and kind (they usually want to pet him). I walk in, introduce myself and my dog and tell the SP that he will be helping me out by sitting in the corner haha. I haven't had anyone report an allergy to me or tell me they are uncomfortable with him being in the room. Although, I have a suspicion that the clinical skills coordinator has group of SPs that are fine working with me and my dog -- I always seem to be paired with the same patients hehe

If he's unable to go into a patient’s room during clerkships (for whatever reason), he will be in a down stay outside the patient room or I will put him in a crate that is set up somewhere on the floor (extra room, nurses station, etc.). The few patients I have interacted with thus far have been really excited to have him in the room.

 

[deleted825474]

What accommodations are going to be put in place when you have to start clerkships? A dog can obviously not be in an operating room.

The hospital has some guidelines regarding where a service animal can and cannot go. The guidelines are based off the ADA's recommendations for the use of service animals. Most, if not all, of the recommendations are based off research regarding allergies & patient safety. Generally, there is a low risk of allergic response when a dog is in the hospital. There has been a recent study by the CDC showing that if a dog can be "gowned" he/she can go into the OR and not increase the risk of infection for the patient (BUT I think my dog would hate me if I did that to him…I’m also not sure the medical field is ready for a service animal to be in the OR just yet..)


I just met with the clerkship director for surgery; this is what we came up with regarding where he cannot go:


- OR

- SICU

- med storage rooms

- immunocompromised patient's room

- pt is uncomfortable with having a dog in the room



There will be a crate set up by the nurses' station for the times he cannot be with me. The first four on the list are already identified in hospital policy.


Technically, he is allowed in the ICU, med storage rooms and immunocompromised patient rooms if I (or any other visitor) do not need any type of barrier protection upon entering the room. I’m happy to have him wait outside, though – this is the first “staff” (if I’m considered staff)/service animal team the hospital has encountered. Therefore, I want people to be comfortable as we begin the process of “normalizing” this type of team in the hospital setting.

 

[bashwell]

Awesome, thanks OP! What kind of service dog do you have?

 

[deleted825474]

I find the lack of pictures of said service dog ITT deeply disturbing.

Dude, just ask.

 

[DNC127]

How does a dog go about being trained to help manage PTSD? I am sure it is quite the process.

 

[Doctor Strange]

I have PTSD - he warns me before I have a flashback, often stops it (or at least shortens it), helps with dissociation by creating space around me or standing behind me when we are around a bunch of people. He also has grounding tasks to help when I do dissociate.

Any idea what field you're interested in? How has this limited your choices if at all? Depending on what your triggers are, I can imagine that something like a rapid response or a code situation might be less than ideal.

Sent from my SAMSUNG-SM-G900A using SDN mobile

 

[DNC127]

Dude, just ask.

this is awesome (not the circumstances but rather the fact that your pooch gets to chill with ya)

 

[deleted825474]

What happens if your patient is afraid of dogs?

So, technically, I can go get another med student/resident/etc. to take my patient. How long someone can be separated from his/her service animal depends on how they communicate (i.e. if the dog can tell 20 minutes before the handler is going to have a seizure) and what type of service the animal does.


I will put him in his crate at the nurses' station if the door needs to be closed. If the door is open (we are rounding or something), he will be in a down stay outside the door (if that's too close for the patient, then I'll put him in his crate). Thankfully, we don't have to be together every second for him to do his job, so I can accommodate these requests without having to transfer a patient -- would never want to put my patient in that type of a situation.

 

[cbrons]

I have PTSD - he warns me before I have a flashback, often stops it (or at least shortens it), helps with dissociation by creating space around me or standing behind me when we are around a bunch of people. He also has grounding tasks to help when I do dissociate.

Edit: On second thought, this is actually a thing?

https://en.wikipedia.org/wiki/Psychiatric_service_dog

I did not think they would admit someone to medical school with a disability that required use of a service animal. I thought psychiatric problems would be more along the lines of an emotional support animal.

They allow the service dogs inside hospitals?

Man I am very ignorant of the laws these days.

VA and service dogs
Research is underway to better understand if dogs can provide a disability service for persons with PTSD. VA has started a research study to determine if there are things a dog can do for a Veteran with PTSD that would qualify the animal as a Service Dog for PTSD. The study is expected to take several years to complete. The National Center for PTSD is not involved in this study, but we will provide results when they become available.

Currently, VA does not provide service dogs for physical or mental health conditions, including PTSD. VA does provide veterinary care for service dogs that are deemed medically necessary for the rehabilitation or restorative care plan of Veterans with permanent physical impairments. If research supports the use of service dogs for PTSD, VA will provide veterinary care for such dogs. Read more information on VA and service dogs.

http://www.ptsd.va.gov/public/treatment/cope/dogs_and_ptsd.asp

 

[infinityavenue]

Have you gotten any pushback from faculty/staff or have they mostly been accommodating? Also, do you by any chance go to school somewhere in the Northeast? I was at a recent interview where a med student mentioned one of her friends had a service dog that everyone loved!

 

[MSTP18]

Does your hospital employ any animals for patients? (e.g. mine has one come once/week on peds and psych)

Does your dog get an ID badge? Ours does. I love the image: It's identical to ours so it has a picture of his face and his name and they have it clipped to his collar.

@cbrons the FBI even has a therapy dog: https://www.fbi.gov/news/stories/helping-victims-of-crime

Since then, she and Dolce have had a very positive impact, comforting victims and their families in murder cases, kidnappings, and bank robberies, where Dolce’s presence is a calming influence on tellers who minutes before may have had a gun pointed in their faces...“We have worked a lot of cases together,” Pierce said, “helping victims of child pornography and even white-collar crime, where senior citizens lost their life savings to investment scam artists.

 

[deleted825474]

Have you gotten any pushback from faculty/staff or have they mostly been accommodating? Also, do you by any chance go to school somewhere in the Northeast? I was at a recent interview where a med student mentioned one of her friends had a service dog that everyone loved!

Overall, my school has been amazing in terms of support. I did have some pushback from a couple of staff members, but it was because this was so new and the school had no experience with service dog/handler teams. Clearing that up just meant a conversation and allaying fears that I would not be able to become a competent physician because of my disability. I mean, having a service animal in medical school is like...weird, right? Doctors don't get "sick"... It was new/strange/different/whatever - now it's the norm here hehe. Now that people have seen that it is possible to have a service dog and go through med school (at least the first two years), having him is no big deal. I don’t think they will think twice when the next student matriculates with a service animal.

My professors have been AMAZING. I've had professors interact with him (apparently he's an honorary med student haha) and others completely ignore him - both approaches are totally fine. My experience has been that most people are unsure about the PC way to treat/acknowledge a service animal. Some people are really contentious about not treating me differently than anyone else, so they ignore him. Others feel like welcoming him as another part of the class is a way to show their support. Either way has worked fine. One of my professors used to get on the ground with him and hang out while we were working in small groups. Not one of my professors has treated me differently or acted like I am inferior to other students. I've never felt I was held to a different standard or that people treated me as "fragile" because I have a disability.

Ps. hope you get in wherever you interviewed!!

 

[deleted825474]

Any idea what field you're interested in? How has this limited your choices if at all? Depending on what your triggers are, I can imagine that something like a rapid response or a code situation might be less than ideal.

Sent from my SAMSUNG-SM-G900A using SDN mobile

This is a great question. I had to think about it for a bit, but here's my answer:

Has having a service animal limited my choices? No. Has having PTSD limited my choices? Yes and no. We all have to work with our individual biology (to some degree) in choosing a specialty. For instance, I have to sleep 8-9 hours a night...so surgery isn't likely to be the best fit (I also don't like surgery). At the same time, I don't think spending an extended time in the OR without my dog will be healthy for me in the long term. So, yes it has impacted my decision to go the med route vs surgery, but I think I would have ended up down that path regardless.


I would actually do well in a high stress situation - most people with PTSD are on top of their game during emergencies. I was an EMT in college and had no issues. I do think there will be things within my chosen field that will be hard to deal with, but it's a matter of exposure and adaptation that will really determine whether or not I can overcome some of those triggers. For instance, I'm really interested in peds. Child abuse is going to be tough to deal with, BUT having my dog with me will help to reset my HPA axis when encountering those things. I worked in a psychiatric hospital for a few years before starting med school and it was pretty tough at first. After a while, the things that triggered me when I started no longer triggered me by the time I left. Given the plasticity of the brain my own understanding of how trauma therapy works, I'm not concerned about PTSD stopping me from pursuing any specialty. I do think some will be much harder than others. But we all are triggered by certain things. If I had a parent who died of cancer I would probably have a really emotional response to a patient of the same gender/age struggling with the same.


To answer your question, I'm looking at psych, internal (ending in cardio or heme/onc), peds or ob/gyn. So…surgery is totally out. I also don't want to have much to do with the kidneys if I can help it (sorry nephros).

 

[deleted825474]

Does your hospital employ any animals for patients? (e.g. mine has one come once/week on peds and psych)

Does your dog get an ID badge? Ours does. I love the image: It's identical to ours so it has a picture of his face and his name and they have it clipped to his collar.

@cbrons the FBI even has a therapy dog: https://www.fbi.gov/news/stories/helping-victims-of-crime

Yes! The hospital has therapy dogs - for the peds and psych units as well! There's also one for the med students.

I'm not sure if he gets and ID bag?! that would be so totally cool haha. I'm going to ask.

 

[deleted825474]

Edit: On second thought, this is actually a thing?

https://en.wikipedia.org/wiki/Psychiatric_service_dog

I did not think they would admit someone to medical school with a disability that required use of a service animal. I thought psychiatric problems would be more along the lines of an emotional support animal.

They allow the service dogs inside hospitals?

Man I am very ignorant of the laws these days.

VA and service dogs
Research is underway to better understand if dogs can provide a disability service for persons with PTSD. VA has started a research study to determine if there are things a dog can do for a Veteran with PTSD that would qualify the animal as a Service Dog for PTSD. The study is expected to take several years to complete. The National Center for PTSD is not involved in this study, but we will provide results when they become available.

Currently, VA does not provide service dogs for physical or mental health conditions, including PTSD. VA does provide veterinary care for service dogs that are deemed medically necessary for the rehabilitation or restorative care plan of Veterans with permanent physical impairments. If research supports the use of service dogs for PTSD, VA will provide veterinary care for such dogs. Read more information on VA and service dogs.

http://www.ptsd.va.gov/public/treatment/cope/dogs_and_ptsd.asp

Thanks for educating yourself I'm happy to answer any questions you have.

It's not common, that's for sure. And some schools will be much more hesitant than others. The two I know of that are wonderful with accomodations are UVM and UCSF.

Edit: somehow missed the last portion of your post. Yeah, unfortunately there are a lot of things in medicine that don't have a ton of evidence based research to back them up - for a variety of reasons. I'll be interested to see the results of the VA study.

In the meantime, the ADA fully recognizes the use of service animals for PTSD and other psychiatric disorders. Emotional support animals are completely different.

https://www.ada.gov/servicemembers_adainfo.html

 

[Etorphine]

any concern for triggering patient's underlying asthma? From my experience, many patients don't know they have asthma. Same goes for patients being admitted to the hospital w/ new hematologic/immunodeficiency concerns. I definitely wonder about this from a 'do no harm' perspective.

also, more of a personal aside, any concern for spreading C dif/MRSA/VRE from the hospital floor to your home, when your dog jumps in bed?

 

[Mr Roboto]

Edit: On second thought, this is actually a thing?

https://en.wikipedia.org/wiki/Psychiatric_service_dog

I did not think they would admit someone to medical school with a disability that required use of a service animal. I thought psychiatric problems would be more along the lines of an emotional support animal.

They allow the service dogs inside hospitals?

Man I am very ignorant of the laws these days.

VA and service dogs
Research is underway to better understand if dogs can provide a disability service for persons with PTSD. VA has started a research study to determine if there are things a dog can do for a Veteran with PTSD that would qualify the animal as a Service Dog for PTSD. The study is expected to take several years to complete. The National Center for PTSD is not involved in this study, but we will provide results when they become available.

Currently, VA does not provide service dogs for physical or mental health conditions, including PTSD. VA does provide veterinary care for service dogs that are deemed medically necessary for the rehabilitation or restorative care plan of Veterans with permanent physical impairments. If research supports the use of service dogs for PTSD, VA will provide veterinary care for such dogs. Read more information on VA and service dogs.

http://www.ptsd.va.gov/public/treatment/cope/dogs_and_ptsd.asp

Someone at my school has a service animal, though it's not for psych. That dog is everyone's favorite honorary class member.

 

[Mr Roboto]

Yeah, it is a lot of work; we’re constantly training. Under the ADA you can train your own service animal (they cost between $30,000-40,000 if you get one from an organization). My dog wasn't even supposed to be a service animal - just got him as a pet. He started picking up on flashbacks when he was 3mo. old. He would nip at my pants and try to pull me outside. It took me a while to figure out what he was trying to tell me. At the time, I was just entering treatment for PTSD and was not really aware of the physiological changes that occurred preceding a flashback. In that way, he really impacted my treatment; I wouldn’t be in medical school without his help.


SO, back to training. Once I figured out what he was doing and the potential he had to really help me, I started bringing him everywhere. We worked on obedience (with a trainer - because I had no idea what I was doing) and I read a lot about psychiatric service animal tasks. I eventually could teach him to get my attention without putting holes in my pants. We worked on public access training (basically that he behaves in public) and then I taught him different tasks (nudges me when I dissociate, stands behind me in lines at the store so people give me space, constantly stands between me and other people, wakes me up from nightmares - well, he figured that one out on his own). The way I've come to understand it is that he can pick up on the stress response via smell, the same way diabetic service dogs smell their handler’s low blood sugar. He will also respond the same way he does to me when I'm with someone who also has PTSD and is having a flashback (I worked in a psychiatric hospital for a few years).


We are now working with a trainer to get ready for the clinic.

What was the process like for getting a dog your trained yourself listed as a service animal? I have no idea how that works haha

 

[MSTP18]

also, more of a personal aside, any concern for spreading C dif/MRSA/VRE from the hospital floor to your home, when your dog jumps in bed?

I'm sure a dog as highly trained as this can be easily bathed with soap and water. MRSA and VRE are also not really things generally healthy people get sick with. The real concern is us spreading it to other sick patients, not us getting sick.

 

[Etorphine]

I'm sure a dog as highly trained as this can be easily bathed with soap and water. MRSA and VRE are also not really things generally healthy people get sick with. The real concern is us spreading it to other sick patients, not us getting sick.

So you're saying a resident that is working 80 hrs/wk is going to disinfect their dog after every 24 hour shift, clean out the nooks and crannies of their paws? Ever work a 16-24 hour overnight admitting shift? Already barely have enough time to eat and shower..obviously those bugs affect the immunocompromised more, but I know multiple coworkers/faculty that have gotten hospital-associated bugs.. More of a personal aside anyway, as the likelihood is low. But the chance of having multi-drug resistant C dif all over your living room carpet is high..

More realistically is the concern of worsening the condition of new admits that turn out to be asthmatic/immunocompromised.

 

[precisiongraphic]

Dude, just ask.

Cute dog. Love this thread OP.

 

[LaurenMD]

The hospital has some guidelines regarding where a service animal can and cannot go. The guidelines are based off the ADA's recommendations for the use of service animals. Most, if not all, of the recommendations are based off research regarding allergies & patient safety. Generally, there is a low risk of allergic response when a dog is in the hospital. There has been a recent study by the CDC showing that if a dog can be "gowned" he/she can go into the OR and not increase the risk of infection for the patient (BUT I think my dog would hate me if I did that to him…I’m also not sure the medical field is ready for a service animal to be in the OR just yet..)


I just met with the clerkship director for surgery; this is what we came up with regarding where he cannot go:


- OR

- SICU

- med storage rooms

- immunocompromised patient's room

- pt is uncomfortable with having a dog in the room



There will be a crate set up by the nurses' station for the times he cannot be with me. The first four on the list are already identified in hospital policy.


Technically, he is allowed in the ICU, med storage rooms and immunocompromised patient rooms if I (or any other visitor) do not need any type of barrier protection upon entering the room. I’m happy to have him wait outside, though – this is the first “staff” (if I’m considered staff)/service animal team the hospital has encountered. Therefore, I want people to be comfortable as we begin the process of “normalizing” this type of team in the hospital setting.

I'm gonna need a picture of a dog in a sterile gown

 

[drechie]

Thank you so much for sharing this information

 

[Affiche]

I think I would have to pet him. I couldn't just have that cute little face sitting around not getting my attention.

You mentioned your professor got on the ground and played with him during small group stuff. So is it okay if people pet him for a bit, or does that interfere with his work?

 

[MSTP18]

So you're saying a resident that is working 80 hrs/wk is going to disinfect their dog after every 24 hour shift, clean out the nooks and crannies of their paws?

If my PTSD was so bad that I needed and went through all the rigamarole of procuring a service dog to pursue my dream of being a physician, then yes, I'm going to wash that dog after every 24 hour shift.

 

[DokterMom]

Thanks so much for starting this informative thread! And congratulations on all you've accomplished so far. I'm particularly impressed that you chose to work in a psych hospital and have put your own struggles to use benefiting others --

So did you bring your service dog with you to your interview(s) and if so, what were the reactions?

 

[Goro]

Medical school is stressful enough as it is. How are you handling it so far?

Hi all,

I'm opening up this AMA thread to encourage other med students/prospective students to advocate for themselves re: disabilities. I'm the first med student at my school to employ the use of a service animal and I want to share my experience. So please, ask away!

 

[deleted825474]

any concern for triggering patient's underlying asthma? From my experience, many patients don't know they have asthma. Same goes for patients being admitted to the hospital w/ new hematologic/immunodeficiency concerns. I definitely wonder about this from a 'do no harm' perspective.

also, more of a personal aside, any concern for spreading C dif/MRSA/VRE from the hospital floor to your home, when your dog jumps in bed?

Check out this doc from the CDC: https://www.cdc.gov/hicpac/pdf/guidelines/eic_in_hcf_03.pdf


There is no evidence showing that service animals increase the risk of transferring bugs around the hospital. Considering my pup won’t be interacting with any of the patients, I'm more likely to get them sick.


There is very little risk of triggering underlying asthma. He won't be interacting with patients and will be in a down-stay in the room away from the patient. I've had people who are really allergic to him be in the same room with no issues. Also, according to the CDC guidelines from the document linked above, if doctors/students/visitors do not need any PPE when interacting with a patient, then service animals are fine to be near the patient. If there's ever any worry, he can just be in a down stay away from the patient. He just needs to be able to see me, even if it's from across the room.



Ummmm...yeah. C diff in my living room. Not so excited about that, but I will just wipe him down after leaving the hospital. That's all I can do. I'm not too worried because I'm sure that we have those bugs in my house by now - we've both been in and around the hospital for the past year.

 

[deleted825474]

The important questions: What's his name? Is he a good boy? What is his favorite toy?

Also, thanks for doing this! I have a chronic illness (though fortunately not typically disabling if I stay on my meds) and it's good to know there are more of us out there dealing with health issues in med school.

haha his name is Jesse and he's a very good boy. He has this blue ball that he is obsessed with (literally, obsessed. We can't go to bed without it)

Sending you well wishes - thanks for your post

 

[jw3600]

Can people pet it? Or is one of those things where strangers can't touch it?

Him. Sorry haha

 

[libertyyne]

I understand service dogs have different relationships with their owners compared to regular old dogs. Do you still get to have fun with the dog at times like play fetch, or cuddle with it, or take it to a dog park to run around?

 

[deleted825474]

I think I would have to pet him. I couldn't just have that cute little face sitting around not getting my attention.

You mentioned your professor got on the ground and played with him during small group stuff. So is it okay if people pet him for a bit, or does that interfere with his work?

He can say hi to people when I let him. Usually people ask before petting him. Sometimes they can and sometimes, yes, it will interfere with his work.

We have long days (as you know), and he needs a break sometimes. So I usually just let him say hi after class or something. I've started taking off his vest when saying hi. He started getting lazy in his training when I'd let him interact with people too often. Taking the vest on/off helps.

 

[deleted825474]

If my PTSD was so bad that I needed and went through all the rigamarole of procuring a service dog to pursue my dream of being a physician, then yes, I'm going to wash that dog after every 24 hour shift.

Umm LOVE this

 

[deleted825474]

Thanks so much for starting this informative thread! And congratulations on all you've accomplished so far. I'm particularly impressed that you chose to work in a psych hospital and have put your own struggles to use benefiting others --

So did you bring your service dog with you to your interview(s) and if so, what were the reactions?

Thank you

I did not bring Jesse to my interviews. In retrospect, I should have. I was concerned about having a service animal in the medical field, being judged, etc. I even promised myself that I wouldn't use him 24/7 once I started medical school. Surprise, surprise, I realized how much I needed him a few weeks into school. After about a month I got up the courage to talk to the school about it. Thankfully, they were really supportive.

 

[deleted825474]

Medical school is stressful enough as it is. How are you handling it so far?

I have my moments like everyone else, but I'm doing great! Thanks for asking.

 

[deleted825474]

Can people pet it? Or is one of those things where strangers can't touch it?

Him. Sorry haha

lol yes, people can pet him, but they need to ask first. Sometimes I let them and sometimes I don't - it just depends on how I'm doing. He typically ignores people when there's something going on with me. He gets lazy when I let people pet him often and starts just going up to people without permission, so I don't really let him say hi that often (when his vest is on).

I have some general "when strangers can pet him" rules - never in stores (except children, because they are often petting him by the time they get around to asking haha. Also, they're so innocent and don't know any better), when a lecture is going on at school, when I'm studying, when I'm standing in line to get food in the cafeteria - those are some random examples.

 

[deleted825474]

I understand service dogs have different relationships with their owners compared to regular old dogs. Do you still get to have fun with the dog at times like play fetch, or cuddle with it, or take it to a dog park to run around?

We have SO much fun. When he's working too much, he lets me know it haha. We go for walks, play fetch and cuddle all the time. The difference is that he's really always working, even when his vest is off. Even when I tell him to go chill out, he's always watching me and checking on me.

Ps. I strongly discourage going to do parks. Jesse was attacked by a dog at one.

 

[OchemOficionado]

Yes! The hospital has therapy dogs - for the peds and psych units as well! There's also one for the med students.

I'm not sure if he gets and ID bag?! that would be so totally cool haha. I'm going to ask.

Omg, a dog for all of the students! I want to go to this school!

 

[MSTP18]

Omg, a dog for all of the students! I want to go to this school!

Fairly certain OP doesn't go to my med school (I think I would have noticed a dog walking around) but mine also has a therapy dog come to the library once/month. My undergrad did it regularly too. I imagine a bunch of other schools offer it to. If not, something to work on during your first year!

 

[OrthoTraumaMD]

I now want to know how to "gown" a dog so I can have one in my OR.

 

[medstu19]

Like all the rest, just want to say thanks to the OP for this frankly enlightening and cheering thread. Step studying is dragging all of us down mentally and emotionally so you can be sure I'll be checking back here once in a while

All the pets and kisses to Jesse

 

[deleted825474]

I now want to know how to "gown" a dog so I can have one in my OR.

Ummm me too. Also, you know I'm going to try to gown Jesse when I start surgery clerkships (unless it's super frowned upon....so maybe not). I will update with pictures haha

 

[WhittyPsyche]

This is so awesome to hear! My lab has been working on establishing the evidence base for psychiatric service dogs for children and adults and working on how to implement their use into schools. Love reading accounts like this!

PTSD has more backing, but we are trying to establish the same for anxiety and depression.


Sent from my iPhone using SDN mobile

 

[JP2740]

I now want to know how to "gown" a dog so I can have one in my OR.

Haha takes intimidating the third year med student in the OR to a whole new level if you got your doge with you. Especially if you train the doge to detect when the med student's grip is slippin on the retractor.