ThoracicGuy

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Wax. Wax everything!



?
 
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Raryn

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These days, plenty of women don’t.

Plenty of men too, though usually they have hair *somewhere*.

That said, if the alternative was losing my residency, I could totally be convinced to wax everything from head to toe. And I'm a hairy mother-trucker. Might have to keep it up for a while to convince them it wasn't just because of the drug test...
 
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penpenclown

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That said, if the alternative was losing my residency, I could totally be convinced to wax everything from head to toe. And I'm a hairy mother-trucker. Might have to keep it up for a while to convince them it wasn't just because of the drug test...
"Oh yeah I've recently gotten into competitive swimming."
 
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Smurfette

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I heard a story of someone who tried shaving to beat the hair test. Shaved his head to find out either underarm or pubic hair was next, so shaved all that too. Beyond that....anywhere was fair game on full body inspection including eyebrows.
 
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BeLikeH2O

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I am so sorry this happend to OP. Surprise drug tests are very common for airline and fighter pilots, air trafic controllers, crane operators, local motive engineers, nuclear power plant engineers, and the list goes on and on. Canibas could be legal in your state, but we would not want you to operate the aforementioned equipment even if you just had just a little. I was on a golf course with a couple of guys I didn't know whom I was paried up with in a 4-some. Half way through, they pulled out a glass pipe and started smoking crack and offered me some. I emmidiately left and told them I had an emmergency, which I did and it was to get the hell away from there because I had a job interview the next day. My new employer likely will not ask for a drug test, but why chance it.
 
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BoardingDoc

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I was on a golf course with a couple of guys I didn't know whom I was paried up with in a 4-some. Half way through, they pulled out a glass pipe and started smoking crack and offered me some.
I'm sorry, what? You were playing golf and some of the other players stopped to take a crack break? Maybe crack is super prevalent in other areas that I'm not familiar with, but it isn't terribly common around here, and the Venn diagram of people who use it around here definitely doesn't overlap with people who play golf.
 
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yeasports

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I am so sorry this happend to OP. Surprise drug tests are very common for airline and fighter pilots, air trafic controllers, crane operators, local motive engineers, nuclear power plant engineers, and the list goes on and on. Canibas could be legal in your state, but we would not want you to operate the aforementioned equipment even if you just had just a little. I was on a golf course with a couple of guys I didn't know whom I was paried up with in a 4-some. Half way through, they pulled out a glass pipe and started smoking crack and offered me some. I emmidiately left and told them I had an emmergency, which I did and it was to get the hell away from there because I had a job interview the next day. My new employer likely will not ask for a drug test, but why chance it.
Public course?
 
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qwerty89

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Just for context in 2014 in California there was Proposition 46 on the ballot.
Proposition 46 is an initiative statute that would (1) require hospitals to perform drug testing of doctors, (2) require doctors to check a statewide database before prescribing certain drugs, and (3) raise the 1975 cap on noneconomic damages in medical negligence lawsuits to reflect inflation.

Of course the main goal was to increase the malpractice cap but they added on the drug testing to try to get enough public support. Luckily it was defeated. Kamala Harris was the Attorney General at that time.

JUST PEE IN CUP
 
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Mass Effect

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Just for context in 2014 in California there was Proposition 46 on the ballot.
Proposition 46 is an initiative statute that would (1) require hospitals to perform drug testing of doctors, (2) require doctors to check a statewide database before prescribing certain drugs, and (3) raise the 1975 cap on noneconomic damages in medical negligence lawsuits to reflect inflation.

Of course the main goal was to increase the malpractice cap but they added on the drug testing to try to get enough public support. Luckily it was defeated. Kamala Harris was the Attorney General at that time.

JUST PEE IN CUP

Your point? Drug testing doctors isn't a bad thing.
 
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Goro

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Just for context in 2014 in California there was Proposition 46 on the ballot.
Proposition 46 is an initiative statute that would (1) require hospitals to perform drug testing of doctors, (2) require doctors to check a statewide database before prescribing certain drugs, and (3) raise the 1975 cap on noneconomic damages in medical negligence lawsuits to reflect inflation.

Of course the main goal was to increase the malpractice cap but they added on the drug testing to try to get enough public support. Luckily it was defeated. Kamala Harris was the Attorney General at that time.

JUST PEE IN CUP
What does Kamala Harris have to do with it? My understanding of CA and it's innumerable ballot initiatives is that don't need many signatures to get one of these things onto the ballot, and this is why CA has so many of them every year.

Can Golden Staters comment on this?
 
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Beeftenderloin

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I wanna know what happened to this kid

Don’t know if this person is from my training program or not, but something almost identical happened with one of our new interns. The decision was ultimately overturned and the policy is being changed.
 
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gyngyn

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What does Kamala Harris have to do with it? My understanding of CA and it's innumerable ballot initiatives is that don't need many signatures to get one of these things onto the ballot, and this is why CA has so many of them every year.

Can Golden Staters comment on this?
Law by "proposition" is an abomination.
 
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StIGMA

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Don’t know if this person is from my training program or not, but something almost identical happened with one of our new interns. The decision was ultimately overturned and the policy is being changed.

A more nuanced response to this sort of thing is appropriate. Close monitoring for a period is better than getting the axe- for both parties.
 
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Don’t know if this person is from my training program or not, but something almost identical happened with one of our new interns. The decision was ultimately overturned and the policy is being changed.

by any chance is this program at a large healthcare system in a certain midwestern city?

I’ve heard about this policy from a few friends there. Look, with a few medical exceptions, no one should be smoking pot in residency. But this particular policy was dumb. as. hell. Specifically telling residents that they will be urine tested, and then doing a surprise hair follicle test on Day 1.... after everyone’s being stuck at home with nothing to do for 4 months in an unprecedented global pandemic? That’s something you do when you’re trying to get rid of residents.
 

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policy was dumb. as. hell.

No, continuing to smoke pot when you know you're going to be drug tested and trying to time it so you don't pop positive is dumb as hell. Boredom isn't an excuse for irresponsibility, especially in medicine.
 
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IMGASMD

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by any chance is this program at a large healthcare system in a certain midwestern city?

I’ve heard about this policy from a few friends there. Look, with a few medical exceptions, no one should be smoking pot in residency. But this particular policy was dumb. as. hell. Specifically telling residents that they will be urine tested, and then doing a surprise hair follicle test on Day 1.... after everyone’s being stuck at home with nothing to do for 4 months in an unprecedented global pandemic? That’s something you do when you’re trying to get rid of residents.

Can I offer you the grandma test?

Do you want your grandma to be treated by a physician with a positive test regardless what the law is?

Simple test.
 
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ThoracicGuy

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by any chance is this program at a large healthcare system in a certain midwestern city?

I’ve heard about this policy from a few friends there. Look, with a few medical exceptions, no one should be smoking pot in residency. But this particular policy was dumb. as. hell. Specifically telling residents that they will be urine tested, and then doing a surprise hair follicle test on Day 1.... after everyone’s being stuck at home with nothing to do for 4 months in an unprecedented global pandemic? That’s something you do when you’re trying to get rid of residents.

So let's just get high?

 
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So let's just get high?


No.

the point is that 1) they gave residents incorrect information, and 2) they changed from a urine to a hair test only AFTER quarantine had been in effect for a while. To me, this makes it seem like they were specifically trying to “catch” people who had been smoking pot while quarantined.

Considering 1) hair tests are very expensive and do not detect current impairment (takes 2-4 weeks to come up positive), and 2) this healthcare system did not also urine test to detect current impairment, it is reasonable to conclude that patient safety wasn’t the goal so much as punishing and getting rid of incoming residents with PMHx of being a pothead.
 
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Dr.LeoSpaceman

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the point is that 1) they gave residents incorrect information, and 2) they changed from a urine to a hair test only AFTER quarantine had been in effect for a while. To me, this makes it seem like they were specifically trying to “catch” people who had been smoking pot while quarantined.

Considering 1) hair tests are very expensive and do not detect current impairment (takes 2-4 weeks to come up positive), and 2) this healthcare system did not also urine test to detect current impairment, it is reasonable to conclude that patient safety wasn’t the goal so much as punishing and getting rid of incoming residents.

If only there were a simple way for people to avoid this nefarious plot by residency programs....

And it's reasonable to conclude that programs cared more about detecting people with a pattern of use. Yes I care if you're currently impaired. But what Is find just as concerning is someone with a pattern of use who is trying to hide it by simply abstaining enough to pass a UDS. And yeah, that person who "tried it once on vacation" gets caught in the dragnet. But they don't get a pass considering it demonstrates questionable judgement, and I'm not shedding tears over someone who is going to be responsible for 3-7 years of direct patient care. "I just tried it once, but didn't realize it was a hair test" turns into "I just didn't go follow-up once on that nurse call...but how could I predict the patient was going to code in a few hours?"
 
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ThoracicGuy

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No.

the point is that 1) they gave residents incorrect information, and 2) they changed from a urine to a hair test only AFTER quarantine had been in effect for a while. To me, this makes it seem like they were specifically trying to “catch” people who had been smoking pot while quarantined.

Considering 1) hair tests are very expensive and do not detect current impairment (takes 2-4 weeks to come up positive), and 2) this healthcare system did not also urine test to detect current impairment, it is reasonable to conclude that patient safety wasn’t the goal so much as punishing and getting rid of incoming residents with PMHx of being a pothead.

I'll refer you to this post from earlier:



And you're the one that basically said that they were quarantined for 4 months, so what else was there to do to combat boredom except get high on drugs...
 
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ThoracicGuy, you are putting words in my mouth. I never said that “there’s nothing to do but smoke pot.” I said that a last minute policy change seems intended to catch this.

and yes, I do think it is nefarious to lie to residents. They presented these residents a written policy. Then they violated it - in a way that was effectively retroactive.

Let’s say, for instance, I’m a residency program.

I put in my written policy that “anyone who has been arrested in the last 5 years will be denied employment.” I tell prospective applicants about this policy during the interview. I present it to them in writing.

Jimmy has an arrest from 8 years ago. He thinks “ok, I’m good as long as I keep my nose clean from this point on.” He ranks my program #1. He even ranks it higher than other programs with no such policy.

he matches my program. Yay! Time for onboarding. Too bad I decided today that I would be expanding my “no arrests” policy to 10 years - after he already ranked me. Jimmy is denied employment.

sucks for Jimmy. Guess he shouldn’t have gotten arrested, right? Can’t be denied employment if you didn’t get arrested, right ThoracicGuy?

from what I’ve heard, this was essentially the argument that got these residents reinstated.
 
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ThoracicGuy

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ThoracicGuy, you are putting words in my mouth. I never said that “there’s nothing to do but smoke pot.” I said that a last minute policy change seems intended to catch this.

and yes, I do think it is nefarious to lie to residents. They presented these residents a written policy. Then they violated it - in a way that was effectively retroactive.

Let’s say, for instance, I’m a residency program.

I put in my written policy that “anyone who has been arrested in the last 5 years will be denied employment.” I tell prospective applicants about this policy during the interview. I present it to them in writing.

Jimmy has an arrest from 8 years ago. He thinks “ok, I’m good as long as I keep my nose clean from this point on.” He ranks my program #1. He even ranks it higher than other programs with no such policy.

he matches my program. Yay! Time for onboarding. Too bad I decided today that I would be expanding my “no arrests” policy to 10 years - after he already ranked me. Jimmy is denied employment.

sucks for Jimmy. Guess he shouldn’t have gotten arrested, right? Can’t be denied employment if you didn’t get arrested, right ThoracicGuy?

from what I’ve heard, this was essentially the argument that got these residents reinstated.

You are excusing their behavior of doing drugs by saying they had 4 months at home in quarantine, as if it were completely natural to just go get high because they have nothing else to do. That is your words.

Marijuana is still classified an illegal drug by the Federal Government, you know the one that gives out the DEA licenses. Just because it may be legal in one state doesn't mean there are no consequences with its use. It's just not smart to do it, particularly as a 4th year medical student and certainly not as a physician.

Too bad. Don't do drugs, mmkay?
 
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Dr.LeoSpaceman

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I put in my written policy that “anyone who has been arrested in the last 5 years will be denied employment.” I tell prospective applicants about this policy during the interview. I present it to them in writing.

This hypothetical is a terrible argument.

1) Because it's not realistic. No residency of which I'm aware sets limits on arrests. Everything is fair game.

2) The time frame matters. If someone smoked pot 8 years ago, I honestly don't care. But the time difference on positivity for hair vs. urine isn't compelling. Both fall into the category of "recent", and certainly within a time period which would cause concern about whether it may continue in residency.
 
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This hypothetical is a terrible argument.

1) Because it's not realistic. No residency of which I'm aware sets limits on arrests. Everything is fair game.

2) The time frame matters. If someone smoked pot 8 years ago, I honestly don't care. But the time difference on positivity for hair vs. urine isn't compelling. Both fall into the category of "recent", and certainly within a time period which would cause concern about whether it may continue in residency.

I believe it is a perfectly fair argument. Apparently the lawyers did too.

1) a time limit on illegal activity is exactly what a drug test is.

2) your personal opinion on what is “recent” is irrelevant. Only hospital policy is relevant.
 

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I believe it is a perfectly fair argument. Apparently the lawyers did too.

1) a time limit on illegal activity is exactly what a drug test is.

2) your personal opinion on what is “recent” is irrelevant. Only hospital policy is relevant.
Lawyers will believe whatever gets them paid
 
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yeasports

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Yeasports back in the day at Occmed for onbording exam to start internship...

Occmed Tech: Ok so I will need a sample of you hair for drug testing.
Yeasports: Say man, you got a urine test?
Occmed Tech: No, not on me, man.
Yeasports: It'd be a lot cooler if you did.
 
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Dr.LeoSpaceman

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Only hospital policy is relevant.

Relevant to what? Certainly not to those things which are associated with adequate training of residents or appropriate medical care.

And the time horizon for which residencies are interested is long, as demonstrated by the fact that there is no time limit on criminal issues on ERAS. And it certainly should at least cover the time period for which you are in medical school. So like I said, comparing a criminal incident "eight years ago" to something which covers an activity within the past few months is a false equivalence.
 
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Raryn

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In the situation I am referencing the resident used cannabis in a state where it was 100% legal for them to do so.

That does not exist. There is no state where it is 100% legal, because while it might not be a state crime, it's still illegal federally.
 
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Dr.LeoSpaceman

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Never mind the fact that testing for cannabis at all is archaic and pointless. Urine test, hair test, who cares, these aren’t tests for acute intoxication which is all that should matter when it comes to fitness for practicing medicine.
Substance dependence matters for fitness to practice medicine. Judgment and discretion matter for fitness to practice medicine. Would you trust an alcoholic to operate on you just because their BAC is 0.0? They might not be acutely intoxicated, but if their time spent outside the hospital is used for getting plowed, it doesn't exactly inspire confidence that they will 1) be on top of their professional game 2) available if something urgent happens.

A physician can finish their shift, go home, down a pint of vodka and nobody bats an eyelash long as they are sober when they show up to work. How is cannabis any different. Quite frankly it’s much safer.

Best believe that if residencies and hospitals had a way to test for binge drinkers, they would do it and use it to make personnel decisions. In fact, in the era of social media, it already happens...without an objective test. This comparison to alcohol use/abuse gets brought up continually, even though it makes no sense. There's this perception that PDs or hospital administrators are cool with people going out and getting ****canned on the reg as long as they don't show up drunk. People have absolutely been fired for alcohol use issues, and the issue is not that it's "permitted" but simply harder to detect.

Cannabis is recreationally legal in over 20% of US states with another 6 states poised to follow suite this year. What will your argument be when it’s federally legal (which is highly likely in the next couple of years). How about we collectively step out of the dark ages and stop ruining people’s lives for no reason.

Raryn already pointed out that it remains illegal at the federal level. But regardless, the legality is a strawman. Being a pot smoker isn't a protected class, and you can be fired for it regardless of whether it's legal or illegal. Same goes for licensure.

Have fun being on the wrong side of history.
You mean like the history of physicians smoking on rounds and having a drink at lunch?
 
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Raryn

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It does exist. There are 11 states plus DC where it is legal. Another 6 on the way. At the time of use they were under no employment agreement restricting its use and they were not beholden to any organization that federal restrictions would apply to. There’s a reason it was overturned, because it’s wrong.

Keep fighting this one. Have fun being on the wrong side of history. I’ll make sure I stay off your lawn.
I'm not fighting against pot. I'm saying even if you live in a state where it is nominally legal *on a state level* you still live in a country where it isn't. And even if it's legal, employers can - and do - still discriminate. Hell, in 21 states, it's still legal to fire - or not hire - someone for smoking tobacco - which is fully legal everywhere in the US.

(Cleveland Clinic for example will test people for nicotine metabolites before onboarding. If you test positive for cotinine, they rescind your appointment. Even for residents and fellows.)
 
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It does exist. There are 11 states plus DC where it is legal. Another 6 on the way. At the time of use they were under no employment agreement restricting its use and they were not beholden to any organization that federal restrictions would apply to. There’s a reason it was overturned, because it’s wrong.

Keep fighting this one. Have fun being on the wrong side of history. I’ll make sure I stay off your lawn.
You've said it twice, which doesn't make it true. Federal law trumps state law. Here in the United States, it's in the constitution. It's Article VI, clause 2. It's referred to as "the supremacy clause". Here is the exact wording: "This Constitution, and the Laws of the United States which shall be made in Pursuance thereof; and all Treaties made, or which shall be made, under the Authority of the United States, shall be the supreme Law of the Land; and the Judges in every State shall be bound thereby, any Thing in the Constitution or Laws of any State to the Contrary notwithstanding."

Just because states legalize it, that does not make it legal under federal law. See above. Enforcement of federal law is a separate, related issue.
 
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VA Hopeful Dr

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It does exist. There are 11 states plus DC where it is legal. Another 6 on the way. At the time of use they were under no employment agreement restricting its use and they were not beholden to any organization that federal restrictions would apply to. There’s a reason it was overturned, because it’s wrong.

Keep fighting this one. Have fun being on the wrong side of history. I’ll make sure I stay off your lawn.
Nope, that's not how things work.

If my state made murder legal tomorrow, I couldn't go out and kill someone because there are federal laws against it.

Same thing applies here. The only reason marijuana laws aren't being used to jail thousands of people in those states where it's legal is because the DOJ has said they won't go after them if it's legal at the state level.

That doesn't mean it's legal, just that the laws aren't being enforced.
 
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ThoracicGuy

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Nope, that's not how things work.

If my state made murder legal tomorrow, I couldn't go out and kill someone because there are federal laws against it.

Same thing applies here. The only reason marijuana laws aren't being used to jail thousands of people in those states where it's legal is because the DOJ has said they won't go after them if it's legal at the state level.

That doesn't mean it's legal, just that the laws aren't being enforced.

But, but, but muh weeeed!
 
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I'm not fighting against pot. I'm saying even if you live in a state where it is nominally legal *on a state level* you still live in a country where it isn't. And even if it's legal, employers can - and do - still discriminate. Hell, in 21 states, it's still legal to fire - or not hire - someone for smoking tobacco - which is fully legal everywhere in the US.

(Cleveland Clinic for example will test people for nicotine metabolites before onboarding. If you test positive for cotinine, they rescind your appointment. Even for residents and fellows.)

Do they (Cleveland clinic) really rescind the appt without any further evaluation? I thought it was a probationary step that made you have to get retested and negative before starting.

Granted the timing of nicotine metabolites is days and they are very upfront about it, having interviewed there for residency long ago.
 
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Raryn

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Do they (Cleveland clinic) really rescind the appt without any further evaluation? I thought it was a probationary step that made you have to get retested and negative before starting.

Granted the timing of nicotine metabolites is days and they are very upfront about it, having interviewed there for residency long ago.
Yes.

Beginning September 1, 2007, appointments that have been offered to prospective residents and fellows who test positive will be rescinded. Individuals who test positive will receive a referral to a tobacco cessation program paid for by Cleveland Clinic. Those individuals testing positive who test negative after 90 days may be reconsidered for appointment at the discretion of the program director should the residency position remain vacant

So your appointment is rescinded but the PD may, at their discretion, reaccept you 3 months later if you've been clean. You can imagine that most programs will be trying to find someone to replace you before those 3 months are up.
 
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It is terrible that you lost your residency spot like that over something that most reasonable people know is not a big deal. Because they didn't honor elements of their contract such as an appeal, you may want to get a lawyer to see if they can do something for you,

For future reference, if you know something like this is going to happen like they try to trick you from urine to hair test, you should flat out refuse to do the test. Do NOT allow them to have the evidence they try to find. Instead, you refuse and you hire a lawyer who can argue for things like privacy rights and what not. By the time this all gets resolved, chances are they will not be able to detect it on you or will have given up because of the threat of a lawsuit
 

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It is terrible that you lost your residency spot like that over something that most reasonable people know is not a big deal. Because they didn't honor elements of their contract such as an appeal, you may want to get a lawyer to see if they can do something for you,

For future reference, if you know something like this is going to happen like they try to trick you from urine to hair test, you should flat out refuse to do the test. Do NOT allow them to have the evidence they try to find. Instead, you refuse and you hire a lawyer who can argue for things like privacy rights and what not. By the time this all gets resolved, chances are they will not be able to detect it on you or will have given up because of the threat of a lawsuit

How do you know they won't fire you on the spot for refusal? Do you have expertise in this?
 
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Dr.LeoSpaceman

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For future reference, if you know something like this is going to happen like they try to trick you from urine to hair test, you should flat out refuse to do the test. Do NOT allow them to have the evidence they try to find.

You can always count on these threads to contain stupid advice.

My contract contained specific language that said all trainees would be required to complete pre-employment testing. Consequence for refusal was clearly stated to be revocation of the offer.

Even if you try to make an argument regarding employee privacy, they have an easy out. As I understand things, you aren't an employee until you show up for work after completing all the steps necessary to start. So if you don't complete the test, you aren't an employee. As stated elsewhere, your only option would be to complete the test and avail yourself of any associated appeals process. Simply refusing the test is therefore the worst possible course of action.
 
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gutonc

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You can always count on these threads to contain stupid advice.

My contract contained specific language that said all trainees would be required to complete pre-employment testing. Consequence for refusal was clearly stated to be revocation of the offer.

Even if you try to make an argument regarding employee privacy, they have an easy out. As I understand things, you aren't an employee until you show up for work after completing all the steps necessary to start. So if you don't complete the test, you aren't an employee. As stated elsewhere, your only option would be to complete the test and avail yourself of any associated appeals process. Simply refusing the test is therefore the worst possible course of action.
It's akin to refusing a breathalyzer and field sobriety test if pulled over for DUI. You will then be arrested for and charged with that, which is going to be a lot harder to fight than blowing a .12 and lawyering up.

And a DUI conviction is much less harmful to your future career than refusing a pre-employment drug test would be.
 
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Dr Tapatio

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You can always count on these threads to contain stupid advice.

My contract contained specific language that said all trainees would be required to complete pre-employment testing. Consequence for refusal was clearly stated to be revocation of the offer.

Even if you try to make an argument regarding employee privacy, they have an easy out. As I understand things, you aren't an employee until you show up for work after completing all the steps necessary to start. So if you don't complete the test, you aren't an employee. As stated elsewhere, your only option would be to complete the test and avail yourself of any associated appeals process. Simply refusing the test is therefore the worst possible course of action.
What other moves do you have at that point? You know they'll catch you with your pee and fire you. What are you going to appeal? That your pee isn't real? You're not an employee still if they catch you, so back to square 1. The only hope you have is to say that they are changing the rules and making the test more and more invasive. We are talking of a situation where you're going to lose anyway. Might as well go down with some kind of a fight than to just give them the evidence and get fired. At this point OP could find another residency but may need to disclose substance abuse problems as a result of the urinalysis

How do you know they won't fire you on the spot for refusal? Do you have expertise in this?
You're getting fired anyway. This way at least the program may try to avoid a lawsuit and grant some leeway. If not, you're fired anyway. Do you think it's better to just give them the evidence and be fired? These are your alternatives. Do you have expertise in this?
 
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What other moves do you have at that point? You know they'll catch you with your pee and fire you. What are you going to appeal? That your pee isn't real? You're not an employee still if they catch you, so back to square 1. The only hope you have is to say that they are changing the rules and making the test more and more invasive. We are talking of a situation where you're going to lose anyway. Might as well go down with some kind of a fight than to just give them the evidence and get fired. At this point OP could find another residency but may need to disclose substance abuse problems as a result of the urinalysis


You're getting fired anyway. This way at least the program may try to avoid a lawsuit and grant some leeway. If not, you're fired anyway. Do you think it's better to just give them the evidence and be fired? These are your alternatives. Do you have expertise in this?

Arguing about them "changing the rules" on drug testing is pretty much an admission of guilt. People who know they will test negative aren't going to make a huge deal about it. Plus, they can always request a "random" drug test at any time....guess who they are going to pick?

As far as getting sued, the hospital has much deeper pockets than you do, plus that lawsuit is going to drag on for a while before it is settled. And being the person who sued their employer to get out of a drug test is not going to endear you to future employers.

The hair test isn't typically positive for single use of a drug, so it is assumed there was repetitive use over time if it's positive. It catches the chronic users. Which is more concerning to hospitals and employers anyhow.
 
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