Quoted: Essential tremor in a medical student

Doodledog

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The following is posted for a member:

"I am a MD student in the clinical part of the curriculum. I have a mild-moderate essential tremor which has never been particularly impairing. I occasionally have a patient say something, usually during the physical exam, and I simply tell them "it's not that I'm nervous, it's a tremor I always have" and have never had anybody respond poorly. I know this is a subject which has been thoroughly discussed on the forums, but usually in the context of "can I be a doctor even though my hands aren't steady."

I have had several residents/attendings bring this issue up through my clinical rotations. Many initially interpreted the shakiness (eg of my papers that I'm holding when presenting) as being nervous but when we discuss it they say "oh, that makes more sense, you didn't seem nervous in any other way." I have been shaking for a long time and have never had as many people notice it as on clinics - abnormal movements are something doctors are obviously trained to notice very quickly. Notably, I have not run across any situation during clinics where the tremor actually impaired me. A surgeon remarked very positively on my technical skills for my level of training and suggested that if I was interested in surgery, I should still consider pursuing it. I do not intend on becoming a surgeon, in part because this tends to get worse with age.

I have received a number of comments in my written clinical evaluations about "being nervous" that I have not done anything about. I am sure that sometimes when I am actually nervous, as medical students are from time to time, this shows through in other ways, but if I still do have a strong suspicion that these comments were largely due to the tremor. My evaluations have overall been very positive in all of my rotations - even those who wrote these particular comments overall had a positive impression of me.

I plan to mention this issue to our dean who prepares the deans' letters so that he/she is aware of it and has it as another data point when reviewing everything which has been written during my evaluations. Is this appropriate? Am I going too far in either direction with this? Will this blow up into more than I want it to (thinking along the lines of considering something like this as a potential disability?)

Just along the lines of providing more data: yes, I've tried pharmacologic treatment for the tremor. Both first line drugs reduce it significantly, but I don't like the side effects - if my motor function were more impaired, the risks/benefits would be quite different, but at this point I haven't felt the need to take anything chronically.

Anything else I should be aware of or think about in this position? Should I be more proactive in explaining what's going on to people that otherwise may interpret it badly (both patients and supervisors)?"

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In general, I would advise you to bring it up at the beginning of each of your rotations / assignments. It's better to "clear the air", as everyone is going to notice it. I would say something like "I just wanted to tell you that I have an essential tremor. It's not parkinson's disease, I've had it my whole life. So far on all of my rotations, it hasn't affected my ability to work or do procedures. In fact, I did just fine on surgery. I tell you this because others have misinterpreted it as nervousness. In addition, if you think it is affecting my performance in any way, please bring it to my attention."

Another thing to think about is when you apply for residency. I would also seriously consider disclosing this in your personal statement -- talking about how it has been a challenge for you or something. If you don't, what will happen is you'll be interviewed and then people will be surprised, and perhaps uncomofrtable. It's best to bring it up so that people are prepared for it, and make it OK to talk about. Could disclosing it make some programs decide not to interview you? I doubt it, but if so they probably weren't going to rank you anyway.

My 2 cents.
 
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