Seriously considering not attending med school due to medical situation

[Amino Acid]

I really need some advice. Here's the situation: I have been gratefully accepted to many fine medical schools and was in the final decision process of where to attend. Medical school and caring for the sick, or other helpless people has been my aspiration for as long as I can remember.

I am also in the process of receiving medical treatment for Hepatitis C which I unfortunately contracted from a blood transfusion when I was a baby. The treatments are debilitating enough without trying to finish up my last semester of undergrad, interview and make final decisions about med school. I should finish treatments at the very end of July, just in time to start med school. My VL may be clear at that point, hopefully, but the true test is if I am clear six months later. Once one has attained a SVR, it rarely comes back after two years. There is also a chance that i will not even clear the virus this first round and have to go for retreatment but I will not know that before having to make a decison about med school.

Recently I have read that med schools test students routinely to ascertain if they have HCV and those testing positive are not allowed to participate in certain procedures. I do not want to be stigmitized or victimized and for this to go on my record. I do not want it to follow me forever.

I am well aware of standard precautions and know I can protect patients from any extremely minimal chance of them contracting the virus from me.

The question is what should I do? Wait until I know for sure the virus is cleared from my system? Go to med school and hope to test negatively and for no one to ever know? Do I have to tell the schools I have been undergoing treatment? Are there any schools that do not test?

I really need some advice as this is tearing me apart.

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[marina]

Wow-
I'm so sorry that you're that sick. I think you should talk to medical schools about your situation and consider deferring for a year. Or, maybe you could ask them if you could wait until July, see if you're better, and if you need more treatment you could defer.
Good luck! Try to focus on good things, like you got into great schools and you're going to be a wonderful doctor!

 

[Amino Acid]

Wow-
I'm so sorry that you're that sick. I think you should talk to medical schools about your situation and consider deferring for a year. Or, maybe you could ask them if you could wait until July, see if you're better, and if you need more treatment you could defer.
Good luck! Try to focus on good things, like you got into great schools and you're going to be a wonderful doctor!

But the point is I don't want anyone, especially med schools, to even know. The treatments are horrible, but I'll manage; I've been through worse and I'll get through this too. I really don't want anyone to know and I feel being forced to reveal my condition is an invasion of my privacy.

 

[LVDoc]

Sorry to hear about all your troubles. It's possible you could try asking to defer for a year; you don't have to tell them about your situation - you could be fairly vague about it or make up something I suppose. I've heard schools do test for certain infections, and I may be wrong, but I think it really only happens before you start your clerkships. Definitely though, if you intend to matriculate at a particular school, they will ask you for standard immunization records (MMR, Hep B, etc.), a physical exam, and the likes; the rest is generally self-reported history, family history, etc.

Reading your post again, in order to avoid any future complications, maybe it would be best if you defer a year and wait until your results come back clear six months later.

 

[Law2Doc]

I am well aware of standard precautions and know I can protect patients from any extremely minimal chance of them contracting the virus from me.

Well, the problem is that if you ever participate in any sort of surgery or other invasive procedure, there is an significant possibility that you will get nicked (even if you are extremely careful, someone else could get you -- it's tough to always tell what's what in some procedures), and this would put the patient at risk. Some experienced doctors refer to med students as "killer bees" because of the frequency that they stick/nick hospital staff with needles and scalpels. I've been told by surgeons that getting nicked still happens with double gloves, and that people tend to feel that they lose too much fine tune control with double gloves anyhow, so most frown on it unless working on patients with certain known infectious conditions. So I think a medical program really needs to know if you have something potentially blood transmittable before allowing you to do certain things, and will certainly need to consider it in determining if you can satisfy the program.

 

[Amino Acid]

Well, the problem is that if you ever participate in any sort of surgery or other invasive procedure, there is an significant possibility that you will get nicked (even if you are extremely careful, someone else could get you -- it's tough to always tell what's what in some procedures), and this would put the patient at risk. Some experienced doctors refer to med students as "killer bees" because of the frequency that they stick/nick hospital staff with needles and scalpels. I've been told by surgeons that getting nicked still happens with double gloves, and that people tend to feel that they lose too much fine tune control with double gloves anyhow, so most frown on it unless working on patients with certain known infectious conditions. So I think a medical program really needs to know if you have something potentially blood transmittable before allowing you to do certain things, and will certainly need to consider it in determining if you can satisfy the program.

But hopefully by the time I participate in any surgery, I'd be virus-free so why would anyone ever have to know? i know HCV carries a stigma and if I'm virus-free why should I have to be stigmized and discriminated against?

 

[Amino Acid]

Sorry to hear about all your troubles. It's possible you could try asking to defer for a year; you don't have to tell them about your situation - you could be fairly vague about it or make up something I suppose. I've heard schools do test for certain infections, and I may be wrong, but I think it really only happens before you start your clerkships. Definitely though, if you intend to matriculate at a particular school, they will ask you for standard immunization records (MMR, Hep B, etc.), a physical exam, and the likes; the rest is generally self-reported history, family history, etc.

Reading your post again, in order to avoid any future complications, maybe it would be best if you defer a year and wait until your results come back clear six months later.

what do you mean by "future compliacations"? What do first year med students do that could cause a problem?

 

[LVDoc]

what do you mean by "future compliacations"? What do first year med students do that could cause a problem?

Absolutely nothing, but if you're really concerned about routine checks and waiting to have the results come back clear before you start, then deferring would give you a bit more leeway. In a worst-case scenario where you have to go for retreatment, that extra year would help; hopefully that doesn't happen though.

 

[beep]

it's understandable that you want to keep this to yourself, but you have a responsibility to your future patients to do all that is in your power to keep them safe. clearly, not discussing your hep c+ status with the school and coming up with a plan for evaluating and managing the risk could put your patients in some danger. if you don't want to tell, deferring for a year to see if you can clear the virus seems like a reasonable course of action.

as for stigma and discrimination, of course it exists, but i think you'll find that schools are surprisingly able to work with you on this issue. you may or may not have to accept a few limitations in what you can do, but if you are somewhat limited it will be in the service of the greater good and you should suck it up. you should realize that to the extent you are not a danger to patients, you are protected from discrimination by law. (whether or not you actually don't experience discrimination is another issue, but at least you have some protection.)

it seems to me that you are asking for permission from us to not tell and to forge ahead with school. i for one think that would be an unethical course of action and i urge you not to take it.

 

[Law2Doc]

But hopefully by the time I participate in any surgery, I'd be virus-free so why would anyone ever have to know? i know HCV carries a stigma and if I'm virus-free why should I have to be stigmized and discriminated against?

That didn't sound quite right to me so I did a quick google search. According to the Canadian Public Health website, "In most cases, people with HCV infection do NOT get rid of it. They will have HCV infection for the rest of their lives." Hopefully your treatment will result in a fairly healthy life for you, HCV notwithstanding.
While I don't think you should be stigmatized or discriminated against, I do think that medical programs have to be able to take precautions to limit the likelihood that their staff isn't infecting their patients. Whether they can accomodate you via a totally non-invasive form of clinical rotation is something that needs to be up to them. You may want to post on the allo board and see if they are aware of this kind of accomodation ever having been done (and where). Best of luck.

 

[Amino Acid]

it's understandable that you want to keep this to yourself, but you have a responsibility to your future patients to do all that is in your power to keep them safe. clearly, not discussing your hep c+ status with the school and coming up with a plan for evaluating and managing the risk could put your patients in some danger. if you don't want to tell, deferring for a year to see if you can clear the virus seems like a reasonable course of action.

as for stigma and discrimination, of course it exists, but i think you'll find that schools are surprisingly able to work with you on this issue. you may or may not have to accept a few limitations in what you can do, but if you are somewhat limited it will be in the service of the greater good and you should suck it up. you should realize that to the extent you are not a danger to patients, you are protected from discrimination by law. (whether or not you actually don't experience discrimination is another issue, but at least you have some protection.)

it seems to me that you are asking for permission from us to not tell and to forge ahead with school. i for one think that would be an unethical course of action and i urge you not to take it.

I was actually hoping you would tell me my fears were unfounded and that my patients are in absolutely no danger and to go ahead and fulfill my dreams. I realize that is totally unrealistic but realize I have now resorted to a dream world because I no longer like reality. Ok sorry for the melodrama but you have no idea how sick I am over this and I really don't know what to do. Seriously put yourself in my situation (mentally, because you can't begin to imagine how I'm feeling physically) and se eif it's so easy for you to just give up (or even defer) on something you worked so hard for your whole life.

 

[Amino Acid]

That didn't sound quite right to me so I did a quick google search. According to the Canadian Public Health website, "In most cases, people with HCV infection do NOT get rid of it. They will have HCV infection for the rest of their lives." Hopefully your treatment will result in a fairly healthy life for you, HCV notwithstanding.
While I don't think you should be stigmatized or discriminated against, I do think that medical programs have to be able to take precautions to limit the likelihood that their staff isn't infecting their patients. Whether they can accomodate you via a totally non-invasive form of clinical rotation is something that needs to be up to them. You may want to post on the allo board and see if they are aware of this kind of accomodation ever having been done (and where). Best of luck.

That's not true. Many people attain a viral load of zero following treatment. A sustained viral response is when this continues beyond 6 months after completion of treatment.

"According to recent Canadian guidelines, the recommended treatment for HCV infection is with a combination of interferon alfa-2b and ribavirin. Rebetron* is the combination of these two therapies which together have produced better results than either treatment used alone. Rebetron* combines ribavirin capsules (taken orally twice daily) and interferon alfa-2b (injected 3 times weekly).

Interferon is a biological response modifier. This drug helps your body's immune system to fight infection. Ribavirin, on the other hand, is an antiviral agent which fights HCV.

The success of any treatment is not measured by how effective it is while you are taking it, but whether the results can be maintained for at least six months after treatment. Studies, where combination therapy was the only treatment ever used by a patient, showed that 41% had undetectable levels of HCV-RNA in their blood six months following treatment, and 62% showed improvement in their liver tissue. As well, the use of combination therapy in patients who were previously treated with interferon and then relapsed, showed that 49% had undetectable levels of HCV-RNA in their blood. "

http://www.hepnet.com/hepc/power.html

 

[tinkerbelle]

It seems like the first thing you should do is call each med school (do it anonymously or something) and find out their policy on HepC+ med students. Maybe they won't care. It would be such a shame for you to give up med school for something you have no control over and that's not your fault. Don't give up hope yet. Good luck

And I hope your treatments are going ok and will be over soon

They really need to make a "hugs" smiley face. It would be so appropriate right now.

 

[beep]

I was actually hoping you would tell me my fears were unfounded and that my patients are in absolutely no danger and to go ahead and fulfill my dreams. I realize that is totally unrealistic but realize I have now resorted to a dream world because I no longer like reality. Ok sorry for the melodrama but you have no idea how sick I am over this and I really don't know what to do. Seriously put yourself in my situation (mentally, because you can't begin to imagine how I'm feeling physically) and se eif it's so easy for you to just give up (or even defer) on something you worked so hard for your whole life.

i have also had tough medical problems (~2 years spent hospitalized). by saying that i don't mean to imply that i certainly know what you're going through or to play a sicker-than-you game, just to say that i can relate. it has been agonizing for me to contemplate giving up being a doc at the times when my medical problems looked like they might prevent me. luckily, i am better now, but i still have a major physical disability. it will not keep me out of school, but i will also definitely need some accommodations to make it through, and i will not be able to persue some specialities.

i am so sorry that you are struggling now, both with being sick and with the prospect of having your dreams limited. however, as i said before, i think the bottom line here has to be your future patients' safety. in order to make sure you don't put someone else in your current situation (or a worse one), you need to either put off school until you know you can't infect anyone or talk to the school and make a plan for accommodating you. i don't think it's "so easy", but sometimes one has to deal with hard things.

i hope things work out well for you.

 

[TwoLegacies]

I was actually hoping you would tell me my fears were unfounded and that my patients are in absolutely no danger and to go ahead and fulfill my dreams. I realize that is totally unrealistic but realize I have now resorted to a dream world because I no longer like reality. Ok sorry for the melodrama but you have no idea how sick I am over this and I really don't know what to do. Seriously put yourself in my situation (mentally, because you can't begin to imagine how I'm feeling physically) and se eif it's so easy for you to just give up (or even defer) on something you worked so hard for your whole life.

Hey.

It seems like you know what the answer is. Patient safety aside (though it's nothing to dismiss), don't you think it would be best for YOU health-wise to defer one year? You want to start med school on your best footing, because it's going to be much more demanding than undergrad. It will take a toll on anyone physically, especially someone who is already having health issues.

I think you should defer *because* you've worked so hard. If testing positive or perhaps not being healthy enough (YET) to begin the demands of med school are risks to your success in med school, then why take those risks? Err on the side of safety.

It's understandable that you want to start right away. But deferring is nowhere near giving up on the dream. Take the year to do some things that you've been missing out on because of your health, and get better! Good luck.

 

[cfdavid]

Yeah, sorry to hear about what you're going through. IMHO, it seems that you would regret not pursuing your dream as a result of your condition. It could cause you to be resentfull down the road, and maybe even bitter.

On the other hand, remember, you can always wait to see if it clears up, or determine if you'll be up to med school in July. If NOT, perhaps there are other ways in which you can prepare that may not be as demanding. Then, when things finally clear up (I'm sure they will in time), you can go back at medical school.

Regardless, your experiences will make you stronger, and hopefully, a better doctor. So, don't give up the dream for anything.

 

[elicash]

amino acid,
this has been a concern of mine because i have been sick for a while, not with hepC... but mine is not a condition that puts patients at risk. however, the frustration of average doctors who can't diagnose (even top doctors at two top NYC hospitals), the frustration of having tests and tests and having to teach my self about my own health -- all that has led to a frustration that makes me have second thoughts about going to medical school, because i feel like, why join a profession where so many of the practitioners are unable to find the answers to questions.

however, my advice is this.
1. you should not give up med school because of this. at the worst, you should defer for a year, because even then you could decide not to go in a year.
2. do you really need to defer? remember that in your first two years, you won't be doing too many procedures that put people at risk.
3. why not call a school where you are NOT going, talk to someone who knows, and give them your whole situation-- and ask for some honest advice. i would call a few schools to get some different takes, and this should have no effect on your situation, since these are not your schools.
4. a lot of people are going to give you incorrect answers--as you have seen by the disparity of comments on this thread--they are going to think that this is a disease that will always compromise you, so they'll say that you might not be able to go; or they'll say that you can be disease free, so go ahead... but what the official stance is, that is tougher to figure out. that's what you should figure out-- what the "law" is, so to speak.
5. i don't think you have to tell people about your specific condition. you can leave it vague. in a deferral request, for example, i think saying that you have medical problems and want a year to clear them up, that should be sufficient.
6. YOU SHOULD NOT BE EMBARRASSED. first of all, it's a medical condition and doctors are basically nonjudgemental about these things... and if they are judgemental, screw them. furthermore, it was contracted as a baby, so it's totally NOT YOUR FAULT. it's was not a fault of bad judgement/foolish behavior.
7. as a med student, you may not be able to participate in certain procedures. big deal. it is a condition you have. there's nothing you can do about it. you just have to tell the head teacher (in private), look, i have a blood condition contracted as a baby through a bad transfusion (not HIV), and i am disease free right now, but i don't think i should do X Y and Z. what do you think? and i believe that these doctors will be sympathetic and work out a way that you do the procedures that you can do safely for your patients, and not do the things that will put patients at risk... it probably means that you can't be a surgeon, but there are plenty of specialities where there is an incredibly low risk of doctor-patient blood contact.
8. again, it's not your fault. however, of course it is going to affect the course your medical career takes, so just accept that and work with what you have.

don't let people tell you what you can't do. clearly this is not easy, so be tough and strong and follow your instinct to what is right. good luck.

 

[beep]

amino acid,

4. a lot of people are going to give you incorrect answers--as you have seen by the disparity of comments on this thread--they are going to think that this is a disease that will always compromise you, so they'll say that you might not be able to go; or they'll say that you can be disease free, so go ahead...

don't let people tell you what you can't do. clearly this is not easy, so be tough and strong and follow your instinct to what is right. good luck.

just for the record, no one here has yet said the op won't be able to go to med school or won't be a doc.

 

[1Path]

i am so sorry that you are struggling now, both with being sick and with the prospect of having your dreams limited. however, as i said before, i think the bottom line here has to be your future patients' safety. in order to make sure you don't put someone else in your current situation (or a worse one), you need to either put off school until you know you can't infect anyone or talk to the school and make a plan for accommodating you. i don't think it's "so easy", but sometimes one has to deal with hard things.

I agree with you 1000%.

And I'm not too sure why everyone is saying that people shouldn't give up on their "dreams" especially with something as serious as a highly infectious disease (notice I said INFECTIOUS NOT contagious). Life sometimes creates situations where you have to change your dreams, NOT give up on them. For example, I desperatley wanted to be an astronaut/physician back in the early eighties, but had to change my "dream" because my vision is soo bad. Then I wanted to be a medical officer in the Navy, but was disqualified because I now have asthma. If I somehow became blind and couldn't become a pathologist, I'd probably do Cancer Epidemiology. Just because I couldn't do these things doesn't mean I gave up on my "dream". I just found another one!

 

[Amino Acid]

I agree with you 1000%.

And I'm not too sure why everyone is saying that people shouldn't give up on their "dreams" especially with something as serious as a highly infectious disease (notice I said INFECTIOUS NOT contagious). Life sometimes creates situations where you have to change your dreams, NOT give up on them. For example, I desperatley wanted to be an astronaut/physician back in the early eighties, but had to change my "dream" because my vision is soo bad. Then I wanted to be a medical officer in the Navy, but was disqualified because I now have asthma. If I somehow became blind and couldn't become a pathologist, I'd probably do Cancer Epidemiology. Just because I couldn't do these things doesn't mean I gave up on my "dream". I just found another one!

but the thing is, once the VL is down to zero, it is not infectious, so why is everyone making it sound like I'm doomed forever?

how many of you are actually in med school now? Do you know as a fact they routinely check for HCV? I thought there weren't clinical rotations in the first year or more. I should be clear of the virus by then. In that case, why is it necessary to defer? I am not putting anyone at risk.

And changing a dream and creating a new one is essentially giving up the first one. I already lost the most important dream of my life 3 years ago. I was very cautious never to dream again; this was the first time I even remotely allowed myself to. It will not go over well if I have to give it up.

 

[elicash]

but the thing is, once the VL is down to zero, it is not infectious, so why is everyone making it sound like I'm doomed forever?

how many of you are actually in med school now? Do you know as a fact they routinely check for HCV? I thought there weren't clinical rotations in the first year or more. I should be clear of the virus by then. In that case, why is it necessary to defer? I am not putting anyone at risk.

i wasn't trying to make it sound like you're doomed forever -- and i think most posters were with me -- that you are not doomed, that it is a slight setback, but nothing that can't be overcome.

i am not in med school. apparently if the virus is clear by the end of first year, there is NO REASON to defer.

in all honesty, my intuition is that your biggest issue is your own self-doubt and frustration. you seem to know/believe that you can start med school in the fall, so do it, be strong, and don't worry.

i'm not trying to sound harsh but just being honest. i feel sympathy for you, both because of this med school issue, and being sick for an extended period-- which is one of the most depressing things there is (in my experience).

if the virus is clear, then there is no reason to worry... like another poster said, life can deal you a bad hand, but you get over it.

 

[LabMonster]

I know a healthcare worker who sticks people with needles on a regular basis. This person also has HCV.

While I think surgery may have serious issues, there shouldn't be any reason for you not to be a physician.

 

[dopaminophile]

My last few posts in the HIV thread are pretty relevent to this topic as well. I imagine that you've been reading them, but the point contained therein is that medical schools accept and will work with students with all sorts of communicable diseases, including Hep C. There will be certain restrictions to your clinical education and you'll have some things to work out with the ocupational health department of your teaching hospitals, but your disease doesn't preclude you from pursuing a medical education. All the best for a happy career doing what you like.

 

[Amino Acid]

Thank you everyone for all your comments and especially those who wished me well and had faith that I could do this.

A resident who had first hand experience PMed me to let me know that i would not have a problem with this diagnosis. That was certainly reassuring news and it certainly changed my apprehension and worry into proaction and a greater desire to get through this and meet the challenges of med school.

 

[nabeel76]

Thank you everyone for all your comments and especially those who wished me well and had faith that I could do this.

A resident who had first hand experience PMed me to let me know that i would not have a problem with this diagnosis. That was certainly reassuring news and it certainly changed my apprehension and worry into proaction and a greater desire to get through this and meet the challenges of med school.

Go to medical School, and if everything turns out fine in 6 months you have no worries. If on the other hand, hopefully not, things do not go your way then you can arrange a confidential meeting with an advisor at the school to determine the appropriate course of action, if any is needed at all.

I am glad to hear that you wouldn't have any problems with that diagnosis, good luck on your route to becoming a doctor.

 

[Amino Acid]

Go to medical School, and if everything turns out fine in 6 months you have no worries. If on the other hand, hopefully not, things do not go your way then you can arrange a confidential meeting with an advisor at the school to determine the appropriate course of action, if any is needed at all.

I am glad to hear that you wouldn't have any problems with that diagnosis, good luck on your route to becoming a doctor.

Sounds like good advice, thanks!

 

[~~premed82~~]

@ Amino Acid, I say continue with things as planned. Go for your routine check-up's, I also know health-care professional's with this illness (my uncle), and they continue to practice. If things come out fine you'll of course have nothing to worry about, again if you are already in medical-school and things take a negative turn inform the proper administration (although they may ask you why this was not brought to the forefront prior), you just tell them you were expecting different result's, and did not feel it necessary to bring it out at that particular time.

I see no reason for you to put off your education due to this, you've come this far continue on. I am sure if they let physicians who've contracted HIV facilitate medicine, they'll make the proper accomodations for you. I wish you the best in your life, you'll be fine.

 

[Amino Acid]

@ Amino Acid, I say continue with things as planned. Go for your routine check-up's, I also know health-care professional's with this illness (my uncle), and they continue to practice. If things come out fine you'll of course have nothing to worry about, again if you are already in medical-school and things take a negative turn inform the proper administration (although they may ask you why this was not brought to the forefront prior), you just tell them you were expecting different result's, and did not feel it necessary to bring it out at that particular time.

I see no reason for you to put off your education due to this, you've come this far continue on. I am sure if they let physicians who've contracted HIV facilitate medicine, they'll make the proper accomodations for you. I wish you the best in your life, you'll be fine.

thanks, I think that's just what i'm going to do.

 

[reddirtgirl]

have you seen any of the student handbooks of the places where you got accepted?

in looking at several medical schools' handbooks & websites, there seems to be a wide variety in what is required on your part as far as disclosure goes. Some are very specific, some are vague. And the ones requiring disclosure seems very accomodating, at least on paper. If you do have to disclose things, it may not be until your clinical years... and by then this may be a moot point you may already be free & in the clear.