Specialties and manual dexterity

[Amxcvbcv]

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Hi all,

I know this is getting a little bit ahead of myself, but I've got a question regarding the dexterity requirements for all the different medical specialties.

A little bit of background first, though...

I have an incomplete spinal cord injury at C-7 that forces me to use a wheelchair most of the time. I have reduced manual dexterity as well, and I am concerned with how this will affect my eventual specialty/residency.

At this point, I am most interested in Diagnostic Radiology, but I haven't had a chance to spend a full day with any radiologists to see what they do on a day-by-day basis. I'm fairly certain I can handle just about anything out there, but I want to know what to expect.

Obviously something like surgery or ob/gyn will be out of the question, but what other specialties should I be aware of? If you're familiar with the procedures required of any of the specialties that I might have difficulty performing, please let me know!

Thanks!

 

[doc05]

remember that radiologists must do a year of medicine, which will undoubtedly require blood draws, LP's, are various other things. Plus there are interventional rotations as part of the radiology residency.

Also keep in mind that matching into rads is very competitive; what would you do if you don't match??

And ob/gyn isn't necessarily out of the question...have you ever been in the OR with one??

 

[starayamoskva]

remember that radiologists must do a year of medicine, which will undoubtedly require blood draws, LP's, are various other things. Plus there are interventional rotations as part of the radiology residency.

Also keep in mind that matching into rads is very competitive; what would you do if you don't match??

And ob/gyn isn't necessarily out of the question...have you ever been in the OR with one??

Why do you feel it is necessary to make disparaging remarks about ObGyn's?
Do you feel so insecure in your surgical skills that you need to make fun of others?

 

[GeneGoddess]

Why do you feel it is necessary to make disparaging remarks about ObGyn's?
Do you feel so insecure in your surgical skills that you need to make fun of others?

I didn't find that remark negative... I know that there was a student at my med school (different class) who was wheelchair bound. I have no idea what speciality he chose, but I know he did every rotation required. If you are interested in psych, that is fairly hands-off. I wouldn't do FP, since there are lots of little procedures that are always being done...

 

[Winged Scapula]

Why do you feel it is necessary to make disparaging remarks about ObGyn's?
Do you feel so insecure in your surgical skills that you need to make fun of others?

Hmmm...I'm not so sure it was meant as a disparaging remark either. I assumed the OP meant that a lot of OB-Gyn was done at the end of the bed and could fairly easily be done in a seated position.

 

[Winged Scapula]

Hi all,

I know this is getting a little bit ahead of myself, but I've got a question regarding the dexterity requirements for all the different medical specialties.

A little bit of background first, though...

I have an incomplete spinal cord injury at C-7 that forces me to use a wheelchair most of the time. I have reduced manual dexterity as well, and I am concerned with how this will affect my eventual specialty/residency.

At this point, I am most interested in Diagnostic Radiology, but I haven't had a chance to spend a full day with any radiologists to see what they do on a day-by-day basis. I'm fairly certain I can handle just about anything out there, but I want to know what to expect.

Obviously something like surgery or ob/gyn will be out of the question, but what other specialties should I be aware of? If you're familiar with the procedures required of any of the specialties that I might have difficulty performing, please let me know!

Thanks!

I'm not sure that your injury really precludes you from anything, with some modifications in technique and expectations, of course.

Is is true that DR does require a prelim year of either Medicine or Surgery but I don't see why you couldn't do blood draws (and you may find yourself in a program where you've got such good nurses or other allied staff that you rarely, if ever have to draw blood) or even an LP while seated. Some procedures might be more difficult - ie, thoracentesis, placing a central line, etc. but again, a little creative thinking, assistance from others and these things can generally be worked out. The concern would be how reduced is your manual dexterity and whether or not you could do these procedures.

Surgery is a little more difficult because of the height of the table in the OR (and the willingness of your attending to adjust to your height) but I've heard of achodroplastic dwarfs making it through ortho residencies, so obviously things are in place (at some programs) to adjust for these difficulties. However, you've mentioned reduced manual dexterity so this would likely be the rate limiting step rather than being wheelchair dependent.

The field of medicine is pretty wide open - you may also consider something like Physical Medicine and Rehab which would possibly be very accepting of someone with your differing abilities, considering the (supposed) belief that you would share something in common with many of your patients and could offer more insight into their care. Psychiatry doesn't require a lot of physical work, although they do have to do a Medicine Prelim year and of course, on more secure units you might be expected to participate in patient physical control (ie, takedowns). Family and Community Medicine do fewer procedures as does Pediatrics but again, it would all depend on your manual dexterity...for me, that is the bigger concern than being in a wheelchair.

 

[spENT]

Pathology does not require a prelim year. Most of the procedures, including autopsies and "grossing in" surgical specimens can be done from seated position. Some degree of manual dexterity is required...it is poor form to lose a 1 mm brain biopsy (that took 3 hours to recover) down the drain. Cutting and staining frozen sections may be challenging because it has to be done within minutes.
After residency, most anatomic pathologists spend the majority of their time reading slides (analagous to the radiologists).

 

[starayamoskva]

The original poster seems to be more concerned with his/her manual dexterity than with the fact that they are in a wheelchair. To me that means he has problems with doing things with his hands, like sticking IV's, drawing blood or suturing.
If the OP can give us some more detail about what he/she is capable of doing with the hands it would be helpful. I think certainly that the intern year could be tailored to his/her needs ie not requiring him/her to do central lines or blood draws etc., which is not unreasonable. Diagnostic radiology doesn't require interventional techniques so should work just fine.

 

[Amxcvbcv]

Thanks for the feedback so far. 🙂

As for sitting vs. standing: I'm not terribly concerned with this. I have pretty good strength and coordination in my legs. For instance, I mowed about 2/3 of my lawn the other day using a push mower, so I don't imagine that will be a problem, although I do lose coordination in my legs as I get tired. I could barely stand after mowing the lawn. 😛

Regarding my hands: It's really quite difficult to describe without showing, but I can give you a few examples of what I have been able to do in my undergraduate courses. I was a microbiology major, so I had to be able to practice sterile technique in a laboratory setting. I poured plates, inoculated plates/slides/tubes, and did all my own staining. I really can recall being able to do everything that was required in my micro labs.

Like I said in the original post, I am getting a little bit ahead of things since I haven't even been accepted to medical school yet. 😳 I can't stop thinking about the future, though! I spend every moment away from the hospital thinking about going back!

Edit: This brings up another question I have that I'd like to have addressed. How much can the the motor requirements of obtaining an MD be compromised without sacrificing what it truly means to be an MD? If I can't promptly administer CPR or perform "simple obstetrical maneuvers" do i deserve to be an MD? For that matter, how do you know until you're faced with that situation? I desire with all my heart and mind to be a doctor, but I don't want to be a doctor with reservations.

 

[Annette]

I've lost a lot of mobility in my right hand, but I haven't had a problem yet in my IM residency. There is also a med-peds resident at my program with moderate CP, and he is also doing quite well.

As for CPR and such, it really isn't that big of a deal. There are so many specialties that there really isn't any "basic set" of skills any more.

 

[Skialta]

I did a PT internship at a rehab hospital in CA where there was a PMR doc who was a quad. He was a great guy and was very inspiring for the patients in the facility.

 

[Nightengale]

A lot of this depends on the school.

(I'm just starting my second year of medical school so I'm sort of sticking my 2c in here if that's OK. I have a neurological condition that affects my hands, so this is a big topic for me as well. Oh, and over the past year I've developed some unrelated mobility problems as well.)

One thing you should know if you don't already is that some medical schools have a list called "Technical Standards." You have to be able to do everything on the list (a certain level of vision, of hearing, of manual ability, etc) before they even accept you into the school. My school has one of those - I signed it but my abilities in some areas are sort of borderline. And I'm having a lot of difficulty here, not with my actual physical limitations, but in getting the few accomadations I've asked for, because our program is completely unaware of the needs of students with physical limitations of any sort, and in some cases, completely unwilling to learn. So while difficulty with CPR, say, would be "no big deal" at some schools, it would be a much bigger deal here. (In my "free time," I'm working on fixing some things around here on this front.


Other schools have accepted, taught and graduated students who would never have met the Technical Standards list that we have. And according to some experts, Techinical Standards actually aren't legal. Thomas Strax, who I got to meet last year, is a rehab doctor in New Jersey with cerebral palsy. He's very respected in his field, and he's one of the leading voices arguing against such requirements. There's a great article on the net about the "Myth of the unidifferentiated medical student" that he had a hand in.

I believe that there should be a lot of leeway in what it truly means to be an MD. Disability issues aside, the skill set and daily routines of a surgeon, for instance, and a psychiatrist and a radiologist are vastly different. They demand different physical requirements, and they also demand different temperment and outlook. While it is important that they all went through the same training in terms of scientific background and philosophy, I'm really unconvinced it matters how good someone who never does proceedures needs to be at physically doing each and every proceedure during training.


Anyway, I guess my point is, if you want to be a doctor, go for it, but research your options so you will be in a program that will allow you to succeed. I have some resources and things if you are interested - either here or on PM.

 

[Amxcvbcv]

If you don't mind, post them here. I'm sure I'm not the only one interested.

Thanks for your input! 🙂

 

[Whisker Barrel Cortex]

Diagnostic radiology doesn't require interventional techniques so should work just fine.

Actually, every diagnostic radiology resident is required to rotate through interventional radiology. Our program has 4 months, other programs may have more. This does require you to be on your feet, sometimes for hours at a time (TIPS can take 1-5hrs, difficult angios, etc.) with heavy lead on. You cannot do interventional sitting down.

However, if you are able to stand for longer periods while using the table for support, you should be able to do these rotations. I've seen interventional attendings with post polio syndrome who walk with crutches, but are still able to practice. The manual dexterity thing is another story. You will need steady hands in IR (maybe not as much as surgical subs).

It is not only the interventionalists that do procedures. General radiologists still do biopsies under CT or ultrasound guidance. However, these should be much more amenable to seated positioning.

Once you get out of residency, you will do fine since most general rads only do biopsies. However, you will need to find a program accepting of your limitations for the interventional months.

 

[neglect]

Thanks for the feedback so far. 🙂

As for sitting vs. standing: I'm not terribly concerned with this. I have pretty good strength and coordination in my legs. For instance, I mowed about 2/3 of my lawn the other day using a push mower, so I don't imagine that will be a problem, although I do lose coordination in my legs as I get tired. I could barely stand after mowing the lawn. 😛

Regarding my hands: It's really quite difficult to describe without showing, but I can give you a few examples of what I have been able to do in my undergraduate courses. I was a microbiology major, so I had to be able to practice sterile technique in a laboratory setting. I poured plates, inoculated plates/slides/tubes, and did all my own staining. I really can recall being able to do everything that was required in my micro labs.

Like I said in the original post, I am getting a little bit ahead of things since I haven't even been accepted to medical school yet. 😳 I can't stop thinking about the future, though! I spend every moment away from the hospital thinking about going back!

Edit: This brings up another question I have that I'd like to have addressed. How much can the the motor requirements of obtaining an MD be compromised without sacrificing what it truly means to be an MD? If I can't promptly administer CPR or perform "simple obstetrical maneuvers" do i deserve to be an MD? For that matter, how do you know until you're faced with that situation? I desire with all my heart and mind to be a doctor, but I don't want to be a doctor with reservations.

If C7, then weakness is distal? This could impair your abilities with some things, but I know plenty of people: not only rads (why is rads the answer to every question? 42 letters?), but PM/R, rad onc, neuro, even IM who have never had to put an IV in, not to mention things that require more dexterity. So it certainly can be done. Didn't even mention occupational, public health, genetics, allergy, and obviosly psych. CPR: oh well, you'll never get to feel ribs break while performing necro-flogging. Still sounds like you could pre-cordial thump.

There are still things in medicine that actually require thought. And, for every person who never pursued manual tasks, there are probably 5 who never pursue thinking. Or more? Poll? Including, of course, PAs/NPs/etcs.

"How much can the the motor requirements of obtaining an MD be compromised without sacrificing what it truly means to be an MD?"

Very harsh on yourself. I'm not sure what it truly means to be an MD myself. Do you think it entails prolonged CPR? Or 8 hour surgeries? Do you think it could be just prescribing something to make someone feel better or alter the natural history of a disease for the better? Or telling someone they have disease X and that they can expect Y? Depending on your definitions, the answer is between mild carpel tunnel and locked in.

Good luck to you.

 

[Nightengale]

Then I realized that all my resources were bookmarked on my old computer which no longer turns on.

The Center on Self-Determination (http://www.healthsciencefaculty.org/index.html) has a whole lot of information about health care professionals with a variety of disabilities. A few of the links are broken, but I encourage you to click around the Profile Gallery. The "Accomplished MD Challenges Perceptions" is about Dr. Strax. In the profile, he challenges the "undifferentiated graduate" theory. The profile about the use of "intermediaries" is also worth reading.

This is a Guidline about criteria medical schools should use for students with disabilities, according to some experts in the field. http://www.physiatry.org/education/whitep1.html Many schools, my own included, have much more stringent (and one might argue, discriminatory) guidelines. So I can't emphasize enough that you should check the criteria for the schools you are considering. Contact them and ask about their policies - and if they haven't got one, move on. Our stated policy in the student handbook ONLY mentions learning disabilities, which goes a long way towards explaining how much of my precious spare time is spent seeking accommodations.

AMSA has some pages about medical education for people with disabilities. I'm not actually an AMSA member so I'm not sure what they have, but here's a link: http://www.amsa.org/adv/cod/


I don't know if you've taken the MCAT yet or if you would need testing accommodations for it. I asked for, and received the accommodation of typing the essay portion. They discuss their testing policy here: http://www.aamc.org/students/mcat/about/faqs.htm There was just a pretty high-profile case about students requesting extended time for learning disabilities, so I will be interested to follow AMCAS policy over the next few years.

Some of these legal cases involve health care workers. http://gwired.gwu.edu/dss/LegalIssues/TenCasesThatHaveShapedDisabilityServicesinHigherEducation/ We read the Pushkin case in my Disability Law class. While it is presented as an example of blatent disability discrimination, for me the take-home message was that Dr. Pushkin did get accepted to a residency program and went on to be a successful phychiatrist.

When people talk about disability and medical school, sooner or later someone brings up Dr. Hartman. http://www.newswise.com/articles/view/504525/ Doctors who have connections to Temple bring up Dr. Hartman and have this great "of course you can" attitude. My new Occupational Therapist, himself an amputee, was citing Temple and Dr. Hartman to me last week, as I described the attitudes I've encountered. I go check out Temple's website when I need cheering up: http://www.temple.edu/disability/. I figure that my school now is where they were twenty or thirty years ago, and it gives me some direction to focus my efforts on the future.

Hope you find some of this helpful!

 

[Amxcvbcv]

Wow... I'd completely forgotten this thread until I was digging through some old e-mail alerts. I feel an update is in order. Since I last posted here, I have been accepted at OU, so that hurdle is passed!

I also wanted to respond to some of the posts subsequent to my last.

If C7, then weakness is distal? This could impair your abilities with some things, but I know plenty of people: not only rads (why is rads the answer to every question? 42 letters?)

I was the one that first mentioned radiology in this thread. It was and still is the specialty that most interests me. Since then I have had the chance to spend a fair amount of time with some radiologists, and those experiences have only reinforced my prior expectations. Although, I have not had the chance to see any interventional procedures, I did get to see more than just staring at a PACS screen for hours on end.

One of the other purposes for this thread was to get input and advice on what other specialties would be appropriate for someone in my situation. As much as I think I know, I'm not so naive to think that I have all the answers.

As for 42 letters... Hitchhiker's Guide to the Galaxy - April 29th! Don't Panic!

If the OP can give us some more detail about what he/she is capable of doing with the hands it would be helpful.

I could clarify this a bit too. Although I was able to accomplish everything in my microbiology labs without much difficulty, the thing that gave me the most trouble (at least as far as frustration level) was putting on rubber gloves! It takes me at least a minute to do it, and I'm afraid it will ruin any of the confidence a patient might have in me, if they see me struggling with rubber gloves. I guess I'll just put them on before going in a room. 😛

As I was typing this up, I realized that it really doesn't seem to be so much a matter of what I can or can't do as a matter of perspective. I'll be able to accomplish practically everything required of me, but it won't look the same.

Then I realized that all my resources were bookmarked on my old computer which no longer turns on.

Thanks for the links!

 

[Winged Scapula]

Congrats on your acceptance and success so far. May you continue to do well in your chosen career.

 

[Nightengale]

Glad to hear you're in and on your way!

 

[wooo]

congrats!

You will only be limited by a lack of desire. Kick some butt and show yourself and others that are sitting back and watching that anything can be accomplished with the right attitude.