TB testing for shadowing?

[Silverfalcon]

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I was recently tried to shadow (actually it was supposed to be today) a doctor, and I received an email saying that I have to fill bunch of documents (standards) and send in a copy of TB (tuberculin) testing for past 12 months (my college didn't require them, so I didn't get it that recently). Is this an usual standard for doctors' offices?

P.S. This doctor's office was affiliated with UPMC, if that helps?

 

[red10]

I had to get a TB test to volunteer in the hospital.
To actually be employed at the hospital I had to have TWO done a couple months apart.

 

[chman]

I just had to get two for volunteering. It's really not a big deal at all. But yea, it is pretty standard. TB, although pretty rare now adays (in the US), is very contagious.

 

[DocMcCoy]

I had to get a PPD plus chest X-ray since I've had a positive PPD in the past.

 

[scapermoya]

my mom is a nurse and she has to get tested all the time

 

[ILikeDrugs]

Everyone at a hospital has to get it done once a year (CA). I did when I worked at one. As a volunteer, I had to do the same. Same thing at the doctors office. The office was actually part of a medical group. Things might be a bit more lax at a private office.

 

[The right Path]

I had to get a PPD plus chest X-ray since I've had a positive PPD in the past.

Why would you be asked to have another ppd after having a history of a positive one?

Once you've converted to a positive reaction to ppd, you should never have to do that again. Chest xray yes, but ppd, no.

 

[DocMcCoy]

no kidding, i told them i had a positive test in the past. I thought it would save money if i went straight to the x-ray. I could only assume they were hoping it was a false positive that way they could save the money on the x-ray in case it came back negative? I don't know, it was on their dollar or I guess the taxpayers... hmm maybe this explains the current healthcare crisis😀 jk

 

[chman]

no kidding, i told them i had a positive test in the past. I thought it would save money if i went straight to the x-ray. I could only assume they were hoping it was a false positive that way they could save the money on the x-ray in case it came back negative? I don't know, it was on their dollar or I guess the taxpayers... hmm maybe this explains the current healthcare crisis😀 jk

If it was for volunteering, I am not sure that the volunteering administrators always know what they are talking about. I asked them why I had to get two TB tests and she couldn't give me an answer, and I think that she even thought I was being rude ( I was just curious).

 

[DocMcCoy]

If it was for volunteering, I am not sure that the volunteering administrators always know what they are talking about. I asked them why I had to get two TB tests and she couldn't give me an answer, and I think that she even thought I was being rude ( I was just curious).

Yes probably something like this. I'm sure they had their reason, whether it was good or bad. Again, I just told them I had a positive PPD and told them I could prove it with medical records but they wouldn't let me out of the test again. Ultimately, no big deal

 

[The right Path]

If it was for volunteering, I am not sure that the volunteering administrators always know what they are talking about. I asked them why I had to get two TB tests and she couldn't give me an answer, and I think that she even thought I was being rude ( I was just curious).

When you first get your ppd test done, the first one can be a false negative, but by the second test, you will be adequately sensitized and have an obvious positve.

Once you do have a positive result, each subsequent exposure will have a more pronounced reaction which is why- I thought- that once you are positive you never do another ppd. You just get cleared by chest xray.

I don't know if there is any risk involved in having additional ppd tests once a person is positive (I guess it is possible), but for sure futher ppd testing is a waste of time and money.

 

[gnomeski]

I don't know if there is any risk involved in having additional ppd tests once a person is positive (I guess it is possible), but for sure futher ppd testing is a waste of time and money.

possible scarring

 

[Depakote]

As occupational exposures to infectious diseases are a real hazard of working in health care, it's not uncommon to have to provide proof of vaccination/TB status/etc when you're going to be working in a doctor's office. One of the doc's I shadowed as a premed required (with good reason) that I provide copies of my Hep B vaccination record. Some of my 3rd year clerkships are the same way. Might as well get used to it.

 

[Old Grunt]

no kidding, i told them i had a positive test in the past. I thought it would save money if i went straight to the x-ray. I could only assume they were hoping it was a false positive that way they could save the money on the x-ray in case it came back negative? I don't know, it was on their dollar or I guess the taxpayers... hmm maybe this explains the current healthcare crisis😀 jk

More likely they didn't understand the immunology behind the issue.

Other than miraculously getting a mosquito bite at the site of injection that persisted for three days, I can't imagine how you would get a false positive on a TB test (that is, for the test itself. There are many TB false positives with the PPD test).

 

[Silverfalcon]

Thank you everyone! 🙂

 

[7starmantis]

More likely they didn't understand the immunology behind the issue.

Other than miraculously getting a mosquito bite at the site of injection that persisted for three days, I can't imagine how you would get a false positive on a TB test.

Can't you have allergic reactions that appear positive but are not? Also (and not sure if this is true but heard it was) if you have had the TB vaccine you would have a positive test without an infection. Otherwise why go for x-ray after a positive to verify?

 

[Old Grunt]

Can't you have allergic reactions that appear positive but are not? Also (and not sure if this is true but heard it was) if you have had the TB vaccine you would have a positive test without an infection. Otherwise why go for x-ray after a positive to verify?

Yeah, I realize I didn't word that well. I meant a false positive for the test itself, meaning you get a positive read (yielding a red bump) that is not tied to your immunologic process for the disease.

A lot of things will give a false positive for TB with the PPD test, even mild exposure. I think the conventional wisdom is that if you are around TB patients a lot, you are going to eventually have a positive PPD read.

Also, in other countries, some people receive a vaccine known as BCG which always yields false positives.

And that is why they do the chest x-ray. The PPD test is sensitive, but not very specific.

 

[7starmantis]

Yeah, I realize I didn't word that well. I meant a false positive for the test itself, meaning you get a positive read (yielding a red bump) that is not tied to your immunologic process for the disease.

A lot of things will give a false positive for TB with the PPD test, even mild exposure. I think the conventional wisdom is that if you are around TB patients a lot, you are going to eventually have a positive PPD read.

Also, in other countries, some people receive a vaccine known as BCG which always yields false positives.

And that is why they do the chest x-ray. The PPD test is sensitive, but not very specific.

Gotcha.

Cool, thats what I was thinking.

 

[Law2Doc]

When you first get your ppd test done, the first one can be a false negative, but by the second test, you will be adequately sensitized and have an obvious positve.

Once you do have a positive result, each subsequent exposure will have a more pronounced reaction which is why- I thought- that once you are positive you never do another ppd. You just get cleared by chest xray.

I don't know if there is any risk involved in having additional ppd tests once a person is positive (I guess it is possible), but for sure futher ppd testing is a waste of time and money.

This. The concern isn't about risk. It's about doing a test that cannot possibly give you any useful information. you already know the person will test positive once they have the history. So why do the test. Skip to the xray.

 

[Old Grunt]

Gotcha.

Cool, thats what I was thinking.

Ironically, I was editing my post for clarification as you made your post.

At any rate, here's a funny anecdotal story about positive PPD tests.

When my unit was in Afghanistan, a few soldiers in my old platoon decided to smoke hash with the locals.

When they got back, they all had positive PPD tests (since, you know, TB is endemic in Afghanistan).

So, aside from getting smacked down by the man for smoking hash, they got to go on the 9 month drug course.

Knuckleheads. Served them right.

 

[DocMcCoy]

Just for the sake of argument, and forgive my ignorance, but what would cost more money- a PPD test or a chest x-ray?

-Mantis, dig the new avatar

 

[Law2Doc]

Just for the sake of argument, and forgive my ignorance, but what would cost more money- a PPD test or a chest x-ray?

-Mantis, dig the new avatar

An xray. Plus there's a health issue with exposing folks to radiation more than necessary.

 

[7starmantis]

Just for the sake of argument, and forgive my ignorance, but what would cost more money- a PPD test or a chest x-ray?

-Mantis, dig the new avatar

Yeah, X-ray.

Thanks, gotta change it up from time to time.