Vandy Behavioral Interview?

[jewel1881]

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I have been lurking on this site for awhile... I decided it is time to ask my own questions and contribute. I have an upcoming interview with Vanderbilt and in my interview email I was told this would include some aspects of the behavioral interview to determine "my personal strengths in the ACGME competencies such as professionalism and interpersonal skills." What have other interviewers experienced with their interviews and what questions should I be prepared to answer? Thanks!!

 

[militarymd]

I have been lurking on this site for awhile... I decided it is time to ask my own questions and contribute. I have an upcoming interview with Vanderbilt and in my interview email I was told this would include some aspects of the behavioral interview to determine "my personal strengths in the ACGME competencies such as professionalism and interpersonal skills." What have other interviewers experienced with their interviews and what questions should I be prepared to answer? Thanks!!

what's up with the popularity of Vanderbilt?

 

[SexPanther]

what's up with the popularity of Vanderbilt?

Mil, I'm telling you man, it's a quality program.

As far at the behavioral interview, don't sweat it. Just be yourself, it's really no different than any other interview I had last year. Good luck in the upcoming match.

 

[militarymd]

Mil, I'm telling you man, it's a quality program.

As far at the behavioral interview, don't sweat it. Just be yourself, it's really no different than any other interview I had last year. Good luck in the upcoming match.

I'm sure it is👍


This is just my way of giving crap to a number of folks I know who don't even read here...or maybe they do...I don't know...but I love giving them crap

 

[UMMS FMD]

I interviewed there earlier this year and it's pretty benign - honestly! It's a typical interview style seen more in the business world rather than medicine. I was asked questions (by some interviewers) along the lines of, "Tell me about a time you were faced with an ethical dilemma..." Stuff like that. Nothing too stressful. Good luck! Hmmm... I really liked the program, maybe I shouldn't wish you luck. 😉 j/k

 

[coprolalia]

As far at the behavioral interview, don't sweat it. Just be yourself, it's really no different than any other interview I had last year.

Please explain. This, to me, is borderline (if not over the border) inappropriate, if it is (or is close to) what I think it is. It may even be illegal, depending on which questions are asked.

It never ceases to amaze me sometimes what some ivory tower academician thinks is a "good idea" in screening a soon-to-be physician and future colleague. If you were good enough to get into (and nearly finish) medical school and go on multiple other interviews where you were not subjected to such a test, why should you have to during this interview? Personally, I would be offended if they suggested I take such a test.

You give parts of yourself away in bits and pieces. This, in my estimation, is simply another way - beyond all other ways you've already had to - to prove yourself to someone, despite the fact that you are a medical professional and should have the courtesy and respect to be treated as such. And, the more you agree to such things, the more people, who shouldn't, start to feel empowered that it is their "right" to do them to you.

Personally, I'd tell Vandy "no thanks" and that I'm not going to play their little personality game, unless they are willing to supply me all of the results of the same test administered to the faculty so I could determine if I want to be part of their program. There are plenty of other GREAT programs out there who don't subject their candidates to this nonsense.

-copro

 

[SexPanther]

Please explain. This, to me, is borderline (if not over the border) inappropriate, if it is (or is close to) what I think it is. It may even be illegal, depending on which questions are asked.

It never ceases to amaze me sometimes what some ivory tower academician thinks is a "good idea" in screening a soon-to-be physician and future colleague. If you were good enough to get into (and nearly finish) medical school and go on multiple other interviews where you were not subjected to such a test, why should you have to during this interview? Personally, I would be offended if they suggested I take such a test.

You give parts of yourself away in bits and pieces. This, in my estimation, is simply another way - beyond all other ways you've already had to - to prove yourself to someone, despite the fact that you are a medical professional and should have the courtesy and respect to be treated as such. And, the more you agree to such things, the more people, who shouldn't, start to feel empowered that it is their "right" to do them to you.

Personally, I'd tell Vandy "no thanks" and that I'm not going to play their little personality game, unless they are willing to supply me all of the results of the same test administered to the faculty so I could determine if I want to be part of their program. There are plenty of other GREAT programs out there who don't subject their candidates to this nonsense.

-copro

Copro,

There was no personality testing or whatever at the interview, it really was just like any other. I would've felt the same way as you do in the above post had I gone to any interview and been pimped or forced to take another test. This wasn't the case at Vandy (or anywhere else I interviewed).

 

[pgy13]

For the record, I am not at Vandy, but I'll tell you why they have chosen to try out some behavioral interviewing questions, which are commonly used in business interviews. It is because every year, every program ends up with one or two people that seemed fine on paper and during the interview, but end up being unsuited for anesthesia and/or a particular program. We then spend an inordinate amount of time trying to "fix" the problem resident, rather than working to improve the educational experience of everyone else. Vanderbilt is simply trying to figure out who might not be a good fit before the match.

 

[scotchnwater]

The "behavioral interview" was honestly extremely benign at Vanderbilt and ultimately no different than questions I was asked at other programs such as Michigan.

The PD is big on it, and it seems like everybody else just puts up with it. The residents told us the night before that it was no big deal and they were right. The idea is predicated on the theory that people's future behaviors are predicted by their past behaviors. They just ask for examples of your past behavior. It's not weird, it's not uncomfortable, it's not illegal, unethical, etc. etc. etc.

The only difference between this interview and others I've been on in the past is summarized in the following two points:
1) They tell you that they will ask these questions
2) They give these questions/interview method a name

 

[coprolalia]

Okay, guys. I see what you're saying. I thought this was like the MMPI or the like (which has been ruled illegal to administer in some states because it can provide a strong indication of clinical diagnosis on Axis I or Axis II).

And, I guess by telling you that they're going to subject you to this before you interview gives you the choice about whether or not you want to subject yourself to it. In my book, I suppose that's fair play.... I suppose.

-copro

 

[militarymd]

Okay, guys. I see what you're saying. I thought this was like the MMPI or the like (which has been ruled illegal to administer in some states because it can provide a strong indication of clinical diagnosis on Axis I or Axis II).

And, I guess by telling you that they're going to subject you to this before you interview gives you the choice about whether or not you want to subject yourself to it. In my book, I suppose that's fair play.... I suppose.

-copro

a premier anesthesia group that I interviewed with gave a personality test before they invited me to come for an interview.....seems like a good idea.

 

[coprolalia]

a premier anesthesia group that I interviewed with gave a personality test before they invited me to come for an interview.....seems like a good idea.

Did you take it? And, what did it tell you (or, more importantly, them) that you didn't already know and/or want them to know?

How about a drug test? Should this be "required" for anesthesia providers? Routinely and randomly too?

-copro

 

[Coastie]

Sororities.

what's up with the popularity of Vanderbilt?

 

[militarymd]

Did you take it? And, what did it tell you (or, more importantly, them) that you didn't already know and/or want them to know?

How about a drug test? Should this be "required" for anesthesia providers? Routinely and randomly too?

-copro

I took the test, and they invited for an interview...nothing else was said about it...

I think drug tests are good....the only people who are against drug tests are usually the folks who use drugs.

 

[coprolalia]

I took the test, and they invited for an interview...nothing else was said about it...

Aren't you curious why they "required" it before offering you an interview? Didn't you feel marginalized? Again, I wouldn't have a problem if it was a two-way street, that they'd send me the results of their personality tests.

I think drug tests are good....the only people who are against drug tests are usually the folks who use drugs.

Just anesthesiologists? Or, everyone who is in healthcare? Why not test everyone then? Why single us out? Just because we have greater access?

-copro

 

[VentdependenT]

Interview Drug test is a common place as a handshake now-a-days.

 

[coprolalia]

Interview Drug test is a common place as a handshake now-a-days.

Oh, trust me I know. I gave one myself at beginning of residency.

But, I'm more interested in the philosophical nature of the issue. If it's good for some, then why isn't it good for everyone who has the public interest and public safety in their trust? I would argue that a nurse who's chronically smoking the cheeba is every bit as dangerous as any physician who's diverting narcotics. So, why are physicians - anesthesiologists in particular - singled out? Or, are we singled out? Is it because we purportedly have greater access? I would argue that a nurse on the floor can just as easily divert narcotics as I can. Should we, therefore, be singled out?

-copro

 

[militarymd]

Oh, trust me I know. I gave one myself at beginning of residency.

But, I'm more interested in the philosophical nature of the issue. If it's good for some, then why isn't it good for everyone who has the public interest and public safety in their trust? I would argue that a nurse who's chronically smoking the cheeba is every bit as dangerous as any physician who's diverting narcotics. So, why are physicians - anesthesiologists in particular - singled out? Or, are we singled out? Is it because we purportedly have greater access? I would argue that a nurse on the floor can just as easily divert narcotics as I can. Should we, therefore, be singled out?

-copro

why not? we have free access to narcotics AND people's lives are literally in our hands on a second to second basis.

I have no problems with testing anyone who has easy access and/or whose jobs deal with life and death on a daily basis....police, fire&rescue, military, nurses...

I personally don't care if my plumber is on dope or not, but I do care about the cop who pulls me over and carries a gun.

 

[amyl]

another program, not vandy, asked me questions like - tell me about a time where you had to break bad news to someone. tell me about a time where you disagreed with an ethical decision being made. tell me about a time where you had to work with someone you don't like....etc.
i guess they think they learn something from putting you on the spot. a few of the people that i interviewed with on that day with said that they often said they couldn't think of a time that this or that happened... they were kind of taken back, not expecting it and felt like they blew interviews because they did not have an anecdote. one of the residents there said that our answers were supposed to correlate with professionalism, ethics, etc. (or lack thereof) and other qualities that they were looking for in a resident.

 

[militarymd]

Aren't you curious why they "required" it before offering you an interview? Didn't you feel marginalized? Again, I wouldn't have a problem if it was a two-way street, that they'd send me the results of their personality tests.



-copro

I think it was a good idea. They are a premier anesthesia group with good pay, good hours, good reputation.

They are busy. Why waste time on someone who won't fit their profile?

Why waste my time to interview with a group who I won't fit in with?

It IS NOT a 2 way street. The group held all the cards...I wanted to be a part of their group.

A new hiree is a liability until proven otherwise. I think it was wise of them to limit their losses.

In any case, my wife didn't want to move to that location, so it didn't matter that I "passed" my test.

 

[coprolalia]

I have no problems with testing anyone who has easy access and/or whose jobs deal with life and death on a daily basis....police, fire&rescue, military, nurses...

I'm not disagreeing with you, Mil. I'm making a Socratic argument here.

I'll give you an example that got my panties in a ruffle over this whole issue.

Sometime back, a pharmacy tech (not even the pharmacist), who was also responsible for noting returned narcotics and disposing of them (how they do this is within their realm of responsibility and I have no real knowledge or care what their actual procedure is), sent me an email about a perceived discrepancy in one of my returned lots. An email, as you may be aware, is an actionable item. It can be sent to medical boards, it can be kept in employment files, and it can be used in court.

In this email, this particular "tech" laid out, in detail, the excrutiatingly minute details of the discrepancy, including times from the anesthesia record that I'd given all other narcotics during the case, and then insinuated strongly - in so many words - that I had failed to comply with good clinical practice because a particular narcotic was missing and unaccounted for, based upon forgetting to chart 100 mcgs of fentanyl given towards the end of the case (mea culpa).

While it was mostly a factual email, it left the impression by the way it was worded that I had diverted the narcotic and that I needed to immediately rectify and/or respond to this matter or it would be submitted for further formal chart review at the institutional level, in so many words. The email also stated that this was a random audit, and that other records of mine might be reviewed against the master return sheets if I was unable to provide an adequate response.

I was furious.

After formally rectifying the problem via email explaining the situation and then fixing my documentation, I additionally responded at the end of my message saying, "I'm prepared right at this moment to submit to a drug test. Are you?"

Well, you can only imagine the **** storm that started necessatiting visits to office, apologies, etc. But, the point stood - and was, I'm happy to say, heard out and at least acknowledged by my superiors - that we have essentially created a system where the default position and assumption is that someone has done something illegal when discrepancies occur, and that we have further empowered subordinates to police us in that regard.

I'm all for accountability and control. But, I think it is unfair and irresponsible to single out an individual cohort that is felt to be "high risk" while ignoring all others who may be involved in the process. I know for a fact that the tech in question, like myself, had to submit to a drug test for employment screening - but, unless there is cause, is not required to do so to continue employment. Likewise, this person also has equal access to my waste narcotics and, for all I know, could just as easily have diverted them and then tried to pin it on me. But, they don't necessarily have direct patient contact, despite the fact that if they're high and pull the wrong drug off the shelf they could kill someone.

And, I'm not sure I like that kind of system, especially one that assumes by default that I'm the "perpetrator" when the numbers don't add up. And, pre-employment drug screening does not prevent subsequent abuse. That much is known. So, what's the point? That's all I'm asking.

-copro

 

[militarymd]

life ain't fair.

he's doing his job.

you responded emotionally.

get over it...piss in the cup...end of story.

 

[coprolalia]

A new hiree is a liability until proven otherwise. I think it was wise of them to limit their losses.

You're right, but some practices are also notoriously full of scumbags that want to suck a new hire dry for two years then dump them without offer of partnership. You say this was a "premier" practice, so I imagine you had them fully vetted. But, another perspective on all of this could be thought of as testing you to see how much **** you're going to take from them by making you jump through these hoops.

None of this matters, though, unless you get what you want in the contract. And, like when you haggle for a new car, if you let your emotions get the best of you you're gonna make not necessarily the right financial decision.

-copro

 

[militarymd]

You're right, but some practices are also notoriously full of scumbags that want to suck a new hire dry for two years then dump them without offer of partnership. You say this was a "premier" practice, so I imagine you had them fully vetted. But, another perspective on all of this could be thought of as testing you to see how much **** you're going to take from them by making you jump through these hoops.

None of this matters, though, unless you get what you want in the contract. And, like when you haggle for a new car, if you let your emotions get the best of you you're gonna make not necessarily the right financial decision.

-copro

ffffffffff

 

[coprolalia]

he's doing his job.

Yeah, whatever happened to respecting someone by default and not assuming things that aren't true and/or deferring professionally and politely for clarification? Is this generally reflective of the overall disdain people have for physicians these days? That we're all a bunch of crackpot quacks and drug addicts in waiting? How sad if that's true.

-copro

 

[coprolalia]

SNIP

Well, I'm not really all that keen on and patient with someone who's supposed to exist to faciliate my job instead accusing me of diversion in an actionable, legally subpoenable medium.

-copro

 

[militarymd]

Yeah, whatever happened to respecting someone by default and not assuming things that aren't true and/or deferring professionally and politely for clarification? Is this generally reflective of the overall disdain people have for physicians these days? That we're all a bunch of crackpot quacks and drug addicts in waiting? How sad if that's true.

-copro

Respecting someone by default appears to be a thing of the past (or just the South where I am)

Reality is that S h it rolls down hill....and most people will shovel it on at any opportunity they get.

Here's my story on drug testing.

When I was doing my ccm fellowship in 98, I was still in the Navy, so I was subject the Navy's random drug screens.

I was assigned to a rotc command 200 miles away from my fellowship location. The rest of the "students" in my command were students in college, but the commanding officer just knows as all as "students"....

FYI...commander's of rotc units usually are the non-promoteable nitwits on their way out of the Navy....but a commanding officer is a commanding officer.

Anyways, I got a message on my answering machine one day when I got home from the hospital to come and "pee" for your country.

Needless to say, I wasn't able to go.

The CO called me up and yelled at me on the phone...saying things in such an unprofessional manner that I wish I had taped the conversation to play for the local news.

I couldn't get a word in edge wise, and I was ordered to drive 200 miles that night to pee in the cup...he certainly implied that I was using drugs and that was why I didn't show up...he then slammmed the phone down.

He sure let the s hit roll on to me.

So I called up Bureau of medicine and Surgery in DC, and got a pretty high ranking officer and explained the situation....although I was in a rotc unit....I really wasn't a college student...I was a bc anestheiologist with a hardship tour under my belt doing a ccm fellowship (one of 2 in the Navy at the time).

Washington DC told me "don't give it a second thought, we'll take care of it"

Although I did not receive an apology from the said CO, he was extremely courteous to me when I showed up 3 months later to check out of his commnad.

Lessions learned for me.....s hit rolls down hill.....you have to take the ****.unless you know people higher up on the hill from where the s h it is rolling.....

It applied in the Navy...It applies in PP....

It ain't fair, but that's life.

 

[coprolalia]

Reality is that S h it rolls down hill....and most people will shovel it on at any opportunity they get.

Well, in my case the "stuff" attempted to roll uphill... that's the problem I have with "empowerment" of people who shouldn't really be empowered.

-copro

 

[militarymd]

Well, in my case the "stuff" attempted to roll uphill... that's the problem I have with "empowerment" of people who shouldn't really be empowered.

-copro

herein lies the problem...you consider yourself ABOVE this person who is just doing his job with POSITIONAL AUTHORITY over you.

I would recommend getting used to it now.

There'll be the hick low IQ cop who's going to give your sobriety test or speeding ticket.

The low IQ TSA agent who wants to look at your feet when you fly.

The paramedic at the scene of a accident who'll ask you..no tell you to step aside.

It didn't roll "uphill"....it came down on you just like it will for the rest of your life...might as well get used to it..

 

[CA0708]

I have been lurking on this site for awhile... I decided it is time to ask my own questions and contribute. I have an upcoming interview with Vanderbilt and in my interview email I was told this would include some aspects of the behavioral interview to determine "my personal strengths in the ACGME competencies such as professionalism and interpersonal skills." What have other interviewers experienced with their interviews and what questions should I be prepared to answer? Thanks!!

I interviewed there before they decided to re-vamp their program selection. But from studying psychology (well, a minor), behavioral science tells alot about someone. They will find out your dark secrets.

 

[militarymd]

You're right, but some practices are also notoriously full of scumbags that want to suck a new hire dry for two years then dump them without offer of partnership. You say this was a "premier" practice, so I imagine you had them fully vetted. But, another perspective on all of this could be thought of as testing you to see how much **** you're going to take from them by making you jump through these hoops.

None of this matters, though, unless you get what you want in the contract. And, like when you haggle for a new car, if you let your emotions get the best of you you're gonna make not necessarily the right financial decision.

-copro

that 's easy to find out.

1) talk to admin
2) talk to surgeons
3) talk to all previous employees.

and If you think that all of the above are conspiring to get you into a bad job just so the partners can screw you then PM johankriek and find out where he works.

 

[oudoc08]

I think drug tests are good....the only people who are against drug tests are usually the folks who use drugs.

Ouch. Dude, um, not really.

Think about this.

1. There are qualitative & quantitative drug testing methods. Do you know which you're being subjected to?
2. Workplace exposures happen. You're constantly surrounded by substances which are being aerosolized, splashed on your fingers, etc.
Same as certain workers in certain environments would have increased levels of lead, arsenic, mercury, etc., you after awhile may have certain drugs or their metabolites on a scant level in your system.
3. Every test has false positives.
4. Most importanly, as an anesthesiologist, think about how hard you worked to get where you are at this point. Think about what one false positive, or a true positive of a qualitative test which has a incredibly low threshold for someone who has possible workplace exposure, would do to your career. You'd be out. Out of work, out of coverage, out of future employment. Even worse, you might be doomed to do *shudder* primary care for the rest of your natural existance. Can you imagine the nightmare in trying to defend yourself, trying to get future employers to believe that you were that one false positive? Would you hire someone with that story?

A cashier at wal-mart can find another line of work. How about you?

Yes, substance abuse is a problem in anesthesia. But, just imagine if you had to go p!ss, knew it was clean as a whistle, and then BAM. "POSITIVE" for synthetic opiates.

Since I don't believe in black and white answers, my solution is simple. Double sample, quantitative drug testing with published thresholds. The stakes should mandate the increased level of testing.

These concerns were brought up by residents in my program, and as you might expect, the first reaction was similar to yours, until these concerns were voiced. Then, when people stopped to think about what it might be like to get that call into the bosses office, there were a whole lot less people advocating random fly-by-night drug testing.

Most don't believe there are sufficient accumulations of substances in the workplace of an anesthesiologist to trigger even a remote qualitative test.

I happen to be one, but the problem is, can you prove it, and are you willing to lay your career on the line for it?

 

[militarymd]

Ouch. Dude, um, not really.

Think about this.

1. There are qualitative & quantitative drug testing methods. Do you know which you're being subjected to?
2. Workplace exposures happen. You're constantly surrounded by substances which are being aerosolized, splashed on your fingers, etc.
Same as certain workers in certain environments would have increased levels of lead, arsenic, mercury, etc., you after awhile may have certain drugs or their metabolites on a scant level in your system.
3. Every test has false positives.
4. Most importanly, as an anesthesiologist, think about how hard you worked to get where you are at this point. Think about what one false positive, or a true positive of a qualitative test which has a incredibly low threshold for someone who has possible workplace exposure, would do to your career. You'd be out. Out of work, out of coverage, out of future employment. Even worse, you might be doomed to do *shudder* primary care for the rest of your natural existance. Can you imagine the nightmare in trying to defend yourself, trying to get future employers to believe that you were that one false positive? Would you hire someone with that story?

A cashier at wal-mart can find another line of work. How about you?

Yes, substance abuse is a problem in anesthesia. But, just imagine if you had to go p!ss, knew it was clean as a whistle, and then BAM. "POSITIVE" for synthetic opiates.

Since I don't believe in black and white answers, my solution is simple. Double sample, quantitative drug testing with published thresholds. The stakes should mandate the increased level of testing.

These concerns were brought up by residents in my program, and as you might expect, the first reaction was similar to yours, until these concerns were voiced. Then, when people stopped to think about what it might be like to get that call into the bosses office, there were a whole lot less people advocating random fly-by-night drug testing.

Most don't believe there are sufficient accumulations of substances in the workplace of an anesthesiologist to trigger even a remote qualitative test.

I happen to be one, but the problem is, can you prove it, and are you willing to lay your career on the line for it?

uhh...I was active duty in the Navy for 11 years....been pissing in the cup randomly for 11 years...I know the drill.

While active duty in the Navy, I've dealt with several physcians (one of whom was a resident of mine) who've either tested positive or were actually abusing...I know the drill.

While in private practice, I've sat on credential committees which pulled the ticket on impaired physicians (one of whom was in my anesthesia department)....although none came up because of testing....I know the drill.


Yes...testing is not perfect, but, as I said, if you have nothing to hide, you have nothing to hide.

False positives don't lead to what you think it will lead to.

Using drugs will lead to what you think it will lead to.

Random drug screens help "us" nail the bastards who use drugs.

 

[Mman]

3. Every test has false positives.
4. Most importanly, as an anesthesiologist, think about how hard you worked to get where you are at this point. Think about what one false positive, or a true positive of a qualitative test which has a incredibly low threshold for someone who has possible workplace exposure, would do to your career. You'd be out. Out of work, out of coverage, out of future employment. Even worse, you might be doomed to do *shudder* primary care for the rest of your natural existance. Can you imagine the nightmare in trying to defend yourself, trying to get future employers to believe that you were that one false positive? Would you hire someone with that story?

I personally know an anesthesiologist who was abusing some serious narcotics on the job for about 18 months and got caught twice. Clean and sober now for over a decade and working as an anesthesiologist in a great practice.

A false positive test isn't going to end your career.

 

[coprolalia]

Does tramadol result in a "true positive" urine screen?

-copro

 

[Planktonmd]

Does tramadol result in a "true positive" urine screen?

-copro

No,
It can not be detected on conventional drug screens.

 

[oudoc08]

A false positive test isn't going to end your career.

No, and getting sued a few times wouldn't either. Boy that'd be fun, too.

But, do you really want to go through the headache, stress, anxiety and such of having to check the "Yes, please explain below..." box for the rest of your life on licensure and insurance coverage forms?

Nobody wants extra baggage they don't deserve, and IMO, an anesthesiologist with a positive drug test is a 7-year leper.
Everybody knows it or finds out, and "career-ending" or not, you'd have a hard time restoring trust or reputability amongst your colleagues, who'd wonder every time you looked a bit tired, red-eyed, or whatever, whether you'd been sippin' the juice.

It's not worth it. (Again, MHO)

 

[militarymd]

No, and getting sued a few times wouldn't either. Boy that'd be fun, too.

But, do you really want to go through the headache, stress, anxiety and such of having to check the "Yes, please explain below..." box for the rest of your life on licensure and insurance coverage forms?

Nobody wants extra baggage they don't deserve, and IMO, an anesthesiologist with a positive drug test is a 7-year leper.
Everybody knows it or finds out, and "career-ending" or not, you'd have a hard time restoring trust or reputability amongst your colleagues, who'd wonder every time you looked a bit tired, red-eyed, or whatever, whether you'd been sippin' the juice.

It's not worth it. (Again, MHO)

I've done this quite a few times....there was never a question that asked if you "tested positive" on a random drug screen...

They ask if you've ever had problems with drug use...yes...but who tells the truth if they've never been busted....


I say test everyone....bust the bastards.......and that's what they are...if they come to work with drugs in their system.

 

[oudoc08]

uhh...I was active duty in the Navy for 11 years....been pissing in the cup randomly for 11 years...I know the drill.

So what? I've done the dew as long as I can remember for nearly every job I can remember. Paramedic, anesthesia extern, pizza delivery guy.
The problem is, you can't prove or argue a qualitative result, which nearly EVERY drug screen is. (Hence, my argument for double sample, quantitative sampling). The question is, are you the employer willilng to pay for it, in order to avoid the risk of ruining the career of a colleague?

Yes...testing is not perfect, but, as I said, if you have nothing to hide, you have nothing to hide.

If it's not perfect, then you have nothing to hide, but you do have something to fear. 1 out of 100 or 1 out of a 1000? Too much when it's your life and license on the line. Again, quantitative testing.

Random drug screens help "us" nail the bastards who use drugs.

"us" vs. "them"? What if it's the "us" who's hittin' the juice?


The points I brought up were concerns voiced by faculty and residents at my program, not mere rantings of a medical student. I was in the crowd who thought drug testing for the specialty most likely to abuse, was a great idea, w/o argument. That is, until I considered the points above.

You say it would't be career ending? Consider this. I'm a 4th year medical student who's applying to anesthesiology residencies. I'm also an anesthesia extern. I had to piss in a cup. A damn, qualitative test. Thank god it came back negative. Are you freaking kidding me that if it came back as a false positive, even once? That I'd ever have a shot in hell at getting into any residency program in the country?

What if it happened to a resident? Are you going to hire them?

But in the end, it comes down to the old prisoner argument. Better to let a few guilty walk than fry an innoncent? Or vice-versa.

I guess I sympathize w/ the one innocent guy sitting on death row.

(This from a moderate conservative , hard to believe I know)

 

[militarymd]

My point....a random false positive is not going to cause any problems for you..

Why are your academic attendings so paranoid?

I've dealt with impaired physicians...and random testing caught one of them...and if random testing had been in place would have nailed the other one sooner.

Do you REALLY believe that there are any truly "innocent" people on death row?

 

[militarymd]

You say it would't be career ending? Consider this. I'm a 4th year medical student who's applying to anesthesiology residencies. I'm also an anesthesia extern. I had to piss in a cup. A damn, qualitative test. Thank god it came back negative. Are you freaking kidding me that if it came back as a false positive, even once? That I'd ever have a shot in hell at getting into any residency program in the country?

What if it happened to a resident? Are you going to hire them?

I don't know the data. Tell me what the false positive rate is with the commerically available drug screens.

 

[oudoc08]

I don't know the data. Tell me what the false positive rate is with the commerically available drug screens.

No, see that's it. I don't know what it is.
If you don't either, then it's awfully cavalier to assume that it's not significant enough to consider, given the significance of what a false positive would mean.

In addition, this is without considering whether commercially available screens take into account, the workplace exposure of a anesthesiologist to certain substances.

Ever gotten fentanyl on your fingers? Does it absorb? Of course it does. But you wash it off immediately, right? But it's a negligible dose, right? Almost certainly. You've done this for years, pissed in the cup, no problem right? But at what threshold does the standard commercial test break? Do you know the cutoffs? What about metabolites? What about accumulation of unknown metabolites? What substances does your company test for? Are you consistantly using the same lab? My last test while I was an extern tested for over 20 substances, including several specific tests for individual narcotics and synthetics (I didn't know they could do this, but it was on my result form).

Again, quantitative testing. Drum banging...

 

[oudoc08]

My point....a random false positive is not going to cause any problems for you..

Are you serious? Did you even go through the match? If you can't concede that a 4th year medical student who had a positive random drug test while working in an OR environment as an anesthesiology extern would have any problems trying to find a residency position, then I can't argue rationally with you.

Do you REALLY believe that there are any truly "innocent" people on death row?

Google "Joyce Gilchrist"

Or here's one if you don't feel like it.

http://query.nytimes.com/gst/fullpage.html?res=9505E4DC1530F933A0575BC0A9679C8B63

Oklahoma's little chemist nightmare.

Here's another. The subjects of John Grisham's latest book, The Innocent Man. Whether you think it's political or not, the fact remains, these guys were exonerated from death row based on DNA evidence after spending over 10 years on death row.

http://www.pbs.org/wgbh/pages/frontline/shows/burden/profiles/williamson.html
http://www.pbs.org/wgbh/pages/frontline/shows/burden/profiles/fritz.html


But it's getting away from the point. One of the worst feelings ever, is being falsely accused of something. But with so much at stake, it's alot more than a bad feeling.

 

[oudoc08]

False positives don't lead to what you think it will lead to.

Lost work and wages, forced rehab visit, probationary status (if you still have a job), lifelong suspicion of being an "addict" from friends, colleagues, patients, spouse, children and extended family, disclosure on licensure and insurance forms, difficulty in finding future employment, negotiating contracts, obtaining prescriptive authority, transferring licensure. Presumptive guilt by people like mil, who automatically think of you as one of those "bastards". General embarassment, loss of the ability to argue the liability of the false positive drug test that put you in the situation in the first place...

I could go on, but hey it's not really that bad...

The funny part is, again, I'm pretty conservative, a republican (most of the time anyway), a huge personal responsibility guy, and all that. Probably somebody that agrees w/ mil 95% of the time on everything else. But this is an issue that I just see having too much impact on someone that would have too much to lose, all at the hand of some error by a $10/hr lab tech or bad reagent on some $10 lab test.

Actually, since I have a fairly piqued interest in this subject given all the debate. Do any of you think this would be a basis for a conceivable research project in residency?
Maybe something on workplace exposure, testing methods, efficacy of random drug testing or any of the above points?
Any suggestions?

 

[militarymd]

After some reading on the internet...it appears that the ACLU is the organization responsbile for all this fear.

False positives are just that ...false postivies.....

You're right, I don't know what it means for matching in the residency, but as I said, aplications for medical staff, malpractice, etc...DOES NOT ask you about false positives.

 

[militarymd]

My point....a random false positive is not going to cause any problems for you..

Why are your academic attendings so paranoid?

I've dealt with impaired physicians...and random testing caught one of them...and if random testing had been in place would have nailed the other one sooner.

Do you REALLY believe that there are any truly "innocent" people on death row?

note the " " around innocent....I have yet to find a report of truly "innocent" folks on death row.

They may be innocent of that specific crime, but they they aren't "innocent" people.

 

[oudoc08]

You're right, I don't know what it means for matching in the residency, but as I said, aplications for medical staff, malpractice, etc...DOES NOT ask you about false positives.

Perhaps not directly. Just a few examples of what they DO ask are questions such as:

1.Have you ever been treated for, or do you currently have any medical and/or psychiatric problem including alcohol and/or drug dependence?
2.Are you able to perform the procedures and the essential functions of the position for which you have applied or requested privileges, with or without reasonable accommodation according to accepted standards of professional performance and without posing a direct threat to patients?
3.Are you currently, or have you ever been engaged in the illegal use of drugs, or the misuse of legal drugs?
4.Have you ever been subjected to actions by a utilization and quality control Peer Review Organization (PRO)?
5.Have you ever withdrawn your application for appointment, reappointment, and/or clinical privileges, resigned from the medical staff, or surrendered your clinical privileges while under investigation or before a recommendation or decision was rendered by a hospital or healthcare facility's medical executive or governing board?

All these were questions taken directly from an application for medical malpractice coverage by PLICO, the physician liability coverage provider for the entire state of Oklahoma.

Now, if you have a positive drug test, and since you can't prove whether it was false or not, you may be subject to many different things including mandatory rehab (the first step in our institution), suspension, demotion, loss of privileges, termination, etc.

In addition, every one of the questions above will require explanation all of which are going to sound like pleas from a death row "innocent".


Regardless of whether a form asks you specifically whether you have ever had a positive drug test (I was told by a resident at our institution that the application for Oklahoma licensure asks that very question), it is the sequelae of the event that causes so much trouble with the rest of the forms, and will haunt you for the rest of your career.

 

[proman]

I don't think there's any amount of fentanyl that can be casually absorbed transdermal during routine anesthesia AND show up in the urine. Serum fentanyl + metabolites are a different story with gas spec and tandem mass spec. I believe that excuse as much as the pot head who is THC utox + and says he was "around" pot at a party but didn't smoke. Any screening test requires confirmation with GS/MS for the diagnostic lab to call it positive. Check out the information on NIDA's website www.nida.nih.gov

 

[oudoc08]

I don't think there's any amount of fentanyl that can be casually absorbed transdermal during routine anesthesia AND show up in the urine. Serum fentanyl + metabolites are a different story with gas spec and tandem mass spec. I believe that excuse as much as the pot head who is THC utox + and says he was "around" pot at a party but didn't smoke. Any screening test requires confirmation with GS/MS for the diagnostic lab to call it positive. Check out the information on NIDA's website www.nida.nih.gov

I don't think there likely is either, the problem is I don't know, and nobody I've talked to knows either, it's all alot of "I don't think" or "I don't believe", but nobody has any hard data. So, if there is a false positive as a pure function of lab error, and then GS/MS looks for metabolites, is it not conceivable that an anesthesiologist could have trace amounts enough purely from cutaneous absorption and aerosolization to show on that study?
The problem is, GS/MS is itself a quantitative test, so a false positive qualitative pos and a GS/MS showing a spike for fentanyl metabs, still wouldn't be collectively quantitative and thus still couldn't differentiate between a fluke false pos, and a snowed fentanyl junkie.

So, GS/MS is an excellent test in a situation such as testing for banned substances in atheletes. It's either there or it's not.
However, in an anesthesia doc, when you're looking for any micro trace of narcotics, you've got to be kidding yourself to think that it's not conceivable that there might be something there, either parent or metabolite.

Yes, I'm playing devils advocate, but I want to be educated on the subject so our profession doesn't get railroaded by corporates looking only out for their liability, who could give a rat's ass about some doc who happened to be the unlucky statistic.

Also the NIDA link is interesting. The section on Accuracy in Urinalysis is good reading for those interested in the subject. Good QC and lab handling are important, however it is noted that statistically speaking, errors and outliers will occur. Also of interest is the recommendation that urine from false positives should be retained in order to conduct further studies if the results are contested. Theoretically, if quantitative testing could occur on that sample, I guess that would be a pretty simple answer to the rare false positive.
Here's the link to that particular pub:
http://www.nida.nih.gov/pdf/monographs/download73.html

 

[fval28]

The drug tests are there to catch people using drugs- and protect patients from those people who are using drugs.

If they want to get high, keep them away from patients.

And in response to the "us" vs "them" comment, once someone uses drugs and comes to work, they stop being one of "us" and becomes one of "them".

They (IMHO) are not deserving of professional respect and become less like a colleague and more like a patient.

They may deserve our help and pity but DO NOT deserve to endanger patients because of their habit(s).

BTW, no addict was ever done any favors by having his or her addiction kept a secret. Random drug testing is a good way to get "them" the help they need.