what if you fail your physical?

[sdnstud]

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can school take back your acceptance if you fail your physical prior to enrolling? let's say for example you tested positive for some std...how do schools handle cases like that?

 

[meister]

You can't have an STD?

 

[Ypo.]

Crap I guess that means I'm out. 😀

 

[Thundrstorm]

har har har

 

[Mr hawkings]

The only thing they can hold you for is TB, and thats only cos its a communicable disease. Even then, you will be fine as long as you aggree to go on a treatment regimen. No one will withdraw their app cos you tested positive for an std. Its just so they dont have med students running around who dont even know their own health status. That way at least you know what precautions to take and not being a vector spreading the "love" arounds unkowingly.

 

[Psycho Doctor]

The only thing they can hold you for is TB, and thats only cos its a communicable disease. Even then, you will be fine as long as you aggree to go on a treatment regimen. No one will withdraw their app cos you tested positive for an std. Its just so they dont have med students running around who dont even know their own health status. That way at least you know what precautions to take and not being a vector spreading the "love" arounds unkowingly.

seriously they can hold you for TB???? and that's not the only communicable disease...or communicable by what method? What about AIDS or hepatitis?

 

[Uegis]

seriously they can hold you for TB???? and that's not the only communicable disease...or communicable by what method? What about AIDS or hepatitis?

TB is highly contagious and communicable through coughing, so they are more cautious about it. Other diseases, unless you have intercourse with everyone or run around with wounds splashing blood everywhere, I'm sure its okay.

 

[euromd]

McGill is not so forgiving.

http://www.medicine.mcgill.ca/ugme/infectioncontrol.htm#Policy

POLICY ON STUDENTS KNOWN TO BE SEROPOSITIVE
(e.g., Hepatitis B, Hepatitis C)

As is stated in the Health Sciences calendar, "Applicants who know they are carrying this virus (Hepatitis B) should consider carefully their intention to become a doctor and govern themselves accordingly".

Students who are seropositive for Hepatitis B and/or C have an obligation to notify the Dean's Office upon entry into the program. Specific measures will be undertaken by the Dean's Office.

The student will be referred to the Infected Health Care Worker Committee of the McGill University Teaching Hospital Council. The Chair of this committee is Dr. Mark Miller (tel: 340-8294). In consultation with Dr. Miller, modifications to clinical rotations will be made. The student will be assisted in acquiring appropriate health care. Specific career counselling will be given. Students will be advised not to select residency programs where patient safety would be put at risk. This will severely limit the residency programs to which the student may apply.

Should core clinical rotations need to be modified, notation of this will be made in the Dean's letter. Should a student apply to a residency program where patient safety would be put at risk, the Dean's Office has a duty to notify the program director that the student is seropositive.

 

[Psycho Doctor]

McGill is not so forgiving.

http://www.medicine.mcgill.ca/ugme/infectioncontrol.htm#Policy

POLICY ON STUDENTS KNOWN TO BE SEROPOSITIVE
(e.g., Hepatitis B, Hepatitis C)

As is stated in the Health Sciences calendar, "Applicants who know they are carrying this virus (Hepatitis B) should consider carefully their intention to become a doctor and govern themselves accordingly".

Students who are seropositive for Hepatitis B and/or C have an obligation to notify the Dean's Office upon entry into the program. Specific measures will be undertaken by the Dean's Office.

The student will be referred to the Infected Health Care Worker Committee of the McGill University Teaching Hospital Council. The Chair of this committee is Dr. Mark Miller (tel: 340-8294). In consultation with Dr. Miller, modifications to clinical rotations will be made. The student will be assisted in acquiring appropriate health care. Specific career counselling will be given. Students will be advised not to select residency programs where patient safety would be put at risk. This will severely limit the residency programs to which the student may apply.

Should core clinical rotations need to be modified, notation of this will be made in the Dean's letter. Should a student apply to a residency program where patient safety would be put at risk, the Dean's Office has a duty to notify the program director that the student is seropositive.

What? Are you serious? Are there other schools that screen like that and limit residency programs? Come on, just use practices for universal precautions and it's never an issue. Give me a break! 😡

 

[purpledoc]

McGill is not so forgiving.

http://www.medicine.mcgill.ca/ugme/infectioncontrol.htm#Policy

POLICY ON STUDENTS KNOWN TO BE SEROPOSITIVE
(e.g., Hepatitis B, Hepatitis C)

<<SNIP>>

As far as I know, this policy wouldn't even be legal in the United States, so I'm not surprised that I've never heard of a U.S. program doing it. Even if a school could somehow find a way around the provisions guarding confidentiality of medical records to get your status, they could never release that information to anyone else, and even if they did, the Americans with Disabilities Act would protect you with regard to discrimination. (Interestingly, the ADA does not protect you with regard to medical boards, which is a whole different story, though I've never heard of Hep B/C seropositivity being an issue.)

I should add that being TB positive would never keep you from being enrolled or admitted to a medical school or residency. The only problem would be if you have active TB -- fever, coughing, etc -- which is contagious and an entirely different story. For TB positive status, which is not rare if you work with homeless or prison populations, or if you got immunized against TB overseas as a child, you just need to do the 6 months of medications and a yearly CXR. You can enter school or residency while doing that, and no one will discriminate against you for it, because most TB-positive people will never get active TB if they are young and healthy with good immune systems.

 

[VPDcurt]

seriously they can hold you for TB???? and that's not the only communicable disease...or communicable by what method? What about AIDS or hepatitis?

AIDS? They can't stop you from going to med school if you have AIDS. If they could, we would have heard about it long ago (most likely thanks to the ACLU).

 

[Psycho Doctor]

As far as I know, this policy wouldn't even be legal in the United States, so I'm not surprised that I've never heard of a U.S. program doing it. Even if a school could somehow find a way around the provisions guarding confidentiality of medical records to get your status, they could never release that information to anyone else, and even if they did, the Americans with Disabilities Act would protect you with regard to discrimination. (Interestingly, the ADA does not protect you with regard to medical boards, which is a whole different story, though I've never heard of Hep B/C seropositivity being an issue.)

Where would we find that information for sure? There's got to be something written about it. Also even if it was true, or for McGill, how receptive would they be for someone who no longer has the virus but has antibodies for Hep C due to previously having the virus?

 

[Pinkertinkle]

Canadian schools are whack.

 

[Phased]

AIDS? They can't stop you from going to med school if you have AIDS. If they could, we would have heard about it long ago (most likely thanks to the ACLU).

Personally, I wouldn't want a doctor with AIDS to be doing surgery, handling needles, etc.

 

[Psycho Doctor]

Personally, I wouldn't want a doctor with AIDS to be doing surgery, handling needles, etc.

what about someone with hep C? how would you feel about them doing surgery on you?

 

[Psycho Doctor]

The New England Journal of Medicine makes reference to this in their article "Transmission of Hepatitis Viruses by Surgeons".

One editorial states "A surgeon who harbors such viruses can become a danger to his or her patients. Since it is our duty to protect patients at all costs, surgeons should be tested for communicable diseases, and those with positive results should not be permitted to perform invasive procedures. "

Maximo Deysine, M.D.
State University of New York at Stony Brook
Stony Brook, NY 11794

Another says: In the case of surgeons, it may be that those with viremia above designated threshold levels will no longer be able to operate. Such surgeons should be offered counseling, disability compensation, and help finding alternative work as part of an active policy, as opposed to the haphazard way in which these situations are currently handled in most institutions.

Amy Beth Kressel, M.D.
New York Medical College
Bronx, NY 10451

http://content.nejm.org/cgi/content/full/335/4/284

 

[MNgrrl]

Some med schools don't require a physical - UVM doesn't. They just make you prove that you have titers (i.e. not just the shots, but get blood drawn to make sure you have antigens) for hep B, TB, varicella, measles, mumps and rubella, and maybe one other one...

So I'm not saying it's good to go out and get an STD, but some med schools wouldn't ever know.

 

[Blake]

Mcgill has got to the most demanding med school ever. Geez, they act like they're God's gift to mankind... Those who applied and had an interview there know what I'm talking about.

 

[MizzouDrWannabe]

Where would we find that information for sure? There's got to be something written about it. Also even if it was true, or for McGill, how receptive would they be for someone who no longer has the virus but has antibodies for Hep C due to previously having the virus?

I don't think they've pronounced anyone cured of hep c...although there are people with zero viral counts. Maybe hep B though. I wouldn't think they could hold it against you for having antibodies because everyone who's been vaccinated for hep B or hep A have antibodies.

 

[Psycho Doctor]

I don't think they've pronounced anyone cured of hep c...although there are people with zero viral counts. Maybe hep B though. I wouldn't think they could hold it against you for having antibodies because everyone who's been vaccinated for hep B or hep A have antibodies.

i meant zero viral counts due to a regimen of pegylated ribavirin and interferon.

well with antibodies to Hep C from such a treatment still makes you ineligible to donate blood. i'm sure you can donate blood and give organs for transplantation when you have antibodies to Hep A and B due to innoculation, so someone is make a differentiation

 

[pinkey]

what about someone with hep C? how would you feel about them doing surgery on you?

not exactly thrilled.

 

[Phased]

what about someone with hep C? how would you feel about them doing surgery on you?

I wouldn't want anyone with HCV (or other 'communicable'-like diseases) in their blood to be dealing with sharp tools near me, especially if they're cuttin' me up and what not. Again, this prejudice is only my personal opinion.

 

[Psycho Doctor]

I wouldn't want anyone with HCV (or other 'communicable'-like diseases) in their blood to be dealing with sharp tools near me, especially if they're cuttin' me up and what not. Again, this prejudice is only my personal opinion.

the question is whether it is ethical and whether med schools and/or hospitals would verify it and not accept/hire soemone if they have one of those diseases

 

[Phased]

the question is whether it is ethical and whether med schools and/or hospitals would verify it and not accept/hire soemone if they have one of those diseases

I don't see why it be unethical to do so, especially if you're just looking out for the interest of the patient.

 

[Psycho Doctor]

I don't see why it be unethical to do so, especially if you're just looking out for the interest of the patient.

perhaps ethical was the wrong word, b/c yes i can see it being ethical for the patient i mean is it discriminatory to the doctor and are they allowed to do that? if one takes universal precautions there shouldn't be any problems.

 

[stinkycheese]

I don't see why it be unethical to do so, especially if you're just looking out for the interest of the patient.

It is a violation of the physician's privacy. Transmission to patients is actually a statistically negligible risk under universal precautions. The only way a bloodborne pathogen could be transmitted to a surgical patient would be if a surgeon cut herself and did not immediately remove her wounded hand from the sterile field. Surgeons don't cut themselves often (with a scalpel), and a needlestick would pose risk to the physician, not the patient - blood wouldn't get through a double gloved hand. People with hep b/c or hiv should not have to disclose this information to anyone at any time, except for sexual partners. Occupational disclosure is unethical and prejudicial.

 

[ellehcim]

Surgeons don't cut themselves often (with a scalpel).

Actually, it happens all the time. Surgeons, especially cardiothoracic, gynae, ortho, actually have a fairly high rate of sharps injuries. Last lecture we had on this stated an average of one sharps injury per 12 months for all surgical specialties. A survey of US and UK orthos found that 39% and 49% respectively had suffered sharps injuries in the last month.

Would you really be happy to have a surgeon with a blood borne infection doing your surgery given those statistics, if they promise to "remove their hand from the sterile field quickly?". If they are performing surgery and cut their hand whilst inside, if the cut is bad enough, it's not going to matter how quickly they remove the hand.

 

[stinkycheese]

Actually, it happens all the time. Surgeons, especially cardiothoracic, gynae, ortho, actually have a fairly high rate of sharps injuries. Last lecture we had on this stated an average of one sharps injury per 12 months for all surgical specialties. A survey of US and UK orthos found that 39% and 49% respectively had suffered sharps injuries in the last month.

Would you really be happy to have a surgeon with a blood borne infection doing your surgery given those statistics, if they promise to "remove their hand from the sterile field quickly?". If they are performing surgery and cut their hand whilst inside, if the cut is bad enough, it's not going to matter how quickly they remove the hand.

Most sharps injuries are needlesticks, which I accounted for in my post, and which pose a significantly reduced risk of bloodborne pathogen transmissions from physician --> patient than do scalpel injuries.

I don't think my physician's health history is my business. I would have to choose a surgeon I believed was competent and trustworthy. Beyond those parameters, I have no right to any other information about my surgeon's health.

And when you say it's not going to matter how quickly a surgeon removes a bleeding injury fromthe field, I ask you this: do you know the rate of HIV transmission? It is very low, even for known exposures. Getting someone's blood into your body is sufficient to get infected, but the transmission rate for needlestick injury is only 1 transmission per 1000 dirty (known positive) sticks. Secondly, post-exposure prophylaxis is extremely effective and would be utilized in the (rare) case that a surgeon cut himself to the point of bleeding while inside an open wound and got infected blood into the body.

 

[ellehcim]

Most sharps injuries are needlesticks, which I accounted for in my post, and which pose a significantly reduced risk of bloodborne pathogen transmissions from physician --> patient than do scalpel injuries.

I don't think my physician's health history is my business. I would have to choose a surgeon I believed was competent and trustworthy. Beyond those parameters, I have no right to any other information about my surgeon's health.

And when you say it's not going to matter how quickly a surgeon removes a bleeding injury fromthe field, I ask you this: do you know the rate of HIV transmission? It is very low, even for known exposures. Getting someone's blood into your body is sufficient to get infected, but the transmission rate for needlestick injury is only 1 transmission per 1000 dirty (known positive) sticks.

Sorry, I meant to say those stats were about scalpel injuries!

I don't know what it's like in the states, I imagine it would be different because your privacy laws are different to ours, but in Aus there are rules about what procedures a doctor with illnesses like blood borne pathogens is able to perform. They do not have to tell the board what specific illness they have, but they do need to alert their supervisors that they can no longer perform exposure prone procedures, which are generally defined as procedures involving sharps or in areas of poor visibilty, eg most surgeries. Their treating specialist must report them if they continue to perform these procedures whilst viraemic.

These include infections other the HIV, for which the transmission rates are much higher, eg Hep B/C, from memory about 20 per 100 injuries involving postive patients/HCWs.

HIV incidence in Australia is so low that when we talk about blood borne pathogens we are usually talking hepatitis, but of course they do take HIV into consideration.