I hate this school sometimes

[Saora1]

Last term, we had to update our physicals and get a PPD repeated before we could get our clinical clearance.

For whatever reason, I had a 9 mm induration which is less than the 10 mm required for a positive result in "health care workers". I was given the okay and told I didn't need to get a chest X-Ray done while several of my classmates were sent for them (mostly students who had had a BCG vaccine).

I just now (only now, nearly 3 months later!!!) received an e-mail from the infamous nurse in charge of our health records informing me that I cannot receive completion status and a permanent placement letter until I go get an X-Ray and have my doctor sign that I am healthy.

Thanks a lot SGU. Why do you teach us anything (like that 10 mm is the cut-off) if you don't respect those guidelines? It's 10 or greater not 9 or greater. And thank you for the great communication you have with your staff, including the Associate Dean of students in St. Vincent who is the one that told me I'm fine and don't need to get an X-Ray or do anything further. And one final thank you for waiting this long to let me know.

I've replied asking them to re-evaluate that decision but I don't really expect anything to come of it. *sigh*

***

Sorry for the rant, but this is just stupid.

[tralfaz]

I know someone who could not get their ppd test validated 48hrs after the fact. They were told that the clinic would be open...but no one was there. This was not an isolated event either.

My suggestion to future 6th terms is try and get your health requirements taken care of with your family doctor.

[stephew]

my recomemendation: write letters to those involved and cc'd to higher up. make it professional. write that you were given different information at different times and that you would have been able to get the matter settled right away if you had been told upfront you needed an xray. tell them they need to make consistent policies both for the safety of the patients you will see and for you so that you can complete any requirements IN A TIMELY WAY. force them to deal with the incongruous information you've received and that gets in your way of going forward.

[Saora1]

my recomemendation: write letters to those involved and cc'd to higher up. make it professional. write that you were given different information at different times and that you would have been able to get the matter settled right away if you had been told upfront you needed an xray.

I did that immediately after receiving the e-mail. Well, after double-checking to make sure I remembered the rules for PPD results correctly.

I debated including a CC to the doctor (Dr. T.M. R.) in St. Vincent but decided against it. I replied to the nurse and Dr. S. W. the dean in charge of Clinical Health Services. However, in the letter, the nurse indicated that he agreed with her decision after consulting him. How accurate that is, I don't know...

tell them they need to make consistent policies both for the safety of the patients you will see and for you so that you can complete any requirements IN A TIMELY WAY. force them to deal with the incongruous information you've received and that gets in your way of going forward.

I didn't really say that although I guess I hinted at it in a general way.

The following is a copy of the letter I sent.

Dear XXXX,

I have received your notice and I thank you for updating me on my health status report. However, I find this news to be very untimely. I am in the middle of preparing for my Step I Exam next month.

The PPD in question was completed last term in St. Vincent (Ratho Mill Medical College) by Dr. XXXX the Associate Dean of Students there. At that time, I inquired as to whether my status was okay and I was told that it was and that I did NOT need to complete a chest X-Ray. Several other students were sent for X-Rays at that time. A time, I may add, that was more appropriate to do so. If it was indicated that I needed to get an X-Ray, I would gladly have done so in order to complete the required tests and obtain clearance.


Given that I am a young male without immunocompromised status, a test result of less than 10 mm induration indicates that I am free of infection.

From multiple sources of notes I have received at this school, including several medical textbooks:

"Larger reactions (greater than or equal to 10 mm) are considered positive in individuals with diabetes, renal failure and health care workers, among others. In individuals with no known risks for tuberculosis, a positive reaction requires a 15 mm or greater induration."

Given that my result is less than 10 mm, I respectfully request that this decision be re-evaluated and I be cleared for completion status.

Regards,

XXXX

CC: XXXX, MD


I'm pretty annoyed now that I have to run around to the doctor (especially at this point in time) first to get a referral for an X-Ray (and another PPD), then get the X-Ray, then go back for the results, then back to the doctor to have the PPD read and show him/her the X-Ray and get a form signed to send to the school.

I could do this after my test but I will be in Miami at that time and will cost me a lot more as opposed to doing it here at the clinic.

Anyway, thanks for the suggestions steph. Glad to see you're still alive. Not seeing much of you these days.

[stephew]

Well you handled it the right way. you wrote a professional letter and cc'd it to the proper people, and its now documented. Will minimize the chances of it happening again (maybe). I hope they replied to you (but am not holding my breath on that one).

yes im around. busy as anything and frankly the sgu forum behaves most of the time so i spend more time spanking kids in the other forums.

hope youre well.
SI did that immediately after receiving the e-mail. Well, after double-checking to make sure I remembered the rules for PPD results correctly.

I debated including a CC to the doctor (Dr. T.M. R.) in St. Vincent but decided against it. I replied to the nurse and Dr. S. W. the dean in charge of Clinical Health Services. However, in the letter, the nurse indicated that he agreed with her decision after consulting him. How accurate that is, I don't know...



I didn't really say that although I guess I hinted at it in a general way.

The following is a copy of the letter I sent.



I'm pretty annoyed now that I have to run around to the doctor (especially at this point in time) first to get a referral for an X-Ray (and another PPD), then get the X-Ray, then go back for the results, then back to the doctor to have the PPD read and show him/her the X-Ray and get a form signed to send to the school.

I could do this after my test but I will be in Miami at that time and will cost me a lot more as opposed to doing it here at the clinic.

Anyway, thanks for the suggestions steph. Glad to see you're still alive. Not seeing much of you these days.

[Toddaa1]

Consider yourelf lucky that they eventually did notify you, even if it did take 3 months. Once you are doing clinicals you will understand what I mean, the school doesn't let u know what you need to be doing and expects you to take care of all aspects of your last 2 years. I even heard one story from a colleague about how a person at bayshore responsible for handling student paperwork quit and the student was never notified.

Im glad to see my tuition dollars hard at work.

(speaking of tuition dollars, did you know that all NYCOM students in old westbury got a free set of Kaplan notes/books for going throught the "great inconvenience" of having to share their campus with SGU students for 3 months following Ivan).

-T-

[stephew]

todd, dont believe that re: NYCOM.

[AKdoc]

re: NYCOM

I heard the same thing. That we paid for their 2 week kaplan course. This is per NYCOM students...but maybe Steph knows more? who knows....

[rokshana]

(speaking of tuition dollars, did you know that all NYCOM students in old westbury got a free set of Kaplan notes/books for going throught the "great inconvenience" of having to share their campus with SGU students for 3 months following Ivan).

-T-

thought it was like a week before they booted us out- jeez! and was that OUR tuition money that paid for that?

[Saora1]

Well I got a response which was not to argue and also not to "quote statistics". I don't know when a medical guideline became a statistic.

In this reply, it seemed that I could go get another PPD and if it was positive then get an x-ray done, whereas before, it seemed to me that I was being told that I had to get an x-ray no matter what.

So I wrote back to ask for further clarification if that was the case before I "didn't do as I was told". Got the PPD done this morning (where the clinic nurse proceeded to roll her eyes and ask why I needed it; and also informed me about all the other problems students have had with health requirements).

Just got back home now where I found another message which explains it a little more clearly - that my initial PPD 2+ years ago was measured at 0 and is now 9 so they are concerned. Fair enough I guess but I still contend that I am less than 10. I was told that if my new result is less that 5 mm (which indicated to me that they think I have some kind of immune compromised status
since 5 mm is the cut-off for this population; gee thanks SGU, does it matter that I can't remember the last time I was sick and so much as had a common cold?) that they will accept that. Otherwise, it's some yummy radiation for me.

[AKdoc]

at least they told you before you started your clinicals...imagine going to a clinical center that you had to start at, and being told you weren't starting because your health file was incomplete. That happened to one of my classmates....

[Saora1]

at least they told you before you started your clinicals...imagine going to a clinical center that you had to start at, and being told you weren't starting because your health file was incomplete. That happened to one of my classmates....
Yeah, I'll take this over that alternative any day. But still doesn't make it right.

The lesser of too wrongs is still a wrong.

Anyway, no point in my complaining any more. I have to be SGU's b1tch on this one cause I've stated my case (which was overruled) and it's not worth it to fight. If they want me to do it, I don't have much of a choice because I'm the one who stands to lose. Not them. *sigh*

[Toddaa1]

Well I got a response which was not to argue and also not to "quote statistics". I don't know when a medical guideline became a statistic.

In this reply, it seemed that I could go get another PPD and if it was positive then get an x-ray done, whereas before, it seemed to me that I was being told that I had to get an x-ray no matter what.

So I wrote back to ask for further clarification if that was the case before I "didn't do as I was told". Got the PPD done this morning (where the clinic nurse proceeded to roll her eyes and ask why I needed it; and also informed me about all the other problems students have had with health requirements).

Just got back home now where I found another message which explains it a little more clearly - that my initial PPD 2+ years ago was measured at 0 and is now 9 so they are concerned. Fair enough I guess but I still contend that I am less than 10. I was told that if my new result is less that 5 mm (which indicated to me that they think I have some kind of immune compromised status
since 5 mm is the cut-off for this population; gee thanks SGU, does it matter that I can't remember the last time I was sick and so much as had a common cold?) that they will accept that. Otherwise, it's some yummy radiation for me.

Im sorry to here that they are giving you hassle saora, unless u have aids, been near someone w/ tb or taking lotsa steroids they really shouldnt be giving you trouble. also keep in mind there are many possible ways of getting a false reading. one little trick that can reduce the induration is if for the 5 or more days before they do thee ppd, you expose the area to be tested to a good healthy dose of UV light,10-15 minutes no sunblock on grande anse should do the trick (you just want to get to the point where you have a little redness).

-T-

[algen]

And another thing....when you get your PPD health clearance note the date. During clinics you will have to repeat that test and have the results of it approximately one year from the date of your last PPD clearance. If YOU dont take care of this YOURSELF, the school will send you a letter 1-2 weeks before your due date and say your health clearance is deficient due to your outstanding PPD renewal test. You will be immediately suspended from clinics until you get it done. Yep....this happened to two of my friends who are with me on rotations as we speak.

[medic]

You are a new converter, just get a chest xray. You just spent 2 years in the Caribbean, you do NOT know who may have sent a few Mycobacteria your way. Do you really want Mycobacteria coming back to haunt you later on? You don't. Even if they tell you not to get an xray, go get one done.

PS: and the above post from Todd about how to pre-treat your skin in order to fool the test and reduce the induration of the PPD should be deleted by the moderators.

[dunsoon]

Yeah, I have to agree with Medic on this one. Getting a CXR or another PPD placed is not an insurmountable obstacle, especially considering that you may be seroconverting because of a TB exposure (several people from SGU do every year) and you need to stay on top of that. Don't forget that medical guidelines are called "guidelines" for a reason, not "rules". You have to apply a bit of common sense: zero to nine is a problem, not eight to nine.

As for cheating a medical test to avoid the hassles of follow up - what can I say? The foolishness of it speaks for itself.

[Saora1]

Yeah, I have to agree with Medic on this one. Getting a CXR or another PPD placed is not an insurmountable obstacle, especially considering that you may be seroconverting because of a TB exposure (several people from SGU do every year) and you need to stay on top of that. Don't forget that medical guidelines are called "guidelines" for a reason, not "rules". You have to apply a bit of common sense: zero to nine is a problem, not eight to nine.
My major issue here is:

1. The timing. It's close to my exam date and going to the doctor 4 times is a pain at the moment.

2. The fact that I was told differently initially. I even queried whether or not I should get the x-ray done when my reading was 9 and was told no.

Like I said in my subsequent responses, when I was actually given a reason i.e. that it was the increase that was a concern (I did my first PPD in July of 2004 and couldn't even remember what it was; just that it wasn't positive).

***

Anyway, to add another complaint to the list I just got back from "reading" my PPD. It's biggish again. Not as big as the 9 mm last time but greater than the 5 (I measured it as 7 mm) so I just went to get the x-ray referral. The doctor at the clinic was pretty clueless. I had to explain to him multiple times that I had just gotten this PPD on Monday. I think he was confused by the fact that I mentioned the one I got in Nov. Then he asked me if I ever had a Mantoux. I was like, uh, a BCG you mean? Yeah, that was it. Not very confidence inspiring.

Then he told me that they probably just want me to take the medication. Huh?

Whatever. Getting the freaking x-ray tomorrow I guess. Bloody waste of time.

[Saora1]

You are a new converter, just get a chest xray. You just spent 2 years in the Caribbean, you do NOT know who may have sent a few Mycobacteria your way. Do you really want Mycobacteria coming back to haunt you later on? You don't. Even if they tell you not to get an xray, go get one done.Well I agree that I don't want to get T.B. coming back to "haunt me" but I've spent close to 21 years in the Caribbean rather than 2. :D

[dunsoon]

My major issue here is:

1. The timing. It's close to my exam date and going to the doctor 4 times is a pain at the moment.

2. The fact that I was told differently initially. I even queried whether or not I should get the x-ray done when my reading was 9 and was told no.


Understood. No one has EVER accused SGU of being timely or convenient.:evil:

My first clue should have been when I applied for the August class, didn't hear a peep after my interview in May until July when they told me i hadn't made it into the August class but had been accepted for January. Wha??? Talk about poor communication. Who the hell said I wanted to start in january?????? Ok, sorry for the mini rant and off topic.

[Saora1]

Hmmn, my PPD is turning yellow today. Looks like a bruise which is weird cause I don't bruise easily. I have to really whack myself to get one.

I wonder if the nurse injected it too deeply...

[EMT2RN2MD]

Yep. Too deep. And now you got an imperfect wheal and a bruise. Call it all off and retry after the bruise resolves.........j/k. But, it was probably too deep making a sweet wheal takes a steady hand. Sorry to hear about your problems. I finally got all my health care crap in order last month. HEAD - ACHE.


Have fun/Study hard which ever is relevant.

[Saora1]

Call it all off and retry after the bruise resolves.........j/k.

lol

Maybe I should redo all of my vaccinations as well? :p

Got my stinking x-ray this morning. Went to the private clinic rather than the general hospital. The latter would be free but I'd have to wait. Still, can't beat EC $90 for an x-ray. My sis came down with an infection last year at the hospital she works at in Miami and had to get one. I think she said the bill quoted close to US $400 or something stupid like that (I may be mistaken but I know it was a lot). Her co-pay was only $10 though. Man, the US health-care system is farked!!!

Sorry to hear about your problems.

Bleh, such is life.

Thanks though.

I finally got all my health care crap in order last month. HEAD - ACHE.

Tell me about it. Oh well, at least you're done now. Hopefully...