Hand pain and residency choice

[SadGiraffe]

Hello everyone

My brother was recently diagnosed with De Quervain’s (both hands!) and carpal tunnel syndrome in his left hand.

I personally experience some sort of hand pain, but not to the same degree as him.

He’s interested in Pathology and IM (Pulm), but ever since he got the diagnosis, he’s been feeling down about it and questioning his ability to work in Path or IM pain free.

I’m currently an IM resident and I think he’d be fine in a non procedural subspecialty. Not so sure about pulm or pathology tho

does anyone have any experience with this?

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[deleted1100659]

De quervain is "gamer's thumb", often people who play a lot of video games is one of the stereotypes. I had it myself, lasted around 3-5 months (forget how long) but eventually pain was 100% gone. Not a permanent condition so I dont think it should affect residency choice.

There are many treatments for carpal tunnel as well, some people even do surgery for it.

 

[housestaffhustle]

Agree that you shouldn't discount any specialties so early on. Sounds like your personal hand pain is limited. If you do end up deciding to go into a procedural specialty you should be sure to buy true own occupation disability insurance now!

1. You may be able to get a slightly better deal on it as a med student/resident.
2. It's ideal to apply when you have as few health issues a possible. This is the one situation where it's good if you haven't seen a doctor in a while (ie. Don't go see your PMD now and get a diagnosis for your hand pain. Since it doesn't seem that serious by your description, get disability insurance first, then get it checked out.)
3. Be careful about what actually gets listed in your medical chart by your PMD or the specialists you see. Even little things can increase the cost of disability insurance (or even get you denied). I hadn't considered this before applying for disability insurance myself, but they really delve into every minute aspect if your medical history.
4. Everyone should probably have disability insurance but proceduralists and surgeons should definitely have "true own occupation" disability insurance. The idea is that even if you aren't fully disabled, if you are unable to perform at the same level as you did previously, you should received some sort of pay out. With regular disability insurance you may have to be fully disabled (ie. unable to function clinically in any capacity) to receive a payout.
5. It will seem like a large monthly cost, but you are in effect insuring your most important asset, your own ability to work/generate income. It's crazy when you hear horror stories of totally unforeseen circumstances (ex. dentist who lost the ability to use their right hand) and how lucky they were to have disability insurance. It's the insurance you always want to have but never want to use.
6. Learning more about this, I've also learned that sometimes even with reliable/reputable insurance companies it may be challenging to get them to pay out even when you clearly meet the qualifications. There was a recent podcast episode on The White Coat Investor where guests shared anecdotes of their struggles to get compensated for their claims, even needing to hire lawyers. Obviously not ideal, but I think still better than not having the insurance at all.

Anyway, best of luck deciding on a specialty! Decide what you like intellectually first, see if you fit in with the people, then see how you feel about the practical aspects of the job. If you do end up considering a procedural/surgical specialty, look into getting disability insurance sooner rather than later.

 

[Saddleshoes]

From a dentist's prospective where we do procedures contently...

I entered the profession with a carpal tunnel condition, in my left hand, due to using a jackhammer in my summer jobs for 5 years. I developed a De Quarvain's, in my right hand, midway though my career.

In both cases, I have learned to "work around" the issues. By changing the ergonomics of my procedures I was able to practice without problems. The De Quarvais has not been a problem for years. The carpal tunnel thing has gradually increased over the years but I have yet to feel the need for a surgical solution.

The single best practice to reduce those problem was simple. Have your assistant do all retraction.

My Advice...
...Go for the surgical specialty, just learn to adapt your technique around your condition.

 

[hmockingbird]

De quervain is "gamer's thumb", often people who play a lot of video games is one of the stereotypes. I had it myself, lasted around 3-5 months (forget how long) but eventually pain was 100% gone. Not a permanent condition so I dont think it should affect residency choice.

There are many treatments for carpal tunnel as well, some people even do surgery for it.

This… definitely don’t make any permanent decisions before attempting treatment.

I had pretty bad tennis elbow a few years ago and had a lot of pain even holding my stethoscope to auscultate but a few months of PT had me back in shape.

 

[Crayola227]

Ditto the own occupation insurance, before this stuff is all over your chart.

Most people do get better from these conditions, however, some do not. I know of at least a couple docs that no longer practice at all due to chronic musculoskeletal pain and are poor AF. It started as something just like this, only it was impossible to make it go away entirely with therapy and became chronic pain. It can be difficult to predict who will be the unlucky sap, except that chronic pain can sometimes run in families, so if you have a first degree relative with a similar issue with chronic pain I would be more concerned.

Personally, if you're already developing overuse injury, I would cultivate a back up specialty plan in case this doesn't resolve and MS4 needs to shift what they apply to.

Lastly, I cannot say enough how important it is for people in school and training to try to take care of themselves and allow these things to heal, if they can.