Would you apply to medical school if you had an immune issue?

[OpheliasWings]

Hi Everyone,
I just wanted to post here and get some input from someone outside of the box. I am a non-traditional student, about to finish out my bachelors degree in Psychology. I was originally a pre-nursing student then decided I wanted to apply to medical school to become a pediatrician. Last Spring at this time I had an unexpected spleen removal surgery and have since been on high alert about my health and lack of immunity. I was assured by my surgeon that I could go into any line of work I wanted to as long as I was cautious and stayed up to date on my vaccines every 5 years.
The problem is that I feel that being a med student and eventually a doctor would put me at a huge risk of infection being around ill people in a hospital setting all the time. Perhaps this is common sense or perhaps it's just my self preservation setting in, but I wanted to get opinions from others.
Would any of you go into medicine knowing that you would be at a higher risk of infection?

I have also considered going into pediatric physical therapy as an alternative route. I figure that it would give me a different option where I could help people, but reduce my risk of being in a high risk environment all the time.

Any thoughts? Any suggestions on alternative career paths in the medical field?

Thanks in advance!
Sonseria

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[QofQuimica]

Other than a splenectomy, you have a perfectly normal immune system, correct? If that's the case, it sounds like the real issue is that you're a bit of a hypochondriac. Though if you're so worried about your health that you feel like you can't handle being around sick people, I agree that medicine is not the best career choice for you.

 

[DesertPT]

I have also considered going into pediatric physical therapy as an alternative route.

If you have not shadowed a PT (particularly a pediatric PT) I would exhort you to. Pediatric medicine and pediatric rehab are very different in what you do on a day to day basis. The debt:income ratio is also much more poor for PT than for medicine. Pediatric PT is really awesome but it is not for everyone, so that's why I highly recommend some observation hours. There are just certain people who are more meant to work with kids than others. And you have to go into PT because it is your passion, otherwise the time and effort it takes just won't seem worth it considering the earning potential you will have.

Also, don't go into PT school too dead set on a certain specialty. PT school trains you as a generalist and you may have to take a job outside of your desired specialty after you graduate if you can't find work in your specialty of choice right away.

 

[OpheliasWings]

So would you say that your earning potential as a PT is not worth the school loan debt but becoming a physician is? I had a chance to do some shadowing under an OT for a little while in a pediatric clinic. I found it interesting. They had OT, PT, and SLP in different parts of the clinic.
I want to work in pediatrics, I know that much. I would love to be a pediatrician, but my concern is since I have my spleen removed am I going to be at such a high risk of infection that it's not worth it to pursue a career in the medical field?

 

[OpheliasWings]

Other than a splenectomy, you have a perfectly normal immune system, correct? If that's the case, it sounds like the real issue is that you're a bit of a hypochondriac. Though if you're so worried about your health that you feel like you can't handle being around sick people, I agree that medicine is not the best career choice for you.

As fas as I know I don't currently have any other immune issues. Thanks for your input, but I don't see that having a legitimate health concern makes me a hypochondriac.

 

[doctorjunior]

I have an autoimmune disease and I'm on an immunosuppressant (prednisone, specifically). I work in urgent care and I'm planning to go into medicine- also interested in peds. Now, I don't have the medical knowledge that others have on here, but I do have my personal experience. After starting the pred, I got sick for the first time since starting my work at the urgent care center- and it was just a sinus infection. Maybe it was coincidental (I've always had a strong immune system), but maybe it was due to the immune issues.

In any case, I don't think it's something to be terribly concerned with. I have had almost no issues working in healthcare while with a suppressed immune system. I'm a little more compulsive with hand sanitizer and make sure to eat a vitimin- rich diet, but I feel I'm not at any greater risk.

 

[DesertPT]

So would you say that your earning potential as a PT is not worth the school loan debt but becoming a physician is?

I would say that depends on whether you want to be a PT or a physician more. You can provide for yourself/your family perfectly well in both professions. If long-term wealth is your goal, yes the debt:earning potential ratio for PT is quite a bit worse. But if you don't want to be a doctor and you do want to be a PT, then that pretty much answers your question (and visa-versa).

 

[DesertPT]

But it sounds like you're well on your way to being a typical dingus M.D. Congrats!

You're not going to get far in getting advice on this forum with posts like this, just so you know (nor will you make it far in medicine if you can't learn to bite your tongue at people who are superior in experience to you, FWIW).

 

[OpheliasWings]

I have an autoimmune disease and I'm on an immunosuppressant (prednisone, specifically). I work in urgent care and I'm planning to go into medicine- also interested in peds. Now, I don't have the medical knowledge that others have on here, but I do have my personal experience. After starting the pred, I got sick for the first time since starting my work at the urgent care center- and it was just a sinus infection. Maybe it was coincidental (I've always had a strong immune system), but maybe it was due to the immune issues.

In any case, I don't think it's something to be terribly concerned with. I have had almost no issues working in healthcare while with a suppressed immune system. I'm a little more compulsive with hand sanitizer and make sure to eat a vitimin- rich diet, but I feel I'm not at any greater risk.

Thank you for your response. I appreciate your personal input, it's nice to actually get a response from someone that has experience dealing with being immune depressed and that has worked in the healthcare field. I appreciate your time and your input.

 

[OpheliasWings]

You're not going to get far in getting advice on this forum with posts like this, just so you know (nor will you make it far in medicine if you can't learn to bite your tongue at people who are superior to you, FWIW).

I have no problems with biting my tongue and am very respectful to other people, however, I'm not going to bend over and kiss the rear of someone that thinks that their superior to me, I'm too old to care about playing people's games. Besides I'm not going to just stand by and have someone call me a hypochondriac for having a legitimate concern. I was simply asking for opinions from others that have or will be working in the health care industry. I could really care less, my life is not going to come to a screeching halt because I don't play games with forum trolls.

 

[didymus]

I have no problems with biting my tongue and am very respectful to other people, however, I'm not going to bend over and kiss the rear of someone that thinks that their superior to me, I'm too old to care about playing people's games. Besides I'm not going to just stand by and have someone call me a hypochondriac for having a legitimate concern. I was simply asking for opinions from others that have or will be working in the health care industry. I could really care less, my life is not going to come to a screeching halt because I don't play games with forum trolls.

 

[DesertPT]

I have no problems with biting my tongue and am very respectful to other people, however, I'm not going to bend over and kiss the rear of someone that thinks that their superior to me, I'm too old to care about playing people's games. Besides I'm not going to just stand by and have someone call me a hypochondriac for having a legitimate concern. I was simply asking for opinions from others that have or will be working in the health care industry. I could really care less, my life is not going to come to a screeching halt because I don't play games with forum trolls.

@QofQuimica is hardly a forum troll, lol.

I am not suggesting you kiss anyone's butt or play anyone's games. I am suggesting that you respond to the input that you don't want to hear with the same level of poise that you have when you respond to the comments you do want to hear.

Also, for future reference, my impression is that the non-trad forum is one of the more "tough love" forums here on SDN, so don't feel like you have to take any comments too terribly personally. People here will give you harsh but helpful real talk somewhat more readily than people will in the pre-med forums because, well, everyone here is a grownup.

 

[NonTrad16]

I'm on an immunosuppressant. No one I've talked with (parent MD, rheumatologist PA, shadow MD, etc) has made any suggestion I should be overly concerned, though I've never asked directly. Different circumstance, but I'm going forward and applying.

Somehow the reactions to Q's comment really escalated.

Being concerned for your health is one thing, but I don't see anything accusatory in Q's response. You're coming here for advice, and Q is a physican (unlike you) whose advice is certainly more valuable than mine. You edited your post, suggesting you do think it was too extreme, there's no harm in admitting it.

You can be to old to "play games", but hopefully you're mature enough to honestly assess yourself and your behaviors.

 

[Mad Jack]

Looking into the research, the most serious offender in regard to post-splenectomy infections is S. pneumoniae, which you can be vaccinated against, after which you'll have a competent enough immune system to handle it. Other major offenders (Haemophilus influenzae, Neisseria meningitides) that lead to sepsis in post-splenectomy patients have vaccines as well. Once you are vaccinated against most of these bacteria, you should be mostly fine in the hospital, as your ability to handle most other infections will be slow but competent. You might get sick slightly more often, but you're probably not going to up and die, barring terrible, terrible luck.

 

[Mad Jack]

Other than a splenectomy, you have a perfectly normal immune system, correct? If that's the case, it sounds like the real issue is that you're a bit of a hypochondriac. Though if you're so worried about your health that you feel like you can't handle being around sick people, I agree that medicine is not the best career choice for you.

In all fairness, there are a good number of commonly encountered bacteria in the hospital that can kill a person post-splenectomy. Fortunately we've got vaccines, but someone outside of the medical profession, like OP, only knows she has a weakened immune system and is unaware of the specifics. While I don't appreciate her response to you, as you are pretty awesome, I can see how a layman might worry about not having a spleen and going into medicine, knowing only that they'll be working with the sick and more prone to being sick themselves.

 

[QofQuimica]

In all fairness, there are a good number of commonly encountered bacteria in the hospital that can kill a person post-splenectomy. Fortunately we've got vaccines, but someone outside of the medical profession, like OP, only knows she has a weakened immune system and is unaware of the specifics. While I don't appreciate her response to you, as you are pretty awesome, I can see how a layman might worry about not having a spleen and going into medicine, knowing only that they'll be working with the sick and more prone to being sick themselves.

I'd be the last person to criticize anyone for wanting to know what their health risks are if they choose a career in medicine. I do have a (as far as I know) actively functioning spleen, and believe me, I didn't balk for one second at starting my cipro prophylaxis when several of us were exposed to a meningitis patient back in residency. That being said, the OP in this case has all of her immune cell lines present and functioning. She has discussed her career interests with her doc, who has already told her that she does not have to limit her choice of career if vaccinated against encapsulated organisms. She, like you, is presumably literate enough and internet-savvy enough to look up the information for what she needs to do to reduce her risk of infection, even if her doc hadn't already given her a list of the vaccines she needs to get. We all agree that she does need to be vaccinated against encapsulated organisms (which she should do regardless, even if she doesn't go into the medical field). But as you pointed out, happily, those vaccines exist and are readily available. Hence my conclusion that her concern was excessive given the situation.

When I first clicked on this thread, I figured it was going to be a question from someone with a major immunodeficiency that couldn't be easily mitigated. I was expecting something extreme like a bone marrow transplant, or on chemotherapy/neutropenic, or yes, even an autoimmune disease/solid organ transplant recipient on chronic high-dose prednisone/immunosuppressants that majorly knock down T cell activity. Those people really do have to be careful, because they can be floridly septic and may not show the typical signs and symptoms. But that isn't the case here.

Put simply, if the OP (or anyone else who is similarly worried about infectious exposure) is not able to come to terms with her fears of being infected by a patient, it will not be possible for her to complete medical training. There's no "right" or "wrong" here; she will need to do some soul-searching and make the decision to accept whatever level of risk she decides she can live with. The risk of exposure to pathogens for health care workers is real, and while it can be minimized by prophylaxis and operational behaviors, it cannot be completely eliminated. I've been stuck twice so far with potentially contaminated sharps, for example, neither of which was due to me flouting safety procedures or not using proper safety equipment. One time was a high-enough risk stick that both the patient and I had to get tested for HIV and hep C. It was a nerve-wracking few days for me until everything came back negative, and I will continue to do everything in my power to prevent being stuck again. But there's a possibility it will happen, and I can't go to work every day so worried about a needlestick that it interferes with my ability to perform my job.

As fas as I know I don't currently have any other immune issues. Lol well it's easy to call someone else a hypochondriac when you're not in their position. But it sounds like you're well on your way to being a typical dingus M.D. Congrats!

Apologies if you find my perspective unhelpful, OP. I hope the above response to Jack helps clarify my prior post. For the record, I'm a female, and therefore less of a "dingus" and more of a....well, we really shouldn't be posting misogynistic four letter words on SDN.

 

[Mad Jack]

I'd be the last person to criticize anyone for wanting to know what their health risks are if they choose a career in medicine. I do have a (as far as I know) actively functioning spleen, and believe me, I didn't balk for one second at starting my cipro prophylaxis when several of us were exposed to a meningitis patient back in residency. That being said, the OP in this case has all of her immune cell lines present and functioning. She has discussed her career interests with her doc, who has already told her that she does not have to limit her choice of career if vaccinated against encapsulated organisms. She, like you, is presumably literate enough and internet-savvy enough to look up the information for what she needs to do to reduce her risk of infection, even if her doc hadn't already given her a list of the vaccines she needs to get. We all agree that she does need to be vaccinated against encapsulated organisms (which she should do regardless, even if she doesn't go into the medical field). But as you pointed out, happily, those vaccines exist and are readily available. Hence my conclusion that her concern was excessive given the situation.

When I first clicked on this thread, I figured it was going to be a question from someone with a major immunodeficiency that couldn't be easily mitigated. I was expecting something extreme like a bone marrow transplant, or on chemotherapy/neutropenic, or yes, even an autoimmune disease/solid organ transplant recipient on chronic high-dose prednisone/immunosuppressants that majorly knock down T cell activity. Those people really do have to be careful, because they can be floridly septic and may not show the typical signs and symptoms. But that isn't the case here.

Put simply, if the OP (or anyone else who is similarly worried about infectious exposure) is not able to come to terms with her fears of being infected by a patient, it will not be possible for her to complete medical training. There's no "right" or "wrong" here; she will need to do some soul-searching and make the decision to accept whatever level of risk she decides she can live with. The risk of exposure to pathogens for health care workers is real, and while it can be minimized by prophylaxis and operational behaviors, it cannot be completely eliminated. I've been stuck twice so far with potentially contaminated sharps, for example, neither of which was due to me flouting safety procedures or not using proper safety equipment. One time was a high-enough risk stick that both the patient and I had to get tested for HIV and hep C. It was a nerve-wracking few days for me until everything came back negative, and I will continue to do everything in my power to prevent being stuck again. But there's a possibility it will happen, and I can't go to work every day so worried about a needlestick that it interferes with my ability to perform my job.


Apologies if you find my perspective unhelpful, OP. I hope the above response to Jack helps clarify my prior post. For the record, I'm a female, and therefore less of a "dingus" and more of a....well, we really shouldn't be posting misogynistic four letter words on SDN.

I don't disagree with you. I mean, I was stuck by an HIV and Hep C positive needle (high viral load, to the point hepatitis was INCALCULABLY high, lucky me!), had to do the PEP and everything. And I still went to medical school afterward, because ****, I'd still be doing this even if I had some awful disease that compromised my immune system or physical capabilities. So I get the whole sacrifice thing. But I also get the fear side of things, particularly for someone who plans to have or already has children and knows that they have something wrong with them. It may not be the worst case of being immunocompromised, but when you're a non-physician and you hardly know what a spleen actually does, that sort of thing can be scary, regardless of what your doctor says (and your own Google fu will just scare the crap out of you even more, because you're far more likely to Google up the most awful things possible than what an average splenectomy patient's outcomes are).

I agree with you. But I also try to be as nice to new (and naive) posters as possible, and give them the benefit of the doubt unless they really push things too far (a lesson I begrudgingly learned from @Catalystik and @Winged Scapula). Patients are often at the mercy of their own minds in regard to how they handle a diagnosis or prognosis, as they lack the level of understanding we do in regard to things. You can tell one person they have asthma, and they'll Google up how to manage their symptoms and how the disease is far less fatal than it has been in decades past, while another patient will do nothing but focus on the worst case scenario and feel like they're one allergen away from becoming a statistic. Op isn't a physician. She's not a medical student. She's not even a health care provider. So for her a bit of knowledge can go a long way.

You don't need to be ready to die for your patients to be a physician. But you do need to be aware that there's a risk, and an even greater one if you have underlying issues with your immune system. If you can live with that, then proceed, but if not, you should really look elsewhere.

 

[DesertPT]

when you're a non-physician and you hardly know what a spleen actually does

I'm a non-physician and I have a pretty detailed understanding of what a spleen does. Not true for most of the population though, I'll admit, but we can't just automatically assume that someone who hasn't been to medical doesn't have information at their disposal.

Agree though regarding Google. It's amazingly quick and easy to scare yourself into or out of almost anything with a Google search. You can convince yourself that your headache must be due to a brain tumor in about 2 minutes without trying very hard at all.

 

[jl lin]

I'm not gonna give more away about myself than I have already done. I have a fairly stable autoimmune diso, with an attendant factor that not everyone with what I have gets. If I follow the regimen, I do well, and I have worked in healthcare as a RN with some of the sickest people in the world--including peds, where everyone pretty much gets sick a lot until they get enough exposure to them, sooner or later. Suffice it to say I do have a decent immune system, but I have to do what I know to do to get it up to par. If I do those things, it's not a big deal, and since, like a crazy person, I love working with babies and little tots as well as older children and adults, I've been able to moderate things pretty well. Much of it is the same darn stuff everyone else has to do: Exercise--especially with G-force use to get the lymphatic system as well as the cardio system going. Eating right. Stay well-hydrated with quality fluids--like water. Not getting too crazy with losing sleep. Taking wise supplements and prescribed meds. Seeing the docs on a regular basis. Finding outlets for stress. Learning to say no to things that sap the crap out of you--this is huge for everyone IMHO. See the dentist regularly--people can take this for granted, but it's good for maintaining overall health too. Say yes to healthy relationships, and hell no to unhealthy ones.

Basically it's pretty much the same stuff we all should be doing, regardless. But, you have to be serious about taking care of you. And again, working in peds, especially if they are little ones, you will get exposed to just about every virus in the world. Your immune system will get a workout. I'd only advice against it, if your immune system has just about no ability to build memory and function adequately. If you can tweak and moderate your immune system to be well under most situations, fine. If you cannot, then do not consider doing peds.

 

[DepressedEngineer]

I'd be the last person to criticize anyone for wanting to know what their health risks are if they choose a career in medicine. I do have a (as far as I know) actively functioning spleen, and believe me, I didn't balk for one second at starting my cipro prophylaxis when several of us were exposed to a meningitis patient back in residency. That being said, the OP in this case has all of her immune cell lines present and functioning. She has discussed her career interests with her doc, who has already told her that she does not have to limit her choice of career if vaccinated against encapsulated organisms. She, like you, is presumably literate enough and internet-savvy enough to look up the information for what she needs to do to reduce her risk of infection, even if her doc hadn't already given her a list of the vaccines she needs to get. We all agree that she does need to be vaccinated against encapsulated organisms (which she should do regardless, even if she doesn't go into the medical field). But as you pointed out, happily, those vaccines exist and are readily available. Hence my conclusion that her concern was excessive given the situation.

When I first clicked on this thread, I figured it was going to be a question from someone with a major immunodeficiency that couldn't be easily mitigated. I was expecting something extreme like a bone marrow transplant, or on chemotherapy/neutropenic, or yes, even an autoimmune disease/solid organ transplant recipient on chronic high-dose prednisone/immunosuppressants that majorly knock down T cell activity. Those people really do have to be careful, because they can be floridly septic and may not show the typical signs and symptoms. But that isn't the case here.

Put simply, if the OP (or anyone else who is similarly worried about infectious exposure) is not able to come to terms with her fears of being infected by a patient, it will not be possible for her to complete medical training. There's no "right" or "wrong" here; she will need to do some soul-searching and make the decision to accept whatever level of risk she decides she can live with. The risk of exposure to pathogens for health care workers is real, and while it can be minimized by prophylaxis and operational behaviors, it cannot be completely eliminated. I've been stuck twice so far with potentially contaminated sharps, for example, neither of which was due to me flouting safety procedures or not using proper safety equipment. One time was a high-enough risk stick that both the patient and I had to get tested for HIV and hep C. It was a nerve-wracking few days for me until everything came back negative, and I will continue to do everything in my power to prevent being stuck again. But there's a possibility it will happen, and I can't go to work every day so worried about a needlestick that it interferes with my ability to perform my job.


Apologies if you find my perspective unhelpful, OP. I hope the above response to Jack helps clarify my prior post. For the record, I'm a female, and therefore less of a "dingus" and more of a....well, we really shouldn't be posting misogynistic four letter words on SDN.

If you dont mind sharing, can you please explain how you got poked? This really scares me especially since there are so many safety protocols (im assuming)

 

[DepressedEngineer]

I don't disagree with you. I mean, I was stuck by an HIV and Hep C positive needle (high viral load, to the point hepatitis was INCALCULABLY high, lucky me!), had to do the PEP and everything. And I still went to medical school afterward, because ****, I'd still be doing this even if I had some awful disease that compromised my immune system or physical capabilities. So I get the whole sacrifice thing. But I also get the fear side of things, particularly for someone who plans to have or already has children and knows that they have something wrong with them. It may not be the worst case of being immunocompromised, but when you're a non-physician and you hardly know what a spleen actually does, that sort of thing can be scary, regardless of what your doctor says (and your own Google fu will just scare the crap out of you even more, because you're far more likely to Google up the most awful things possible than what an average splenectomy patient's outcomes are).

I agree with you. But I also try to be as nice to new (and naive) posters as possible, and give them the benefit of the doubt unless they really push things too far (a lesson I begrudgingly learned from @Catalystik and @Winged Scapula). Patients are often at the mercy of their own minds in regard to how they handle a diagnosis or prognosis, as they lack the level of understanding we do in regard to things. You can tell one person they have asthma, and they'll Google up how to manage their symptoms and how the disease is far less fatal than it has been in decades past, while another patient will do nothing but focus on the worst case scenario and feel like they're one allergen away from becoming a statistic. Op isn't a physician. She's not a medical student. She's not even a health care provider. So for her a bit of knowledge can go a long way.

You don't need to be ready to die for your patients to be a physician. But you do need to be aware that there's a risk, and an even greater one if you have underlying issues with your immune system. If you can live with that, then proceed, but if not, you should really look elsewhere.

Can you also please share how you got poked by a needle....It is pretty scary and I want to hear your story too....

 

[QofQuimica]

If you dont mind sharing, can you please explain how you got poked? This really scares me especially since there are so many safety protocols (im assuming)

One time when I was a med student scrubbed in for a surgery, a fellow carelessly nicked me with an instrument she was setting down without looking. It did cut my glove, but the instrument was not hollow bore; it did not cut my skin; and the exposure was low risk. Occupational health determined that no testing was needed.

The second time, I was blowing up a catheter balloon with a syringe as a resident, and when I pulled the needle out of the balloon, it rebounded and stuck me in the thumb. Also not super high risk because the needle was full of air and not body fluids, and I was wearing gloves. However, there was visible blood on the surface of the needle, and I had an obvious puncture wound, so I did have to go through the entire testing regimen. No prophylaxis pending testing results, which were happily negative.

Again, safety protocols are helpful but not perfect. I've never been stuck for doing something stupid like recapping a used needle (most common reason people get stuck with contaminated sharps), but any time you play with sharps, there is always a risk of getting stuck. It cannot be completely eliminated.

 

[giantswing]

I have no problems with biting my tongue and am very respectful to other people, however, I'm not going to bend over and kiss the rear of someone that thinks that their superior to me, I'm too old to care about playing people's games. Besides I'm not going to just stand by and have someone call me a hypochondriac for having a legitimate concern. I was simply asking for opinions from others that have or will be working in the health care industry. I could really care less, my life is not going to come to a screeching halt because I don't play games with forum trolls.

Third year is going to be rough for you. But hopefully by then you'll have learned what the people who are giving you advice already know, and will be less obnoxious.

Also, you're fine if you get the vaccines.