Dr. Andy

Reflections on medicine and biology among other things

Saturday, June 18, 2005

I'd hate to be this resident:

According to a memo prepared by the Department of Veterans Affairs for members of Congress, the surgical resident contracted TB sometime between June 2003 and June 2004.

After a positive skin test, she was referred to the Boston Public Health TB clinic by Boston Medical Center, but never showed up for her July 2004 appointment for a chest X-ray.

The memo said she first showed symptoms in January, but it is not clear whether she revealed the earlier skin test. Other tests were negative, so she was treated for pneumonia.

The resident then developed a cough and other symptoms in mid-May, and a chest X-ray on June 2 and additional tests revealed infectious TB. No information on how she contracted the disease has been released.

Apparently this resident was walking around with TB for at least a couple weeks and maybe six months. I wonder what those "other tests" were, specifically if they included a chest x-ray.

I predict the "official response" will involve
1. Demonizing the resident
2. A new time-consuming protocol to prevent this exact thing from happening again (doctors with a positive PPD will not be allowed to work until they have a chest x-ray) but won't address the underlying issues that allow things like this to happen (like resident's not having enough time to take care of their health).

One other thing seems odd about this. This resident worked 80 or more hours per week in a hospital, but when she had a positive PPD she was referred to some sort of public health clinic. Why in the world didn't they have her get a chest x-ray at work? Being able to walk down and get it done when she had a few minutes would have greatly increased the chance of her getting it and thereby detecting the TB before she became infectious (or at least a lot sooner). Would you want to take a day off work to go to some TB clinic where you'd probably waste 1/2 a day and risk catching TB? I wouldn't


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