Hi Dr. Bob,
It is the resident again writing you. I wanted an honest opinion from you, and to disregard the fact that you know I have an excessive worry about HIV. I know that you told me the my fears considering the debriding incident are unwarranted but here is my dilemma. I spoke to occupational health and they told me that if I wanted they would test the patient for HIV and hepatitis and they would do follow-up testing on myself. They are basically leaving the decision up to me. As I told you, the incident consisted of myself using a scalpel to debride a diabetic ulcer. I thought that I may have cut myself as the scalpel might have scraped my hand, but I did not have any cut on my hand, and to be honest with you, I would not even be able to tell you where on my hand I may have gotten cut. I immediately became very anxious about this incident, and the anxity will not subside. I cant sleep and I dont know what to do. I am unable to think rationally about this incident. I do not want to put this patient through unnecessary testing. The advice I have gotten from occupational health is really not helpful. I trust your opinion so much, and I would really appreciate it if you could help me out. Should I have the patient tested and do I need testing. Is it possible that I could have gotten infected even if I could not see a laceration on my body?? Please please answer and help me. I would be so gratefuland I am still going to get therapy for my excessive worrying. Thank you so much, and I will again donate to your charity.
Hello Very Anxious Resident,
I haven't changed my assessment; "Your fears regarding your debriding incident today are once again completely irrational." I also haven't changed my advice. See below.
HIV testing is not warranted. Psychotherapy is.
A question about residency and HIV
Jul 17, 2009
Hey Dr. Bob, I have written you a couple of times in the past regarding incidences that have happened and you have always reassured me when you answered me. I think that youre awesome and am so thankful for all that you do. I am a resident in the 2nd year of my residency, and over the past year especially, I have had a fear of contracting HIV. It all started while I was a student and sustained a needlestick injury back then. Since then, I have come to know your website and look to it for information and encouragement. Im finally seeing a psychologist in a few weeks to help me out with my problems because I know that my thinking is pathological. I have a few questions for you that Im hoping you could answer regarding getting over my fears. First of all, do you really think that cognitive behavioral therapy will be useful to help me get over my fears? What is your experience in seeing people go through with these therapies. I have worked extremely hard to be where I am today, and I am so upset that Im letting this problem get in the way of my happiness. My worry is that the therapy sessions will not work, and I will have nowhere else to turn. Let me just tell you briefly about my issues. I always think that things I am doing are putting myself at risk and I always feel the need to get tested. I have spoken to occupational health about multiple incidences, and they reassure me but these incidences keep on happening. Even today, I was working in a clinic where I was debriding chronic wounds with a scalpel. Few times it happened where the scalpel slipped and I thought I may have cut myself with the scalpel, but I did not have a wound on my skin. I didnt even feel a deep poke or prick, but I worry that I cut myself superficial enough to get an infection. Do you think its possible to transmit HIV or other infections with a scalpel if I did not bleed or even feel a heavy poke? I tend to freak out if even the instruments glaze my skin, and I feel that this behavior is pathological. What do you think. Am I totally irrational? I will be seeing a psychologist, but please help me feel better. I desperately want to WOOHOO, but I find that these incidences are always happening and preventing me from doing such. I love my job, I think that Im a great resident and patients actually really like me, but I cannot truly be happy until I have solved this problem. You really are so understanding, and I would be so appreciative to hear what you have to say about cognitive behavioral therapy in general for this issue, and the incident that happened to me today with the scalpel. Thanks again.
Response from Dr. Frascino
Hello Second-Year Resident,
". . . I know that my thinking is pathological." I absolutely concur with your assessment!
Do I really think that cognitive behavioral therapy will be useful to help you cope with your irrational fears of becoming HIV infected? Yes, I do. Take a read through the archives and you'll find many testimonials discussing how helpful psychotherapy has been for these types of unwarranted worries.
Your fears regarding your debriding incident today are once again completely irrational.
As for your being a "great resident," well, I think you will find it increasingly more difficult to be a great doctor if you are constantly plagued by irrational fears, phobias and paranoia. You will not be able to focus your attention on your patient if you are distracted by irrational thoughts. I agree that if you cannot confront, cope with and conquer these fears, you should consider a different career path or choose a field of medicine that does not involve direct patient care. Certainly your first step is to seek help form a qualified psychologist or psychiatrist. Bring copies of your questions and my responses to your first visit and share them with your therapist. It should help to focus your treatment and hopefully speed your recovery.