Lessons Learned from a PPD Skin Test

April 18, 2014
Eric Postal, MD

Fulfilling the teleradiologist requirement to have annual PPD tests has taught me important life lessons.

My forearm once again carries its annual PPD blemish, proclaiming to anybody who cares that my immune system hasn’t crossed swords with mycobacterium tuberculosis. A worthy pursuit, one might think…if I ever set foot in a healthcare facility, rather than working exclusively from my home reading-room.

As it stands, being something of a shut-in every other week while I cover nightshifts, I would argue that I’m probably at lower risk for contracting or transmitting TB than the general population, let alone healthcare types. That is, unless a new strain of the microbe has developed that can transmit over high-speed internet connections.

Nevertheless, for whatever reason, teleradiologists like me are routinely required to have documented PPD results on file with hospitals for which we remotely read…and often pay out of our own pockets for the privilege. You might understand why some of us have given pushback to what we perceive to be an entirely needless and wasteful charade.

Tilting at this particular windmill has taught me (and I imagine others in similar circumstances) a few lessons I could happily have done without…yet offer some adaptive value in reminding us of the world we inhabit:

Don’t expect any respect for your professional judgment. Or common sense, for that matter. You can have all of the medical facts on your side, with or without the need for any reference-materials to back you up. You can have every single human in the chain of command-other physicians, hospital executives, nurses, secretaries-completely agree with you that a policy (from annual PPDs to mandatory CMEs in hand washing technique) makes no sense whatsoever…but all of this is trumped by a perceived administrative need to have the right mix of paperwork, checked boxes and rubber stamps sitting in a file that some theoretical individual might one day inspect.

No physician, from the would-be PPD-less offsite rad himself to the hospital’s CMO, may size up the circumstances and put pen to paper stating that one doc or even a handful of them, virtually staffing the hospital from a continent away, have zero medical need to comply with this particular policy for onsite staff, and are thus exempt. Even if the CMO did, he knows he’d just be asking for his wrists to get slapped when a regulatory entity came along and decided that his judgment, too, was worth diddly in the face of regulatory bureaucracy.

Costs in healthcare aren’t coming down as much-or as uniformly-as hyped. Ever since I started having to get these PPDs, the quickest and easiest place for me to go, since (lest I belabor the point) I never set foot in a hospital, has been a CVS “Minute Clinic.” The price-tag for this procedure has been $39 for the past two years. This time? It was $56, $28 to get the thing injected, and $28 to return for the reading (because, as a physician whose judgment has been deemed irrelevant, I am not permitted to read my own; the CVS nurse is evidently far more qualified). Now, I’m pretty sure syringes, alcohol swabs or the PPD solution itself haven’t gotten more expensive to manufacture. So, either CVS decided it wanted more of a profit, or its nursing-staff got a raise. Which is as it should be-adjusting prices for one’s goods and services is a basic aspect of capitalism-but some aspects of our healthcare system are allowed to play by these rules, and others are not. We docs are told, by government and insurers, what we’ll receive for the work we do. Even if that doesn’t keep pace with costs of overhead rising all around us, which have no such artificial ceiling to keep them contained.

Going above and beyond is rewarded by having to go further above and farther beyond. The first time I did the PPD dance, I think it was during the month of May. A year later, when I got my notification that the previous year’s form was about to expire, I hastened to comply, and got the PPD in mid-April so everybody would have plenty of time to process and file my paperwork. My reward? The one-year countdown to my next PPD started early, too. Promptness yields shorter deadlines. Similarly, industriousness (for instance, reading 10 percent more cases than other rads in your workplace) has a nasty way of generating a pat on the back and an expectation that, the day you DON’T overperform (by, for instance, at least the 10 percent of which you already proved you were capable), you are officially slacking off.

So, this year, I made sure to wait until the last possible week before the PPD deadline established for me by the paper-pushers. I’m sure they got all sorts of automated reminders, and will be passing those along to me in the next few days. Yes, their precious completed form, with the CVS stamp of approval, is in my files and ready for faxing to a hundred human resources departments across the land, wherein I’m sure the document will be given the careful scrutiny it deserves.