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back to the hospital recruitment field.

when you pass many tests and get admission to a top three university, you may be informed after the physical examination that the penicillin skin test is positive and you will not be admitted.

recently, a recruitment announcement from a grade a hospital in hunan province has attracted widespread attention.

this hospital is recruiting several clinical doctors from various departments. during the physical examination and assessment, candidates for medical positions are required to take a penicillin allergy test. if they are allergic to penicillin, they will be disqualified from the application.

image source: hunan provincial department of human resources and social security

if i am allergic to penicillin, can i not engage in clinical work?

according to the announcement, the main recruitment targets are 7 doctors with associate senior titles or above in departments such as pediatrics, ophthalmology, gastrointestinal surgery, and cardiovascular medicine. according to the additional test requirements for "medical positions", all applicants are required to undergo a penicillin allergy test.

image source: hunan provincial department of human resources and social security

penicillin allergy test mainly includes specific ige antibody determination in the blood, drug provocation test, skin test, etc.wang li (pseudonym), an insider from the hospital, revealed that the additional test items required for this recruitment by the hospital are specifically the "intradermal test" in the skin test, which is commonly referred to as the "skin test" in clinical practice.

wang li said that whether the hospital is recruiting high-level talents or ordinary medical staff, it will specifically require penicillin skin tests during the physical examination. "it has been like this for many years."

in recent years, similar requirements for "additional testing for alcohol and skin allergies to penicillins and cephalosporins" have often been seen in recruitment announcements of many domestic tertiary hospitals.

image source: longshan county people's government official website, recruitment announcement of a tertiary hospital in anhui province

why does penicillin skin test appear in the recruitment of medical staff?

relevant personnel from the hospital that is recruiting said that this requirement was made considering that medical staff may be exposed to penicillin in the diagnosis and treatment environment, and they are worried that medical staff who are allergic to penicillin may experience severe allergic reactions in subsequent clinical work.

this recruitment has sparked heated discussions among medical colleagues. some doctors said they had never seen such a request, while others said the requirement was nothing special and acceptable.

but, does being allergic to penicillin really mean that you cannot engage in clinical work?

most hospitals do not require penicillin allergy testing when recruiting medical staff. in the actual medical environment, there are indeed some medical staff with a history of penicillin allergy.

some doctors said that they had severe penicillin allergy when they were children, but they are still engaged in clinical work. some nurses were unable to engage in clinical nursing work due to penicillin allergy and were eventually transferred to other positions.

image source: dingxiangyuan community

some doctors believe that people who are severely allergic to penicillin are not suitable for practicing medicine, and that relevant regulations should be put in place before medical students are enrolled; but this cannot be a one-size-fits-all approach, as being allergic to penicillin does not mean that one is unable to perform all medical jobs.

"the requirement for skin testing in recruitment may represent a protection demand from the employer to both the employer and the employee, but the probability of severe allergic reactions is a problem."

zhou mi, deputy chief pharmacist at the children's hospital of soochow university, said, "if a medical institution has such a recruitment regulation, will it be followed by other hospitals and become a discriminatory employment requirement?"

at the legal level, there are currently no clear regulations on whether people who are allergic to penicillin can engage in clinical work.

"as an applicant, it is definitely illegal for a doctor to refuse to hire you just because you are allergic to penicillin. there are currently no relevant regulations." zhang yongquan, a lawyer at grandall law firm (tianjin), said that in this case, the applicant can choose to sue.

"but on the other hand, in the absence of regulations, the hospital's behavior will not be mechanically judged to be illegal. instead, the employer needs to provide a reasonable explanation, such as why such a regulation was issued, whether the workers involved have special jobs, whether similar situations have occurred before, and whether they led to work-related injuries, etc."

zhang yongquan believes thatbased on the above circumstances, the employer can independently formulate requirements or restrictions that the employer considers reasonable, but although the intention seems good on the surface, the method is extremely unscientific.

"the hospital may have wanted to avoid related work-related injuries, but in fact it adopted a stupid method. when the accuracy of the skin test is questionable, a tertiary hospital as a professional medical institution regards it as a decisive factor, which is a bit absurd."

using skin tests to screen job applicants is neither scientific nor reasonable

the use of "skin test" to screen people who are allergic to penicillin has aroused opposition from many doctors.

in a poll initiated by dingxiangyuan, more than 60% of medical users do not agree with hospitals conducting penicillin skin tests during recruitment: it is easy to misjudge and lose job opportunities.

image source: dingxiangyuan community

when using skin tests to screen for allergies, what is the probability of misdiagnosis?

"penicillin may cause allergies of various types, including type i, ii, iii, and iv allergic reactions. some allergies are delayed." pharmacist zhou mi said that skin tests can only screen people who may have immediate allergic reactions to penicillin to a certain extent in clinical practice, and cannot accurately identify other types.

in addition, the high false positive rate is also a major problem that cannot be ignored when using penicillin skin test.

according to a study conducted by the allergy center of west china hospital of sichuan university, more than half of the patients in my country who claim to be "allergic to penicillin" have actually only had positive skin tests, and 99% of them are false positives.

"after research, we found that the penicillin skin test is overused in existing domestic medical institutions. the skin test operation has problems such as lack of control, excessive dosage of skin test solution, and incorrect interpretation standards, resulting in an extremely high false positive rate." meng juan, deputy director of the allergy center of west china hospital of sichuan university, said that it is not reasonable to conduct universal and indiscriminate skin tests on all individuals with no history of suspected penicillin allergy.

"according to relevant research, oral or infused penicillin leading to severe allergic reactions is an extremely low probability event, with a probability of only 0.004% to 0.015%;and inin clinical diagnosis and treatment activities, it will become even rarer for medical staff to experience severe allergic reactions to penicillin due to occupational exposure, contact or inhalation.」

source: the paper

in addition, multiple studies have consistently shown that approximately 90% of penicillin allergy markers are incorrect when tested, meaning that these patients are not actually truly allergic and are able to tolerate penicillin when challenged again.

it would be unfair if an applicant who is not allergic to penicillin was rejected because of a false positive in a skin test.

"if an applicant is not hired because of a false positive, he or she can apply for a re-examination or appeal," said zhang yongquan, a lawyer. "what is exposed is not a problem of medical ethics, but a problem of medical skills:as a professional medical institution, when recruiting, they regard tests that are almost abandoned by the medical industry as the standard, and lack awareness of cutting-edge research and industry perspectives.」

in actual recruitment physical examinations, applying for another skin test is difficult; and whether it is the first skin test or a re-examination, there are potential safety hazards.

「if the medical staff is indeed highly allergic to penicillin and allergies occur through contact or inhalation, then skin tests can also trigger severe allergic reactions that are life-threatening."relying on skin tests to screen for occupational allergies not only fails to avoid risks, but may create risks and conflicts," meng juan said.

acknowledgements: this article was professionally reviewed by meng juan, deputy director of the allergy center of west china hospital of sichuan university, zhou mi, deputy director and pharmacist of children's hospital of soochow university, and zhang yongquan, lawyer of grandall law firm (tianjin)

author and planner: sysoon｜supervisor: carrollero