This is a really long post, which is in essence two joined together, but I'm too tired/fogged to figure out a more sensible arrangement.
I promised myself that I wouldn't let this blog make this look easier than it is. Every time someone tells me to 'just' apply for DSA or 'just' take a year out to sort stuff out or 'just' apply for less-than-fulltime work, it cuts a little deeper. I promised myself that I wouldn't gloss it into 10 simple tips to deal with being the 'problem' in the system.
The truth is chaps, within the current system, it's bloody difficult. There will be a lot of fuckwittery and a lot of paperwork. You will have to overcome the urge to punch each person who says "but that's 'just' the way we do things (so deal with it)" and can't understand why that's not justification for not changing something. Med school will make you find your physical and mental limits, and struggle like mad to defend those limits. And a lot of the time, when the training programme looks like it's just going to be a shitload more of the same nonsense you will wonder why you couldn't do something else with your life (before you remember that you'd probably just revisit the same issues in a different form).
The only advice that I, or anyone else can truly offer is this : always keep in mind why it is you're doing this (and recognise that this will change over time), and know what you are willing to sacrifice to get there, and what you are not.
Things are really rough at the minute, and I offer the reasons why as an example of 'just' how difficult it can be to play this particular game. This is a pretty bog-standard worry list.
1) My SI joints are out and my back is in spasm. I have considered phoning the GP to ask for some drug-related assistance on that front, but being as he thinks that the tramadol is far more than a 23 year old should be taking, that seemed pointless.
I still haven't found a way to sort things out with my GP, and now whenever I think about trying to talk to him about anything I cry. [now is not the time to suggest that I 'just' switch GPs] Advice from any fellow medics on this score would be appreciated. I fear that most other GPs would present similar problems.
2) Placement is a 40 minute bus journey away, which is tiring and sore. I can't take the current wheelchair on the bus, because it's too heavy for me to push outside, and to lift (rush-hour buses "don't do" ramps), so that means a £10 taxi journey, which I can't afford because I still don't have DSA (because no matter how easy it is once you've actually applied, my very best efforts are not enough to persuade my mother to sign a form and send it to me so I am as yet un-funded for the year, thus have no funding body to claim from). There are several closer hospitals, but I am in the current one for most of the year. In many ways it's better in terms of input, but that's useless if I'm too much of a zombie to take it all in.
3) Job applications. We have decided (almost) not to apply for special circumstances after I spent the best part of 2 days sobbing every time I thought about it. Not because of me, but because of the stupid, agressive questions that Beanie (which is now the mrs's's's pseudonym, bien sur?) would have to answer. (I just opened the form to find an example am now crying again - see the end of the post for these questions)
BUT we're not quite sure of one thing - if special circs can dictate more than ending up in a specific part of the country we might need them, because I'm having serious concerns about slotting into part of a regular rota (I think that 13 hour long days would end with fainty, vommy junior doctor, and that's not really what you want as a patient...). The deadline is coming up soon, and we have no idea what to do / if it's possible for part-time foundation years not on a pro-rata basis. We can't meet with the person who might know until a couple of days before the deadline (and not for want of trying to bring it up earlier...)
4) And in the middle of this, I'm pretty sure that depression has slipped in without me noticing again. Of course, it's hard to tell amidst fatigue and big'n'scary decisions. I am so scared of getting ill in this particular direction again, because services screwed up pretty dramatically last time, and I'm pretty sure that this fear clouds the waters still further.
--
And you know what? I am so keenly aware that I'm one of the privileged ones - I'm one of the ones who made it to medical school in the first place - other disabled people, other folk from less-privileged backgrounds (especially now with the tuition fee hikes), other women in some parts of the world - so many folks don't get to this point of being on the inside and bitching about it. That's the part of this I don't talk about often, but it doesn't mean that I'm not thinking about it. I know that the system's not only broken for me.
I'm so tired of fighting fires distracting me from trying to make the course that I love truly and joyfully accessible. That is one of the reasons that I started this blog, and that I'm exploring the possibility of forming a support and campaign group for disabled students within my med school. I have to leave it that bit easier for the next person.
So, here are some of the questions necessary to answer should Beanie wish to apply for Special Circumstances in FPAS as my carer :
"What happened (or will happen) to the person you care for while you were (or will be) on your elective? Who cared (or will care) for them during this time?"
- answer : So many assumptions in one little question! It assumes that everyone can travel for their elective, it assumes that the care-ee isn't doing their own elective...
"What other services does the person you care for utilise e.g. social services, private carers...primary health care team? Have all local support resources been fully considered?"
- answer : Once again, I am also a medical student. I cannot consider "local support resources" until I know where I'll be living. Secondly, non-professional carers often take on that role because outside help does not fall out of the sky. (Remind me to tell you about trying to access a Social Work assessment during another rant...)
"How do you plan to combine these responsibilities with a full time F1 post, which involves irregular shifts, nights and weekends? (Foundation doctors cannot necessarily guarantee to leave exactly at the end of their shift every day.)"
"What arrangements will you have in place for unexpected or planned periods when you will be unavailable? What will happen, for example, if you have a week of nights, you are unwell, or you go on holiday?"
- answer : We don't know, for several reasons. Firstly we don't know if we'll be living here, in which case there is always someone I can call for help if I really need it. Secondly, we don't know how accessible the housing we will be living in is.
However, the main thrust of the answer is that when Beanie is working odd shifts, unless I manage to get a level of DLA/PIP that means I can pay for some help, I will be severely limited in some activities (those that involve leaving the house), and other things will have to work around her schedule (like showering). I will also be at risk when I'm in the house on my own (for example during the night I often fall down and need help to get back up).
It should be pointed out at this point that medical school is anything but a regular schedule or commitment, so anyone applying for special circs as a carer will already have been dealing with these issues to some extent.
--
If you think that I'm being unreasonable, please note that parents do not get asked any of these questions, or any like them (nor should they). These questions are designed to catch out people who are claiming carer-dom for the convenience of staying put, but surely getting a GP / Social Work to certify that someone is a primary carer would be as effective a way to deal with that (being as if someone was determined to lie their way into this, they could do it anyway...). Although even with that suggestion there are problems, for those who do not have supportive professionals around them to confirm their caring role (this is a big problem when applying for benefits etc).
They also require a copy of a 'care plan'. When will people realise that not all of us who need input from professional services get it? What is the point of Beanie preparing a written care plan, just adding to the work she has to do for me? And plus, the variable nature of my condition would make that bloody difficult anyway.
I'm sure that if I brought these points up with whoever decided on these questions they would say "Oh, we didn't think about the fact that the care-ee could be another medic" or "We need to make sure that people aren't trying to play the system". To me, and others like me, the intent doesn't matter - what matters is that my partner is being made to prove herself yet again to a bunch of strangers, that once again noone has considered our situation as a possibility, that this is just another way to make the application process harder and more complicated for those who don't tick the right boxes.
At Both Ends of the Stethoscope.
Tuesday, 6 September 2011
Thursday, 1 September 2011
My body is radical
"As organizers, we need to think of access with an understanding of disability justice, moving away from an equality-based model of sameness and “we are just like you” to a model of disability that embraces difference, confronts privilege and challenges what is considered “normal” on every front. We don’t want to simply join the ranks of the privileged; we want to dismantle those ranks and the systems that maintain them." [Read the rest here]
You know when you find someone smarter than you who is articulating the stuff that is driving your day-to-day actions, but you don't quite have the words for? Mia Mingus and Stacey Milbern are blowing my mind. I've been reading back through the archives of their blogs.
(Do you guys ever do that? Find a new blog, go to the first post and just read through?)
A combination of all of this reading has my head circling and re-circling the same topic. My body is forcing me to live out my rejection of the values of a capitalist society. It's so hard to extracate oneself from the trap of the dominant social model. How often, when we volunteer within groups who are working to change this model, do we force ourself to work at an unsustainable pace, do we measure our success in terms of money or numbers, do we separate our day-to-day from our beliefs and campaigns?
It is hard for me to accept that I will earn less money when I start work. Hard for me to accept that my partner has to do more for me than I do for her. Hard for me to rest, when everyone else keeps going. I know in my head that reciprocity and community are deeper than a simple give and take, and I am learning to embody that.
My body will not allow me to work all of the hours there are to earn more and more money for my family, but never see them. My body will not let me skip lunch to get more done in a day, and therefore be (in terms of short-term focussed capitalism) a more valuable employee. My body will not let me run for the bus, or run each project into the next without stopping for rest and reflection.
My body is radical.
You know when you find someone smarter than you who is articulating the stuff that is driving your day-to-day actions, but you don't quite have the words for? Mia Mingus and Stacey Milbern are blowing my mind. I've been reading back through the archives of their blogs.
(Do you guys ever do that? Find a new blog, go to the first post and just read through?)
A combination of all of this reading has my head circling and re-circling the same topic. My body is forcing me to live out my rejection of the values of a capitalist society. It's so hard to extracate oneself from the trap of the dominant social model. How often, when we volunteer within groups who are working to change this model, do we force ourself to work at an unsustainable pace, do we measure our success in terms of money or numbers, do we separate our day-to-day from our beliefs and campaigns?
It is hard for me to accept that I will earn less money when I start work. Hard for me to accept that my partner has to do more for me than I do for her. Hard for me to rest, when everyone else keeps going. I know in my head that reciprocity and community are deeper than a simple give and take, and I am learning to embody that.
My body will not allow me to work all of the hours there are to earn more and more money for my family, but never see them. My body will not let me skip lunch to get more done in a day, and therefore be (in terms of short-term focussed capitalism) a more valuable employee. My body will not let me run for the bus, or run each project into the next without stopping for rest and reflection.
My body is radical.
Wednesday, 31 August 2011
They're just words.
I keep trying to write. I have boxes full of scribbled half thoughts on the back of bus tickets. Pages and pages of getting It out. Pulling it out of my head, cajoling it out, and trapping it down on paper so I can look at it this way, and that. My mind works on paper, captured thoughts revisited. I'm steeped in other people's words - book on book of ideas and stories - trying to see through all this paper to the few grains of truth that connect it all together.
There is so much that I want to share, but I can't cut through all of these words to communicate.
I am frustrated. I'm having problems articulating (and swallowing). Brain fog regularly robs me of words, but this is different. My voice is drunk and slurring, stumbling and uncertain, especially when I'm tired. I have been particularly conscious of it back at placement - communication is so much a part of what I do.
It's another aspect of control that has fallen away. Fainting, throwing up, giving way. Jerking, shaking, grunting. My body insists on making its presence known, its difference apparent. Now you will lie down, no you can't eat that, I want to jump and bounce and twist. One long lesson in going with the flow.
I feel vulnerable when I can't hide behind words. I am afraid to speak in case the sounds that come out aren't right, aren't acceptable. My control and my mask are being shredded. God, it's scary. I can't 'pass' anymore as non-disabled. Not invisible anymore, for all the good and bad of that.
I'm doing some studying, some reading. I'm listening more. I can't help but wonder if it's not some cosmic lesson telling me to shut up because I talk too much.
I play with communication on placement. Written information, diagrams, trying to get the most infomation from the least questions. Using silence and touch, when appropriate. Studying how my presence interupts or enhances the doctor-patient conversation, how formality and professionalism blend with the personality of both parties. What do I hold back behind my professional distance, and does that limit how patient-centred my approach can be? How do I vocalise the 'elephants in the room' when someone insists they've come because they "can't sleep", but they seem to be saying that the sleeping tablets help their anxiety? Which words build barriers, and which break them? Is it ever appropriate to say "me too", or would showing true compassion render that unecessary?
This feels like just another experiment in communication, not having the words to make them see past the stick or the random movements, or the chair. Letting people see me, react to me, and not feel the need to explain. Working out when it is really important for me to open my mouth, and when it's just noise.
There is so much that I want to share, but I can't cut through all of these words to communicate.
I am frustrated. I'm having problems articulating (and swallowing). Brain fog regularly robs me of words, but this is different. My voice is drunk and slurring, stumbling and uncertain, especially when I'm tired. I have been particularly conscious of it back at placement - communication is so much a part of what I do.
It's another aspect of control that has fallen away. Fainting, throwing up, giving way. Jerking, shaking, grunting. My body insists on making its presence known, its difference apparent. Now you will lie down, no you can't eat that, I want to jump and bounce and twist. One long lesson in going with the flow.
I feel vulnerable when I can't hide behind words. I am afraid to speak in case the sounds that come out aren't right, aren't acceptable. My control and my mask are being shredded. God, it's scary. I can't 'pass' anymore as non-disabled. Not invisible anymore, for all the good and bad of that.
I'm doing some studying, some reading. I'm listening more. I can't help but wonder if it's not some cosmic lesson telling me to shut up because I talk too much.
I play with communication on placement. Written information, diagrams, trying to get the most infomation from the least questions. Using silence and touch, when appropriate. Studying how my presence interupts or enhances the doctor-patient conversation, how formality and professionalism blend with the personality of both parties. What do I hold back behind my professional distance, and does that limit how patient-centred my approach can be? How do I vocalise the 'elephants in the room' when someone insists they've come because they "can't sleep", but they seem to be saying that the sleeping tablets help their anxiety? Which words build barriers, and which break them? Is it ever appropriate to say "me too", or would showing true compassion render that unecessary?
This feels like just another experiment in communication, not having the words to make them see past the stick or the random movements, or the chair. Letting people see me, react to me, and not feel the need to explain. Working out when it is really important for me to open my mouth, and when it's just noise.
Tuesday, 30 August 2011
First day back =)
A quick post, but a happy one!
I hadn't realised just how terrified I'd been about starting this placement until I got home today and noticed that the sick feeling I've been carrying around for weeks had gone. So far the placement seems well-organised, the building is new and pretty easy to navigate (although the doors are on the heavy side) and there's a room I can leave my wheelchair overnight which also has air-conditioning, which will be a godsend (I get really overheated on the wards, and it makes me sound and feel like I'm drunk). Simple things make such a difference.
[I have a big brute of an NHS bog standard manual which I can self-propel on polished, flat, indoor surfaces for short periods of time (think browsing in a shop, or moving between beds on a ward round). I can take it in and leave it in the hospital (I can't manage it outside on my own and I can't afford to get a taxi every day until I get my DSA) so that I will have the option for parts of the day that normally involve a lot of standing around, such as ward rounds and bedside teaching. When my lightweight chair arrives I will hopefully be able to use it for the whole working day and I'll be able to manage short distances outside on the flat as well.]
I'm a bit nervous about how people will react, but I'm in a small unit with only a few other students, so I'll be a bit sheltered until I get used to it. It's totally worth it if it makes placement easier to manage.
I hadn't realised just how terrified I'd been about starting this placement until I got home today and noticed that the sick feeling I've been carrying around for weeks had gone. So far the placement seems well-organised, the building is new and pretty easy to navigate (although the doors are on the heavy side) and there's a room I can leave my wheelchair overnight which also has air-conditioning, which will be a godsend (I get really overheated on the wards, and it makes me sound and feel like I'm drunk). Simple things make such a difference.
[I have a big brute of an NHS bog standard manual which I can self-propel on polished, flat, indoor surfaces for short periods of time (think browsing in a shop, or moving between beds on a ward round). I can take it in and leave it in the hospital (I can't manage it outside on my own and I can't afford to get a taxi every day until I get my DSA) so that I will have the option for parts of the day that normally involve a lot of standing around, such as ward rounds and bedside teaching. When my lightweight chair arrives I will hopefully be able to use it for the whole working day and I'll be able to manage short distances outside on the flat as well.]
I'm a bit nervous about how people will react, but I'm in a small unit with only a few other students, so I'll be a bit sheltered until I get used to it. It's totally worth it if it makes placement easier to manage.
Monday, 29 August 2011
Culture Shock
When I call myself disabled, I am talking about my identity and my experience, I am allying myself with other disabled people whatever their impairment, and I am claiming my place in a community built on shared history and common language. It is personal, it is political, it is cultural.
It also has its uses. It's a shortcut to explain to people that I need that seat on the bus, that they have a legal obligation to make this lecture accessible to me, that I'm taking the lift and not the stairs.
I claim this word with pride, and some find that hard to understand. People have done their best to tarnish it, to use it as a synonym for scrounger, object of pity, incapable - to make it my fault, or my tragedy.
For so long I couldn't say it out loud, in case someone said what I was telling myself in the wee hours of the morning : "You're not sick enough to be disabled. You're just lazy. Get your shit together."
After yet another doctor refused to listen, refused to acknowledge, refused to act, I took my first shaky steps. Found myself a walking stick that was pink and shiny. I came out.
A friend showed me how to wheel, joyfully. Another how to stand up for my needs. My love tells me every day that I'm beautiful - that my bendy, breaky, bruisy body is beautiful - her words have soaked in to each cell and for the first time in my life I am not at war with myself.
My beautiful, complex body is not flawed. It is not an intrinsic failure. It is not appreciated, not accepted, not expected, and this is my disablement.
The finality of 'disabled' scared me before I realised that a word doesn't change who I am - just gives me a fresh perspective on my experience. That a label doesn't become my whole identity - just gives me a name to part of myself that's been their all along. I don't have to be 'bad enough' to use this word, I don't have to fit the stereotypical image it conjures - just acknowledge that I have something in common with this community, that I am part of it.
These are all the things I mean when I say that I am disabled, but it's not what people hear. It's not what people see when they watch me wobble along with my stick.
I don't know how to translate my thoughts, how to share the powerful and prophetic words I read about justice and equality. I don't know how to show my friends the strength I have found through working together with other people 'like me'. I want to communicate more coherently that we cannot separate our own favoured branches of inclusivity or accessibility : "If you have come here to help me, you are wasting your time. But if you have come because your struggle is bound up with mine, then let us work together"*.
And yet my words seem to get stuck in a filter somehow, to become jumbled and stripped of nuance. Culture shock.
Sometimes I think that we can change the world with these conversations - these whispers of a world that could be if we learn that love is far more radical than tolerance, that acceptance for nothing more or less than what we are is life-changing, that capitalist ideas of reciprocity are too shallow. If we could only find the words.
It also has its uses. It's a shortcut to explain to people that I need that seat on the bus, that they have a legal obligation to make this lecture accessible to me, that I'm taking the lift and not the stairs.
I claim this word with pride, and some find that hard to understand. People have done their best to tarnish it, to use it as a synonym for scrounger, object of pity, incapable - to make it my fault, or my tragedy.
For so long I couldn't say it out loud, in case someone said what I was telling myself in the wee hours of the morning : "You're not sick enough to be disabled. You're just lazy. Get your shit together."
After yet another doctor refused to listen, refused to acknowledge, refused to act, I took my first shaky steps. Found myself a walking stick that was pink and shiny. I came out.
A friend showed me how to wheel, joyfully. Another how to stand up for my needs. My love tells me every day that I'm beautiful - that my bendy, breaky, bruisy body is beautiful - her words have soaked in to each cell and for the first time in my life I am not at war with myself.
My beautiful, complex body is not flawed. It is not an intrinsic failure. It is not appreciated, not accepted, not expected, and this is my disablement.
The finality of 'disabled' scared me before I realised that a word doesn't change who I am - just gives me a fresh perspective on my experience. That a label doesn't become my whole identity - just gives me a name to part of myself that's been their all along. I don't have to be 'bad enough' to use this word, I don't have to fit the stereotypical image it conjures - just acknowledge that I have something in common with this community, that I am part of it.
These are all the things I mean when I say that I am disabled, but it's not what people hear. It's not what people see when they watch me wobble along with my stick.
I don't know how to translate my thoughts, how to share the powerful and prophetic words I read about justice and equality. I don't know how to show my friends the strength I have found through working together with other people 'like me'. I want to communicate more coherently that we cannot separate our own favoured branches of inclusivity or accessibility : "If you have come here to help me, you are wasting your time. But if you have come because your struggle is bound up with mine, then let us work together"*.
And yet my words seem to get stuck in a filter somehow, to become jumbled and stripped of nuance. Culture shock.
Sometimes I think that we can change the world with these conversations - these whispers of a world that could be if we learn that love is far more radical than tolerance, that acceptance for nothing more or less than what we are is life-changing, that capitalist ideas of reciprocity are too shallow. If we could only find the words.
*Aboriginal activist group, Queensland, 1970s
Sunday, 28 August 2011
T'will all be alright
With term starting tomorrow, I am starting to panic a little bit about how I'm going to cope. My mobility is worse, and worsening, since my last placement and both of the hospitals I'm placed at this year year are huge. My fatigue is slightly more under control these days (hooray!) but I'm really worried about uni setting it back, especially because finals are at the worst possible time of year for me, fatigue wise.
So here is a a post to myself - a post about how to take care of myself, of ways to make myself feel better.
1) Take care of the lovely mrs. Have plenty of not medic-medic or carer-caree time. Tell her often that everything will be fine. Play with daft cat often.
2) Sleep. Stop work at a sensible time, journal before bedtime, be fastidious about night-time pain management, have catch-up naps naps at the weekend.
3) Drink cherry and cinnamon tea, cointreau hot chocolate and mulled cider. Plenty of water, and salt.
4) Be sensible with my energy. Pace as much as possible without becoming a hermit. Don't feel guilty about the cleaner. Be assertive about my access needs on placement. Take it slow and steady.
5) Read something non-medical - funny, easy, familiar. Listen to an audio book snuggled under a blanket. Sing along to Sgt Pepper. Watch BBCThree nonsense and silly films.
6) Phone lovely people. Go for walks (/wheels) and talks with the mrs. Have people to stay, go to visit notsofaraway best friend. Give plenty of hugs.
7) Don't get cold! Wheat bag, big fluffy dressing gown, electric blanket, woolie socks, hot water bottle, nights in front of the fire.
8) Remember all the reasons I love medicine. Revise in ways that keep it interesting. Don't go near the library in the medical school, and avoid talking about revision with anyone else. It is not worth the inevitable panic.
9) Eat proper food what is warm and has veggies in. Plenty of mashed potato and daal and plum crumble. And porridge for breakfast.
10) If things get bad - rest, cut back, get help. Don't let it build up. Talk. Keep the med school in the loop.
The bottom line is that my health is important. I would rather be well and fail than to burn out passing, so I need to act like it, and not let guilt, or panic or the fact that other people still think they're invincible convince me not to. It could all go really quite pear-shaped otherwise, when it very much needs to all be alright in the end.
So here is a a post to myself - a post about how to take care of myself, of ways to make myself feel better.
1) Take care of the lovely mrs. Have plenty of not medic-medic or carer-caree time. Tell her often that everything will be fine. Play with daft cat often.
2) Sleep. Stop work at a sensible time, journal before bedtime, be fastidious about night-time pain management, have catch-up naps naps at the weekend.
3) Drink cherry and cinnamon tea, cointreau hot chocolate and mulled cider. Plenty of water, and salt.
4) Be sensible with my energy. Pace as much as possible without becoming a hermit. Don't feel guilty about the cleaner. Be assertive about my access needs on placement. Take it slow and steady.
5) Read something non-medical - funny, easy, familiar. Listen to an audio book snuggled under a blanket. Sing along to Sgt Pepper. Watch BBCThree nonsense and silly films.
6) Phone lovely people. Go for walks (/wheels) and talks with the mrs. Have people to stay, go to visit notsofaraway best friend. Give plenty of hugs.
7) Don't get cold! Wheat bag, big fluffy dressing gown, electric blanket, woolie socks, hot water bottle, nights in front of the fire.
8) Remember all the reasons I love medicine. Revise in ways that keep it interesting. Don't go near the library in the medical school, and avoid talking about revision with anyone else. It is not worth the inevitable panic.
9) Eat proper food what is warm and has veggies in. Plenty of mashed potato and daal and plum crumble. And porridge for breakfast.
10) If things get bad - rest, cut back, get help. Don't let it build up. Talk. Keep the med school in the loop.
The bottom line is that my health is important. I would rather be well and fail than to burn out passing, so I need to act like it, and not let guilt, or panic or the fact that other people still think they're invincible convince me not to. It could all go really quite pear-shaped otherwise, when it very much needs to all be alright in the end.
Friday, 26 August 2011
News Stories : Doctors with Visual Impairments
Over the last few years there have been several stories in the national press about disabled doctors or medical students. Most seem to focus on those refused entry to medical school or jobs because of their impairment, although there are a few "Dr Suchandsuch is a surgeon even thought he's in a wheelchair!!!?!". A lot of these stories make for sobering reading, and show the variety of attitudes that are held about disabled doctors, by both patients and colleagues.
The first story I would like to draw your attention to is that of Dr Jemma Saville, who acquired a visual impairment during her time at Southampton medical school. She has shared her story in her own words here on the BMA disability pages, please go and take a look. Dr Saville was unable to find a job after graduating, despite having provisional GMC registration.
"Disabled doctors have so much to give; granted that with a disability you can’t fit into all areas of medicine. I know I can’t be a surgeon, and I don’t want to be. But the system should recognise people’s strengths, and play to them, not just quash anyone who can’t do every single thing. Every person and every doctor has strengths and weaknesses, and disability is just an extension of this. In closing the doors to people with disabilities, the doors will be closed to all sorts of amazing talent..."
She wants to train as a psychiatrist, a field that she believes would play to her strengths, but this has not been possible for, I imagine, two reasons :
1) Concerns over patient safety / her ability to do the job
2) The design of the training programme after medical school
The first point I will not go in to - I believe that if a medical graduate, their medical school and the GMC all consider them capable of proceeding, then it is not anyone's place to argue otherwise.
However, it makes clear what I have found to be true in my trawling of the internet - there is a lot of prejudice and ignorance surrounding the idea of doctors with visual impairments. It provokes some of the most extreme views. For some reason folk seem less able to understand that there is a spectrum of visual impairment - they seem to understand that concept much better in relation to something like mental health problems*.
The (very) general(ised) view seems to be that "if you can't see, of course you can't be a doctor" - which I would argue shows ignorance of both visual impairment and the nature of the medical profession. (Although add 4 little words "...in the current system", and you probably have a not-unrealistic idea of the current state of affairs - for example, see this news story as an idea of the kind of adaptations that are possible) The clincher of such arguments is "and they'll always need to have someone with them to look at stuff so it's inefficient" - but in an age of holistic, multidisciplinary, patient-centred care, no one clinician would be expected to do everything anyway. Very little of my training has been to do with sight - far more to do with communication, with problem solving, with knowing how to react when the [bad word] hits the fan.
The concept of "limited registration" whereby Dr Saville could, for example, be licensed to work as a psychiatrist, but not a surgeon, doesn't exist in the UK (at least, it happens in practice, but it is not part of the regulations governing the licensing of doctors). It happens in parts of the States, I think. There are advantages and disadvantages - namely reassuring everyone that noone's trying to do anything they can't, and not wanting to ghetto-ise a group of doctors or make their license somewhat second class.
My second point was linked to the design of post-graduate training in medicine. You've already explored with me the challenges of trying to fit my non-standard self into a one-size-fits-all training system. Having a national application system is good in some ways - it streamlines the application process by avoiding filling out numerous applications and it is standardised which (is supposed to) reduces bias. My major problem with the system (other than such a heavy weighting being placed on a set of ridiculous questions) is this :
In order for the system to work a set number of 2 year posts have to be created out of the need for various numbers of doctors to staff various wards in various specialities. Once these posts have been created, it makes the system hugely difficult to navigate as a "non-standard" applicant.
For example, in order for Dr Saville to complete her 2 foundation years all in psychiatry (besides drawing up obvious questions about what the minimum general skill set is that you need to acheive before passing on to specialist training, and whether you could get enough exposure to other specialities - no system of the body existing in a vacuum) it would involve chopping and changing up to 6 other roles, which have at that point already been advertised and applied for as is (because under the current system Dr Saville would not have been able to disclose her needs until after the point at which she had been offered a "standard" role). The same will be true, for example, when I apply to complete my foundation years on a less than fulltime basis - other roles will have to be created or adapted to "fill in the gaps" for me.
From all of the peope I have talked to, and the stories I have read where I can find them, it seems that folk have a much easier time - in terms of work - when they acquire an impairment later on in their training or career. It is not unusual, for example, for those organising specialist training to deal with less-than-fulltime arrangements, as by that point a lot of doctors are having children. Colleagues are much more likely to make an effort with adaptations for someone who is already a known and respected part of the team. Of course this is not always the case, but it seems to be the general pattern.
There are many stories like this, many thousands who have been rejected by our profession at whatever stage. I don't know how to make change - I don't know how to make medicine an accessible career, or how to make the NHS an employer that delights in the diversity of its workforce. I'm just reminded of the words of Kaliya Franklin and The Broken of Britain :
"Alone we whisper, together we shout"
On which topic, I had some interesting chat with my disability advisor today about how we could start a conversation between medical students who are disabled or living with chronic illness at my uni. I think it has potential to be quite exciting. =)
Would you like to write a blog post about your experiences as a medic who is disabled, living with a chronic illness or a carer? Leave a comment or email disabledmedic[funnyatthing]hotmail.co.uk
*That is not to say, unfortunately, that there is not prejudice surrounding mental health problems in the medical profession. Indeed, I have experienced more stigma among medics than in any other sphere, except perhaps the church.
The first story I would like to draw your attention to is that of Dr Jemma Saville, who acquired a visual impairment during her time at Southampton medical school. She has shared her story in her own words here on the BMA disability pages, please go and take a look. Dr Saville was unable to find a job after graduating, despite having provisional GMC registration.
"Disabled doctors have so much to give; granted that with a disability you can’t fit into all areas of medicine. I know I can’t be a surgeon, and I don’t want to be. But the system should recognise people’s strengths, and play to them, not just quash anyone who can’t do every single thing. Every person and every doctor has strengths and weaknesses, and disability is just an extension of this. In closing the doors to people with disabilities, the doors will be closed to all sorts of amazing talent..."
She wants to train as a psychiatrist, a field that she believes would play to her strengths, but this has not been possible for, I imagine, two reasons :
1) Concerns over patient safety / her ability to do the job
2) The design of the training programme after medical school
The first point I will not go in to - I believe that if a medical graduate, their medical school and the GMC all consider them capable of proceeding, then it is not anyone's place to argue otherwise.
However, it makes clear what I have found to be true in my trawling of the internet - there is a lot of prejudice and ignorance surrounding the idea of doctors with visual impairments. It provokes some of the most extreme views. For some reason folk seem less able to understand that there is a spectrum of visual impairment - they seem to understand that concept much better in relation to something like mental health problems*.
The (very) general(ised) view seems to be that "if you can't see, of course you can't be a doctor" - which I would argue shows ignorance of both visual impairment and the nature of the medical profession. (Although add 4 little words "...in the current system", and you probably have a not-unrealistic idea of the current state of affairs - for example, see this news story as an idea of the kind of adaptations that are possible) The clincher of such arguments is "and they'll always need to have someone with them to look at stuff so it's inefficient" - but in an age of holistic, multidisciplinary, patient-centred care, no one clinician would be expected to do everything anyway. Very little of my training has been to do with sight - far more to do with communication, with problem solving, with knowing how to react when the [bad word] hits the fan.
The concept of "limited registration" whereby Dr Saville could, for example, be licensed to work as a psychiatrist, but not a surgeon, doesn't exist in the UK (at least, it happens in practice, but it is not part of the regulations governing the licensing of doctors). It happens in parts of the States, I think. There are advantages and disadvantages - namely reassuring everyone that noone's trying to do anything they can't, and not wanting to ghetto-ise a group of doctors or make their license somewhat second class.
My second point was linked to the design of post-graduate training in medicine. You've already explored with me the challenges of trying to fit my non-standard self into a one-size-fits-all training system. Having a national application system is good in some ways - it streamlines the application process by avoiding filling out numerous applications and it is standardised which (is supposed to) reduces bias. My major problem with the system (other than such a heavy weighting being placed on a set of ridiculous questions) is this :
In order for the system to work a set number of 2 year posts have to be created out of the need for various numbers of doctors to staff various wards in various specialities. Once these posts have been created, it makes the system hugely difficult to navigate as a "non-standard" applicant.
For example, in order for Dr Saville to complete her 2 foundation years all in psychiatry (besides drawing up obvious questions about what the minimum general skill set is that you need to acheive before passing on to specialist training, and whether you could get enough exposure to other specialities - no system of the body existing in a vacuum) it would involve chopping and changing up to 6 other roles, which have at that point already been advertised and applied for as is (because under the current system Dr Saville would not have been able to disclose her needs until after the point at which she had been offered a "standard" role). The same will be true, for example, when I apply to complete my foundation years on a less than fulltime basis - other roles will have to be created or adapted to "fill in the gaps" for me.
From all of the peope I have talked to, and the stories I have read where I can find them, it seems that folk have a much easier time - in terms of work - when they acquire an impairment later on in their training or career. It is not unusual, for example, for those organising specialist training to deal with less-than-fulltime arrangements, as by that point a lot of doctors are having children. Colleagues are much more likely to make an effort with adaptations for someone who is already a known and respected part of the team. Of course this is not always the case, but it seems to be the general pattern.
There are many stories like this, many thousands who have been rejected by our profession at whatever stage. I don't know how to make change - I don't know how to make medicine an accessible career, or how to make the NHS an employer that delights in the diversity of its workforce. I'm just reminded of the words of Kaliya Franklin and The Broken of Britain :
"Alone we whisper, together we shout"
On which topic, I had some interesting chat with my disability advisor today about how we could start a conversation between medical students who are disabled or living with chronic illness at my uni. I think it has potential to be quite exciting. =)
Would you like to write a blog post about your experiences as a medic who is disabled, living with a chronic illness or a carer? Leave a comment or email disabledmedic[funnyatthing]hotmail.co.uk
*That is not to say, unfortunately, that there is not prejudice surrounding mental health problems in the medical profession. Indeed, I have experienced more stigma among medics than in any other sphere, except perhaps the church.
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