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 " 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]

*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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