BMJ  2005;330:1455 (18 June), doi:10.1136/bmj.330.7505.1455

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PERSONAL VIEW

Disabled as a medical student, enabled as a doctor

I was involved in a road crash more than three years ago, just after I had completed my second year at the medical school at University College London. The crash resulted in substantial lesions in my right brachial plexus. As you can imagine, the loss of function in my right arm has had, and is having, a considerable effect on my training in medical school.

Needless to say, I have encountered difficulties, but not nearly as many as I expected. Clinical examinations were the first obstacle, but I have found that there are alternative techniques to be used. Some examination techniques I am unable to perform, such as palpation of the kidneys. Thankfully, on occasions when examinations are not possible, pertinent investigations can be requested on the basis of the patient's history alone. The principal restraint on my career is that surgery, and other dexterous specialties, are no longer career options; I am fortunate, therefore, to have interests in areas of medicine other than these.

I have to explain my relatively severe condition to doctors, nurses, students, and even patients and their families

One problem I have encountered is being questioned about my arm. (It is held permanently in a sling.) Although my arm is functionless it looks at first glance to have only a minor injury, such as a strain. As a result I am often quizzed about it on ward rounds or during bedside teaching sessions. I have to explain my relatively severe condition to doctors, nurses, students, and even patients and their families, which is quite an ordeal for me. I feel that this jeopardises my professional identity and my relationship with patients. I now make it a point to tell doctors about my arm as soon as possible and have thus, on the whole, avoided these difficult situations. I have also learnt through experiences such as this to have prepared phrases that can let people know that I do not want to talk about my disability, without making anyone feel uncomfortable. When asked by a patient, "What have you done to your arm?"—which I feel is a perfectly reasonable question—I often reply, "Oh, far too much!" and then change tack. This isn't to say that I never talk openly about my arm; I do, but only when I feel the time is appropriate or when there is a good reason.

As doctors it is our job to investigate a person's health status, so it is often difficult when faced with someone we meet who has an obvious physical or health problem to know when, and when not, to ask about it. As somebody who deals with this difficulty every day, I feel I am in a position to offer some guidance. You need to be aware that the individual concerned is highly likely already to be seeing a doctor, and that it is probable they have already been asked several times that day about their predicament by other interested parties. This will lead you to the conclusion that the person would probably not appreciate your inquiry into their visible health problem, unless of course you are conveying a necessary piece of information. My worry as a disabled person who will be working within a healthcare setting for most of my working life is that I will continually be caught astride the fence: one minute being in the doctor role and the next being interviewed about my disability. It is important that all staff throughout the hospital be aware of this dilemma so that the professional integrity of those staff members with ongoing health problems can be maintained.

I cannot understate the impression that my long stay in hospital has had on my attitude towards practising medicine. My first realisation was the astounding sense of anxiety and insecurity patients feel when placed in a hospital bed. As medical staff we become overly familiar with the sights, sounds, and smells of hospitals, such that we have no comprehension of how alien an environment it really is. Another revelation I had was the appreciation I felt for the doctors who shared a little of themselves with me. Often this was a very small, casual interaction, for instance a doctor reminiscing about when they were at my stage of their medical career or how they could empathise with me, having coped with a broken arm years ago. This tended to restore my confidence and to undermine my paranoia about my needs being an irritation to the doctors.

Through my time in hospital, my education, and my continuing battle with disability, I have come to realise that even though patients lose much dignity in submitting themselves to the medical profession (leading to many intrusions such as examinations, loss of privacy, and admission to hospital) we can help enormously by conveying an attitude of respect. For it is only through our expression of respect for patients as equal human beings that we obtain their trust, allow them to retain what dignity they have left, and thus enable them to gain a sense of peace in their acquiescence.

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Wales College of Medicine, Cardiff University, Cardiff danielmaughan{at}gmail.com

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Disability

Clive H Morgan
bmj.com, 27 Jun 2005 [Full text]

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