Life as a visually impaired doctorBMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7457.s15 (Published 10 July 2004) Cite this as: BMJ 2004;329:s15
Rhianwen Elen Stiff shares her experiences and gives some practical advice to doctors with visual impairments
Iam a 27 year old medical senior house officer (SHO)—and I'm partially sighted. Here's a potted history.
As a consequence of childhood illness, I have always had monocular vision and have always been partially sighted. I attended mainstream schools and graduated from medical school with an intercalated BSc and commendation.
Preregistration house officer (PRHO) jobs passed successfully and I started a medical SHO rotation. Three months later I awoke to discover an overnight, unpredicted deterioration in my vision. I was devastated.
There have been numerous personal and work related consequences. Twenty one months further on, my remaining sight is a monocular corrected acuity of around 6/36. My corneal epithelium is unstable, and on a bad day my acuity worsens. But I have more good days than bad. My new life is a little harder, a little different, and considerably more blurred, but it's not impossible. My eyesight does not define me. I wish that my eyesight did not govern other people's perceptions of me.
Dispelling the myths
Let's dispel some myths about being a visually impaired doctor:
Being blind or partially sighted does not equate with having no useful vision
I do not possess a pair of dark glasses (and have no hidden talent for jazz)
I do have a white stick—it was provided by a rehabilitation officer, as part of standard protocol, and it sits folded and unused in a corner of my office
My hearing has not become supersensitive, and I cannot detect grade 1 cardiac murmurs from the end of the bed
Contrary to popular belief, a Labrador does not guide me to my patients. I don't have a guide dog
Most importantly, being blind and being a doctor are not mutually exclusive.
Getting started in medicine
My attitude has always been that I will go as far as I can. If I'd started at medical school and found that my vision was making things too difficult, then I'd have had to make some radical decisions but at least I'd have tried. Giving up (or not starting) something because someone else thinks it might be too difficult for me is not an option.
The practicalities of negotiating medical school with poor vision were not difficult. I enlarged any handouts on a photocopier, sat near the front of lecture theatres, and borrowed my friends' notes to fill in gaps where I'd missed anything from the overheads. When it came to exams, my papers were enlarged and I was allowed extra time to compensate for the increased time it takes me to read. Laboratory work and dissection were fine as long as I was near the demonstrators.
My new life is a little harder, a little different, and considerably more blurred, but it's not impossible
It was a priority for me to ensure that my visual impairment did not interfere with clinical examination of my patients. The medical school dean was extremely helpful—we discussed a long list of potential problems and worked our way through them. Many issues were simply not a problem in practice. Others required me to examine patients in a different way or to seek help with specific aspects. (Some aspects of clinical examination have always been more difficult for me—for example, there seems little point in me trying to perform confrontation visual field assessment and I haven't been able to find an ophthalmoscope that is suitable for my visual acuity.)
During my intercalated degree year, I did some extra clinical work. The increased experience helped to make me confident and competent with clinical examinations and also proved my abilities to my supervising consultants.
The PRHO period
I graduated and did my PRHO posts without encountering any eye related difficulties. I subsequently started a medical SHO post, intending to gain membership of the Royal College of Physicians (MRCP) and divert from acute clinical medicine to my desired long term specialty.
It sounds straightforward enough, but suddenly my vision deteriorated to a level of counting fingers and I had to step back from the rotation.
My residual vision is now 6/36 thanks to the efforts of several ophthalmologists, optometrists, a high powered scleral contact lens, and spectacle over correction. I will be returning to the SHO rotation in August 2004. But it's not something I can do without a great deal of planning, organisational flexible thinking, and support.
The Disability Discrimination Act
Read it (www.disability.gov.uk/dda/), know it, and don't be afraid to use it if necessary. The Disability Discrimination Act is there to ensure your employer fulfils their responsibilities towards you and provides you with any additional resources you require, as a result of your disability, to perform your job.
Be honest—with yourself and with your colleagues
Identify your difficulties and work out strategies to overcome them
Read the Disability Discrimination Act—use it if necessary
Find a good occupational health physician—you may need to go out of area to find someone supportive or someone with previous experience
Contact your postgraduate deanery. They should act as an intermediary between yourself and your employers and ensure all appropriate adaptations are implemented. In the event of an acute problem, they should be able to ease the situation
Find helpful equipment, schemes, and sources of information, and don't be afraid or embarrassed to use them. Different gadgets suit different people and different tasks—it's handy to try before you buy because they are expensive
Get Access to Work involved early
Keep hold of your good friends, family, and colleagues and accept their offers of friendly shoulders to cry on
Don't let the negativity of people who can't or won't support you drag you down
You will find yourself hitting bureaucratic brick walls—do not despair, keep fighting
Access to Work
This is a government scheme run through local job centre plus offices. Each time you start a new job or change your job responsibilities, the Access to Work team will conduct a workplace assessment and provide a report outlining any additional equipment or support you will require.
Access to Work will fund all of the costs for a new employee and a proportion of the costs for a person currently employed. Seek help early. I underwent assessment promptly, but some hospital departments don't seem to realise that you can't wait six months for specialist equipment—by the time it eventually arrives, you may have moved on.
I can't drive or cycle any more, and I can't identify bus numbers easily. That leaves walking. That's not a problem during daylight but it's lethal at dusk or in the dark, as plenty of lampposts, curb sides, and trees will testify on my behalf. Thankfully, Access to Work can step in here to help with transport if I'm finishing late or if I'm having a “bad eye day.”
Be open and honest. But you'll be a new challenge for the occupational health physician, who may have little or no experience in dealing with visually impaired colleagues. If you find yourself in this position, ask to be referred to someone who does have experience. It's invaluable—you might need someone to coordinate on your behalf. In my case, a few well worded and well directed letters made all the difference in ensuring I was able to continue practising medicine.
The postgraduate deanery
This department should be your ally. When my eyesight deteriorated and I had to step back from the SHO rotation, I was absolutely devastated. Dealing with sight loss was difficult enough, but dealing with losing my job, being forced to consider a complete career change, the financial implications of firstly no job and then a job with a hugely reduced salary, and the dramatic impact on my friendships and social life was overwhelming.
By negotiating with the postgraduate deanery I was given a supernumerary position so that I could have some time to undergo medical assessment and treatment and to evaluate whether or not I'd be able to continue in medicine.
Be prepared to jump through hoops, however inappropriate they seem. I “shadowed” for a while to prove I was a competent and safe SHO.
I was also asked to compile a list of all the things that could pose difficulties for me in a clinical setting. The purpose was for the medical directorate to be able to conduct a risk assessment, and when compiling the list I discovered that my employers were unduly concerned about issues that I already had strategies for dealing with.
Jobs and training
Picking appropriate jobs can be challenging. Choosing a job full of technical procedures increases stress, and I would feel uncomfortable in a job where I had no on-site senior support to call on if required.
However, there are plenty of suitable SHO posts that I am perfectly capable of doing. The difficulty arises because rotations incorporate a variety of specialties to broaden experience and training. This is great for most people—but extremely inflexible when you have alternative training requirements.
And then of course we have to do exams. There's the age old problem of needing qualifications to progress but needing appropriate experience and training to be able to sit the exams in the first place. The Royal College of Physicians does not guarantee anything, but it is amenable to discussing each individual's requirements. It's best to contact them early. In my case, discussions are ongoing.⇓
Life in the workplace
Miles of indistinguishable corridors, variable lighting conditions, abandoned Zimmer frames waiting to trip unsuspecting victims, perpetually changing staff, and the notoriously unintelligible handwriting—not to mention the long hours, the chaos, and the unpredictability that all junior doctors have to deal with. This is possibly not the ideal environment for a visually impaired person.
I work in a hospital where I did a large proportion of my medical school training. I know the layout well and don't need to rely on signs to get around. It's a relatively modern building with fairly even flooring and not too many obstacles.
Few patients have commented directly to me about my eyesight, and on the whole they are accepting
I don't recognise people by their faces. I've often walked past my close family without acknowledging them, let alone my colleagues and friends. I rely on recognising general shapes (tricky when people diet or change their hairstyle) and voices. If my colleagues didn't know about my sight problems, they'd be annoyed with me for not acknowledging them.
I've been up front and honest with all the people that I work closely with. Some were sceptical at first, but as they've got to know me their attitudes have changed. They also look out for me, accept the corrections that I need to make, and let me get on with my job, rather than continuously questioning my behaviour.
Gadgets and gismos
It's a balancing act between not wanting to give in to my impairment but ensuring that I get everything I need to perform my job successfully.
I can read most print with my contact lens and glasses, but for speed and ease of reading, I use a handheld magnifying glass. It contains a built in light to compensate for clinic room gloom and allows me to decipher most poorly photocopied forms and awkward handwriting.
Our x ray examination and laboratory results are published on the hospital intranet. Although I find a conventional computer difficult to use, I have a screen magnification software package that effectively acts as an on-screen magnifying glass and I can access everything I need. The same software package contains a screen reader capability so the computer can read aloud to me. But specifically adapted computers are limited—I end up doing lots of work in my own time simply because my own computer is one of only a few access points I can use.
Association of Disabled Professionals: www.adp.org.uk
Wales Council for the Blind: www.wcbnet.freeserve.co.uk/English/Entry/wcb_home.htm
Closed circuit televisions
Portable, colour closed circuit televisions are now available that allow magnification to x16 (far greater than any conventional magnifier I've come across)—great for ploughing through volumes of patients' notes in search of that elusive clinic letter.
The Parrott is effectively an audio output Filofax. It's time consuming to programme initially, but it now stores, reads, and autodials a range of vital extension numbers.
The general response from the medical profession is, “You're blind?” while organisations aimed at blind or partially sighted people say, “You're a doctor?” It's taken a lot of effort and time to begin to break down these preconceptions. This is where you need support and plenty of determination. Local sight related agencies were particularly helpful through demonstrating equipment and providing advice and support. In my opinion, the bigger agencies and medical organisations were not as helpful as they could have been.
Few patients have commented directly to me about my eyesight, and on the whole they are accepting. I've always been honest, and if I've needed help (for example, with ophthalmoscopy) I've explained why and fetched a colleague.
I'm slowly converting my home to be “eye friendly” with gadgets galore, good and even halogen lighting, non-reflective paints and surfaces, and little orange raised sticky labels that help me identify cooker switches and boiler positions and so on. Sight loss is extremely frustrating and isolating, and one of the most difficult aspects to come to terms with is the reaction from my friends, some of whom have simply not managed to deal with it at all and are now conspicuously absent from my life. Thankfully, others have been fantastically encouraging and supportive.