What’s up with you, doc?BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39504.664028.CE (Published 22 March 2008) Cite this as: BMJ 2008;336:s105
- Paula Newens, foundation year 2 doctor 1,
- Oliver J Corrado, codirector West Yorkshire Foundation School and consultant physician2
Paula Newens describes life as a wheelchair-using foundation trainee, and Oliver Corrado, in his role as foundation school director, discusses the associated training implications
With the advent of the Disability Discrimination Act 1995 and changes in the attitude of society, disability discrimination has increasingly become less acceptable. The act gives disabled people rights in employment, education, retail, and public transport. Since October 2004 businesses and other organisations must take reasonable steps to tackle physical barriers preventing disabled people from fully accessing services.1
It may understandably be difficult for doctors with appreciable physical disability to cope with the daily demands of medical life. In this article we briefly describe some aspects of disability, in particular in relation to a career in medicine, and draw on personal experience as a wheelchair user.
The Disability Discrimination Act defines disability as “a physical or mental impairment which has a substantial and long-term adverse effect on his ability to carry out normal day-to-day activities.”
There are roughly 10.8 million disabled people in the United Kingdom2—more than one in six people has some form of disability.3 The number of wheelchair users is uncertain, but estimates range from 640 000 to 750 000.4 As yet no official statistics for disabled doctors exist.
Although it is unusual for doctors who are wheelchair users to practise medicine, some have been extremely successful. In the 1950s Bill Inman contracted polio as a student and he became a wheelchair user while at medical school. In 1956 he became the first person to graduate in medicine from Cambridge University. His legacy continues as he devised the yellow card system of adverse drug event reporting5; over 20 000 cards are returned annually.6
A foundation doctor’s personal account: Paula Newens
When I started university in 1999 the press was reporting the story of Heidi Cox, who had started medical training but discontinued her studies after an accident. She subsequently applied to Oxford University to restart a medical course and was offered a place. However, the General Medical Council refused to recognise modified courses for undergraduate students. Although she successfully took legal action under the Disability Discrimination Act she subsequently lost her case on appeal and never returned to medicine.7
The GMC has since changed its attitude and is now leading a project designed to support medical students with disability and produce guidance for medical schools.8
The GMC specifically addresses the situation of foundation year 1 (FY1) doctors in The New Doctor9: “All PRHOs (FY1s), including those with a wide range of disabilities and health conditions, can achieve full registration as long as they meet all the outcomes.
“We need to encourage those responsible for training to develop original and individual training programmes to help PRHOs (FY1s) with disabilities to meet the outcomes.”
Before applying for FY1 posts, I contacted the Yorkshire Deanery and West Yorkshire Foundation School. Both were exceptionally helpful with my application. As a wheelchair user many factors had to be taken into account, including access, accommodation, my training programme, and educational supervision. Because of my “unusual circumstances” I applied using a standard application form several months before the main application process.
My experience of being a foundation doctor with a visible disability has been generally positive. One can encounter discrimination as a disabled member of the general population, and this does not disappear as a member of the medical profession. Discrimination can be from patients, carers, and, perhaps surprisingly, even hospital staff.
However, the overwhelming reaction I have encountered from staff and the public was one of acceptance. Most people react to me no differently from any other doctor. Some will tactfully suggest I tell them should I have any difficulties and are only too willing to help. In a way I am fortunate that my disability is obvious. Difficulties are recognised even before I know they exist. Most staff care more that you do the job well than that you do it in a wheelchair.
Practical difficulties are fewer than might be anticipated. All clinical areas are large enough to manoeuvre a hospital bed; I am considerably smaller and more agile than an NHS trolley. Beds come down to my level for examination. I have always examined patients in a way that is most accessible to me; this may often necessitate going round to the other side of the bed and doing half a physical examination at a time. Small things can cause problems: building planners seem to believe staff can use a toilet no bigger than a postage stamp; sharps bins are generally located away from “small hands” at a convenient height for standing people; and the dexterity of an octopus is needed to open security locked doors, let alone negotiate a wheelchair through the door at the same time.
The badge round my neck identifies me as a professional and proclaims me to be a suitably qualified and intelligent person; the expectation of my ability increases. In general, people no longer assume I am deaf and have ceased talking to me in loud, slow, simple sentences. The “doctor” appears to outweigh the “wheelchair.”
Most never ask why I am in a wheelchair. A few nervously start, “I hope you don’t mind me asking but,” implying curiosity but sensitivity. A few begin with the less subtle, “What happened to you then?” or, “So, you can’t walk”; those are harder to deal with.
Foundation training has had its ups and downs as it does for every house officer. The support of my foundation school has made the path far easier than it might have been. The overwhelming majority of staff have been supportive and have shown no difficulty adapting to a disabled doctor on the team, although we still have a long way to go as a profession to full acceptance of difference within our ranks.
Experience of other disabled trainee doctors
Being a disabled doctor can make you worry that you are causing extra work for colleagues. For example, Daniel Maughan suffered a substantial brachial plexus injury after an accident while at university. He refers to small steps colleagues can take which alleviate the paranoia of being a burden: “A doctor reminiscing about when they were at my stage of their career or how they could empathise with me, having coped with a broken arm years ago.”10
However, things are not always so rosy. Andrew Gregan, a doctor who developed transverse myelitis in 1994, found the medical profession unsympathetic towards its colleague. Countless people offered sympathy but no genuine effort was made to help him return to work.11
Susannah Kahtan points out that “unfortunately, we as a profession have a tendency to assume that illness and disability happen to other people.”12 She recognises that most patients would rather feel their doctor has some idea of what it is like on the other side of the stethoscope.11
Tom Wells, who uses a wheelchair following a spinal cord injury, wrote that disability does not automatically make you better at communicating with your patient. It does make you consider the patient’s perspective.13
Foundation training may be the easier part of my medical training. I am located in the same geographical area with colleagues and trainers who know my situation well, but what will it be like later in my training?
Sheila Macpherson developed acute disseminated encephalomyelitis and became wheelchair dependent after she completed her fellowship of the Royal College of Surgeons. She identified that postgraduate training inevitably entails rotation between hospitals. A base hospital might make special arrangements, but will all peripheral hospitals make the same adjustments?14
A foundation school director’s account
I had not been a foundation school director for long when one of the school administrators told me that she had been contacted by the Yorkshire Deanery because Paula had applied to West Yorkshire foundation with “special circumstances.” As a consultant geriatrician I am used to dealing with people with disability and am only too aware of how amazing they can be at coping with disability and overcoming problems. Nevertheless I must confess to having been slightly sceptical about whether a wheelchair user would be able to cope with the demands of being a foundation doctor.
I arranged to meet Paula in advance to discuss her training. The main factors we took into account were her career plans, specific training posts, and access. I suggested Paula did her first placement with me in medicine for the elderly at Leeds General Infirmary as I still had some reservations that she might find it difficult working as a foundation doctor and wanted to ensure she received the necessary level of support. I acted as both her clinical and her educational supervisor.
Paula rapidly settled into life as a foundation doctor, clerking patients, doing procedures, participating in the on-call rota, and passing all the required foundation assessments. She coped incredibly well with the demands of the job manoeuvring her wheelchair dextrously around the hospital.
Paula has comprehensively shown that with forward planning doctors who use a wheelchair can cope with the considerable demands of being a foundation doctor and complete their training. She is an inspiration to us all.