Peter Cross reports on a recent workshop that focused on how doctors with disabilities and chronic illnesses can continue working
Jun 1, 2003
Peter Cross, freelance journalist
Dick Haywood was one of the speakers at a recent workshop that attempted to find ways to enable doctors with disabilities or chronic illnesses to work in the NHS. Dick was diagnosed with multiple sclerosis in 1985. Apart from a two year gap in the early nineties, he has continued to work part time as a general practitioner. He works mornings mostly, seeing patients in surgery; he doesn't do home visits. He is aware of his limitations. There are some physical procedures he can't do. Generally, he feels valued by his colleagues for what he is able to provide, and his patients don't mind that their doctor has multiple sclerosis.
Dick continues to practise long after he could have retired sick. He hasn't done this because he wants to work. Practising as a GP gives his life value and structure. He enjoys the contact it gives him with others, and he plans to keep working as long as he can continue to be useful. But it hasn't all been plain sailing. Dick struggled on at his former practice for six bleak years after he was initially diagnosed. He now feels that his former colleagues wanted to ignore his disability but were resentful that they were expected to cover for him. Dick felt undervalued, drained, and worn down by this subtle negativity.
The fact that Dick Haywod still works is a tribute to the leadership and positive re-enforcement provided by his present practice manager and a progressive practice. The attitudes of the two surgeries could not be more different. Strengths rather than weaknesses need to be found to get the best from employees. People with disabilities or recovering from illnesses are no exception.
Paul Dieppe, professor of rheumatology at Bristol University, posed a number of stimulating questions to the delegates. "Why," he wondered, "are the caring professions unwilling or unable to care for their own?" It is clearly something he has given a lot of thought to. He feels that it comes from a culture that he is part of: he is white, middle class, and male, and he played rugby. This is a culture that lives and works under the "pull yourself together, you're here to help others" creed. It is an ingrained belief that is extremely difficult to shift. Medicine can detach doctors from their emotions. Clearly, it is important to be able to think and make objective choices in times of crisis. But suppressing personal feelings and reactions ensuring that correct clinical judgments are made can result in doctors ignoring or minimising their own difficulties.
Rhona Miller, a Birmingham based BMA industrial relations officer, feels that the Disability Discrimination Act is a useful tool for disabled and sick doctors and their employers. While representing members, she has become aware of a great deal of ignorance by human resources staff and managers at employment tribunals who do not understand the implications of this legislation. The act, which came into force in 1996, puts the onus on employers to make reasonable adjustments for disabled employees. While this legalisation applies only to employers with more than 15 staff, this should not be a problem within the NHS. The positive message to employers is that unlimited government funding is available for aids and building modifications. Funding follows the disabled employee.
Legislation is in place to help disabled doctors and other health professionals work, and an array of technological advances that were not previously invented or affordable are also available. So why is progress so slow and what are the barriers to change?
Attendees at the workshop proposed a number of explanations for these barriers. These included an inflexible mindset and the usual resistance to change widespread in large organisations like the NHS—"We've always done it this way," or, "If it ain't broke don't fix it." Much of the NHS and health sector is run along a firefighting reactive model that makes it hard to anticipate needed changes and find creative solutions. Others spoke of medicine being stuck in a culture that looked for "cures" to diseases when containment, damage limitation, adjustment, and good management were called for.
Many individuals attracted to medicine have unrealistic expectations of themselves and secretly fear that they are not good enough. Accepting that they have a disability and openly asking for help is difficult for them. There is still a huge stigma attached to physical disability and possibly an even greater one towards doctors with psychological problems. One delegate who has been diagnosed with clinical depression said that colleagues and seniors often perceived people with mental health problems as being unstable, unreliable, and a liability in a stressful environment.
"All the heroes in the disability field seem to have physical rather than psychological problems," lamented Paul Dieppe. It is easy to see why. There is something heroic about a colleague working with a physical handicap or disability, minimising their own difficulties while helping others. Clearly, no sane person would wish to suffer the trauma, indignity, and daily inconvenience of multiple sclerosis, a limb amputation, or defective hearing or sight, but at least these people know what they are up against and can make contingency plans. We all hope that if we were in this position we too might cope as well.
Psychological damage is more problematic. It could be argued that people with these difficulties remind us of parts of ourselves we would rather not face. Who doesn't fear that they wouldn't cope in a crisis, would wilt under excessive stress, or be overwhelmed by conflicting demands? While no one would suggest that the NHS inflicts multiple sclerosis on one of its workers, there is an implicit suggestion that workplace demands can cause or at least contribute to psychiatric conditions such as depression in vulnerable staff.
Things that help ill or disabled doctors
Identifying barriers to progress is relatively easy. Finding workable solutions is difficult. Good mentors and mentoring schemes can be helpful especially when individuals are matched with a senior with a similar disability. Open and frank discussions about an individual's problems and needs is helpful if creative solutions can be found. A positive attitude and flexible responses to shift patterns, mobility difficulties, and task allocation can make what once seemed impossible if not easy, at least doable.
Role models matter. Knowing that people like Dick Haywood can continue to work is an inspiration. Paul Dieppe has a point when he suggests that it is harder to identify role models with psychological problems but there are some. Lizzie Miller, a doctor who has bipolar affective disorder and who was instrumental in setting up the Doctors' Support Network, is an excellent example of someone who has learnt to live with a potentially debilitating condition. If more doctors were prepared to talk and write openly about their disabilities, physical or psychological, life might be easier for everyone.
© 2003 BMJ Publishing Group Ltd