As a result of our advances in medical science and technology more lives are being saved than ever before, although many people who are saved from death are left disabled. Add to this the expansion of the ageing population, in whom the prevalence of physical impairments is highest, and disability emerges as a major facet of modern society—one in four people in the United Kingdom has a disability or is closely associated with someone who has.1 Disability has become part and parcel of our human experience. By definition, therefore, the challenges facing citizens with disabilities are now a major “mainstream issue,” both for society in general and for the medical profession in particular.
Yet several reports and studies indicate that doctors commonly fail to identify and tackle disability issues.2-6 Why is it that health professionals often seem unwilling or unable to engage with people with disabilities?
One reason may be the poor record that the medical profession in the United Kingdom has in treating people with disabilities as equal within its own ranks. We recently organised a two day conference to explore the issues faced by doctors with disabilities or long term illness in today's NHS.7 This multidisciplinary conference had a wide range of participants, including doctors with current or recent long term physical disabilities or chronic mental or physical ill health and others with an interest in or responsibility for recruitment and retention of doctors. We collectively identified barriers at several levels—the individual, the attitudes of colleagues, the attitudes of employers, and the stance of the profession (including the General Medical Council). The “macho” ethos that still pervades the medical profession and the inflexibility of the system were themes that recurred throughout the two days.
The issue of discrimination against doctors or medical students with a disability recently gained national prominence in the United Kingdom because of the case of Heidi Cox,8 a medical student who developed paraplegia as a result of a spinal injury and had been accepted to complete her medical studies by Oxford University. The GMC, however, ruled that she should not continue her studies, a stance that she challenged legally through the Disability Discrimination Act 1995. Although she won her initial complaint, the GMC successfully appealed this initial ruling on the technicality that as a regulatory body it is not a trade organisation. Owing to the timing of the case, the incorporation of the Human Rights Act into the law of member states of the European Union (which took place in 2001) was not applicable. The GMC would have a responsibility under the Human Rights Act not to discriminate in respect of disability or serious communicable diseases.8
Some years ago the BMA reported the accounts of almost 50 doctors and medical students with disabilities or chronic illness, and most felt that they had experienced discrimination and lack of equal opportunities, as well as hostile or unhelpful attitudes and behaviours by colleagues.9 It is disconcerting that the introduction of anti-discrimination legislation has as yet failed to help health professionals with disabilities.
A second reason for health professionals' inability to relate to disability issues is the low numbers of students with a disability who are admitted to medical school. Particular concern was expressed regarding the under-representation of people with disabilities in medicine and the healthcare professions generally at the “Enabling disabled doctors” conference. Although not a main focus of the meeting, the problems faced by people with disabilities who wish to gain entry to study medicine and by students who become disabled during their studies was of great concern. As indicated by the Heidi Cox case such concern seems to be well founded and is supported by the findings of another recent workshop, “Teaching health professionals about disability,” held by the Health Council, and supported by the MRC Health Services Research Collaboration. This workshop concluded that we need more doctors and other healthcare professionals with disabilities in order to help improve the poor engagement of health professionals with the experiences of disabled people in general.5
Several years have passed since a BMA report called for rigorous research into this area,9 which as yet has failed to materialise. One interesting pointer, however, is a recent audit of the information made available to the public on the websites of all UK medical, veterinary, and dental schools,10 which indicates that, although most medical schools provide some information for applicants with disabilities, reference to key policy documents is woefully inadequate.
Several creative ideas emerged from the two meetings cited above, which, if acted on, could help enable doctors with disabilities to take their rightful place in medicine. Delegates suggested positive responses to virtually all of the barriers identified and agreed that a vital first step is to confirm by rigorous research that the concerns and experiences reported by doctors with disabilities are widespread and representative. Secondly, more role models of doctors with disabilities who have succeeded in medicine are needed. This in turn requires that representative numbers of disabled students are admitted to medicine, and that all disabled doctors and medical students are given the support they are entitled to. Thirdly, we need to learn from the sex and race equality gains that have occurred in society in general. The medical profession—and doctors with disabilities—would gain from engaging with other health professionals with disabilities and with the wider disability rights movement. Finally, and perhaps most importantly, a meaningful partnership must be struck with key organisations—including the GMC, the royal colleges, and the Department of Health (and devolved equivalents)—if we are to develop and integrate policies that will deliver real change.