Source: Birkett, D. (2003). Ready, Willing and Disabled. ‘The Guardian Educational Supplement’ 10-1.
Daniel Strother, who broke his back climbing Ben Nevis, hopes to make medical history by qualifying as a doctor – in a wheelchair.
The white coat hangs in the hall, there is a pile of medical textbooks on the table and lecture notes are strewn all over the floor. “I’ve always wanted to be a doctor,” says Daniel Strother, a student at St. George’s Hospital medical school in South London. In many ways, this young man is a typical first-year medic. Except Strother, 23, is in a wheelchair.
Until recently, it seemed that no wheelchair user would be able to train as a doctor. In a landmark case last April, the General Medical Council (GMC) advised Oxford University against accepting Heidi Cox, a paraplegic, to study medicine. Cox lacked the mobility and physical strength to carry out basic cardio-pulmonary resuscitation (CPR), and the GMC refused to agree adaptations to the curriculum. Cox’s ambitions to be a pathologist were crushed. At the same time, Strother was at last applying for admission to St. George’s.
In January 2001, he had just sat the entrance exams. A month later, just before he was due to go for a follow-up interview, Strother, a keen mountaineer, was climbing Ben Nevis with his girlfriend when his rope gave way and he fell 20ft on to hard ice, breaking his spine. It would be another year – after six months in a spinal injuries unit – before he was finally well enough to go for his interview at St. George’s.
Unlike other academic courses, medicine requires certain physical competencies that a wheelchair user or someone with significant physical disabilities simply may not be able to fulfil. The most obvious of those is CPR and the insertion of an intravenous drip. Every doctor must first be able to carry out these basic life-support functions before later going on to specialise. But, increasingly, would-be doctors with disabilities and disability campaigners are questioning these pre-entrance requirements which are inevitably exclusionary.
“They’re be things I can’t do. I’m not going to be an orthopaedic surgeon, or in accident and emergency, am I?” admits Strother. “But I would think I could do general practice. The problem is as much about established attitudes as it is about an individual’s abilities.”
Dr. Stephen Duckworth, a Glasgow GP, lost his legs as a child. “I’d wanted to do medicine at school, but the headteacher told me you couldn’t be a doctor with one leg. If there was a cardiac arrest, I wouldn’t be able to run and get there in time – that was the sort of thing that was put up as a barrier. So it put me off, and I did science instead. But I still wanted to be a doctor, so I applied 12 years later and was accepted, aged 30.”
Dr. Steward Mercer questions the need for every undergraduate to be able to perform all tasks. “In most hospitals now, there’s a crash team of two or three expert nurses, a senior house officer, a junior house officer and an anaesthetist at least. You have a crowd of people. Having one person in a team who wouldn’t be able to do the chest compression wouldn’t be a danger at all. They could be doing other things. I was at 30 crashes in my year as a house doctor, and I only did compressions twice. It shouldn’t be a huge sticking point.”
St. George’s has gone to considerable trouble to make adaptations for Strother, making sure that the teaching environment is wheelchair accessible. (Ironically, medical schools, where young people study to tend the sick, may be far less well adapted than other educational institutions, simply because they haven’t had any disabled students before.) They have even cut a leg off the dissecting table so that his wheelchair could fit underneath it.
Strother has had to adapt, too. Unlike other students, he has to wear gloves when he examines a patient, as his hands could pick up dirt from the wheels on his wheelchair. And although he can stand in callipers, he is not allowed to while examining, in case he falls over.
But would St. George’s have accommodated any type and degree of disability? “When we admit a student with a disability, we’re doing a balancing act – the rights of the individual on the one side, and on the other the rights of society to have safe doctors,” says Patricia Hughes, St. George’s dean of undergraduate medicine.
“If we had a blind student apply, there would be real questions whether medicine was feasible for them, because so much of it is visual. It would be very difficult to make adaptations for that person. We’ve got a number of partially-hearing students, which is not too much of a problem; lecture theatres have induction loops and you can get special stethoscopes that will admit sound. But profound hearing loss is a much bigger problem. We have no students who are profoundly deaf. Equally, if someone didn’t have use of their arms, I don’t think they could be a doctor. For each person I would look at the core skills she or he would have to perform as a junior doctor, and say: can this person do enough of this to make it possible?”
But disability campaigners challenge how core skills should be interpreted in an age of hi-tech medicine. With the right will on all sides, it is argued that anyone can become a doctor, regardless of their impairment. Stephen Duckworth, chief executive of Disability Matters, broke his neck in his third year of medical school; he was left with a little movement in his fingers, but that is all. After some pressure, he was allowed to continue to the end of his course and qualify as a doctor, although he has chosen not to practice.
“My situation is extreme. I have poor sensation in my fingers. If I’m feeling somebody’s pulse, it could be argued that I can’t feel whether it’s racing or bounding,” he says. “But with the acoustic technology that we’ve got now, I could do that. We need to understand that we don’t really need to do things the way they’ve been done in the past. We need new ways of doing things.”
Duckworth also sees benefits in introducing new ways of working with patients. “All I have got to be capable of doing is to ask the patient to put the relevant piece of equipment in the relevant place. That also introduces a little bit of partnership approach between the practitioner and the patient, which is empowering to the patient.”
In a 1995 BMA survey of disabled doctors, every respondent answered “yes” when asked if there were any positive aspects of being a doctor with a disability. Mercer says, “I know my experiences have taught me something about life, and these are applicable to being a good, empathetic doctor.” Duckworth discovered he was a better doctor with a disability than without: “What I found was that patients were far more willing to open up and tell me the real issues after my injury than before it.”
If Duckworth had broken his neck three years earlier, before applying to do medicine, he would never have been accepted. While there are very few disabled medical students, there are doctors who have become disabled once qualified and continue in their specialism, where they are no longer required to do basic life support.
According to the General Medical Council (GMC), this situation cannot change until there is a shift in public perception of a doctor’s role primarily as a lifesaver. Until the public chooses to see doctors in a different light, all initial basic training must include life-support skills, and all medical students must be able to do CPR, they argue.
The GMC does not regard it as its responsibility to change these attitudes: “We have a role to protect the public. We don’t have a role for widening access for anyone. It’s up to others to make the arguments.”
At present there is nobody making such arguments for inclusion. The British Medical Journal has established a chronic illness and disability matching scheme, linking disabled doctors with similar conditions or experiences by email. But there are no national statistics on the number of disabled young people applying to or being accepted at medical school, or on the number of doctors with disabilities.
With such a lack of information, the responsibility falls upon individuals such as Strother to be medical pioneers. Strother realises the weight of his responsibilities. “The primary concern is obviously for patients. My desire to be a doctor cannot impact on patient care when I work…But if it were training to be a lawyer, it would be fine. There are many disabled lawyers. Or if I were studying geography, and it included a field trip, I just wouldn’t go on it and nobody would mind. But because you’re training to be a pre-registration house officer, you have to be able to handle all sorts of conditions, and have a wide breadth of knowledge.”
It is ultimately up to individual deans, such as Dr. Hughes at St. George’s, to take the risky decision to admit disabled students like Strother. Mercer believes this leads to a piece-meal approach, with some medical schools being more inclusive than others. “You get one dead who says we can and another who says we can’t. If you’re lucky, you apply to the right place.” This situation, he says, should not be allowed to continue. “Change needs to come from the top. The medical profession should be leading society, not dragging its heels behind it. It’s completely unhealthy.”