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An Example of a Well Written Report

The premise of the following report is that an essential component of the relationship between the medical profession and disabled citizens is not just about the way disabled patients are treated, but also the way healthcare organisations treat their disabled employees.

The report unequivocally places disability as a mainstream priority concern and gives a powerful insight into the cultural challenges faced by healthcare service employees with impairments and/or long-term health conditions. It also demonstrates how issues need to be addressed by tackling traditional fears, attitudes and myths. The language used is direct and uncompromising.

The publication is aimed at policy makers; healthcare, academic training and regulatory organisations that have strategic and operational responsibilities within the medical profession; the UK health departments; and medical workshop managers. The BMA intends this seminal report to be the basis for a significantly improved relationship for disabled people working in and using healthcare services.

SAMPLE REPORT: DISABILITY EQUALITY IN THE MEDICAL PROFESSION

Equal opportunities for disabled doctors and disabled medical students

Disabled doctors and disabled medical students are invaluable within the medical profession. In living with an impairment and/or disability discrimination, they are uniquely placed in terms of responding to the healthcare needs of disabled people and fostering a diverse and inclusive environment. There are numerous examples of disabled people with successful careers in the medical profession; yet, disabled doctors and disabled medical students are disproportionately undervalued. As a result, a medical career is often not supportive or enabling towards disabled doctors and disabled medical students.

Significant difficulties are also faced in accessing the medical profession, as evident from the low numbers of disabled people applying to study medicine. It is essential that disabled doctors, disabled medical students and any individual who acquires an impairment while studying, training or practising medicine have appropriate support and are provided with the same opportunities as their non-disabled colleagues. The amount and type of support available and the reasonable adjustments which are made for disabled doctors and disabled medical students is entirely dependent on the organisation involved, be that a medical school, Royal College, postgraduate deanery or general practitioner (GP) directorate.

Barriers to a career in medicine for disabled people

The lack of equality for disabled doctors and disabled medical students results from direct forms of disability discrimination (for example, failure to make reasonable adjustments) and from more implicit forms of discrimination that can be attitudinal, assumptive, exclusionary or segregational. This implicit discrimination results from the culture in the medical profession where doctors are traditionally viewed as having to be flawless and fully fit.
The historical culture behind medicine and medical training means the approach to disability has traditionally focused on finding a cure or providing care in accordance with the traditional models. One example of this is the GMC publication Tomorrow’s doctors (GMC, 2003) which states that graduates must recognise the importance of ‘reducing or managing impairments, disabilities and handicaps’. Viewing disability in this way sees the individual disabled person’s impairment as the problem and ignores the social model of disability.

It is likely that many doctors and medical students find it difficult to move away from this traditional mind-set. This is compounded by external pressures on how disability is viewed. For example, the definition of disability in the DDA 1995 (as amended) also corresponds to the traditional models of disability, where an individual’s impairment is seen as the problem. In its Recommendations to Government July 2006 (DRC, 2006) the DRC suggests changing the DDA definition to one consistent with the social model of disability.

Under-reporting of impairment

Due to the culture within the medical profession, and the stigma attached to the term ‘disabled’, there is a great deal of underreporting of impairment by doctors, particularly in the case of hidden impairments (for example, mental health problems), as it is felt this may adversely affect career progression. Under-reporting of impairment is also probable among medical students and those applying to study medicine. The problem of under-reporting of impairment is however, not unique to medicine as it is generally acknowledged as being prevalent throughout the higher education sector and in the workplace. There are a number of potential reasons why individuals choose not to disclose information on their impairment, including:

concerns about discrimination or being rejected by people with pre-set ideas about the effects of a particular impairment. The reluctance of doctors and medical students to declare their impairment most likely arises as a result of concern that an impairment may be considered by colleagues and employers to be a sign of weakness that limits professional competence
concerns that it will give the employer or education provider the chance to label individuals by their impairment and make assumptions about what they can and cannot do on the basis of their impairment
a reluctance to provide information on an impairment as this may not allow an individual to convey an accurate understanding of their impairment, or they may find it difficult to explain it in words
the belief that their impairment will have no effect on their ability to do a job or undertake a course.

Under-reporting of impairment is not easily solvable. It necessitates a fundamental shift towards a culture and environment that encourages openness about impairment and views disability positively. It also requires a better understanding of the barriers to declaring impairments and targeted approaches to encourage doctors and medical students to declare information on their impairment. It is important to understand the extent to which impairments are under-reported, as well as the types of impairment that are most/least likely to be declared and the barriers to declaration in the medical profession.

One approach towards reducing under-reporting is to ask doctors and medical students to identify as disabled people using the social model, that is asking them if they experience discrimination on the grounds of impairment, rather than if they are unable to carry out normal day-today activities. This would encourage more disabled people to self define, and encourage a culture where organisations and individuals recognise and deal with discrimination on grounds of impairment, and related matters. Using the application process for the Access to Work scheme, to allow employees the opportunity to disclose as disabled people for monitoring purposes, would provide a more accurate reflection of the number of disabled employees.

Disclosure of impairments

Personal and sensitive information, such as that relating to impairment, should be treated as confidential, and access to this information should be strictly regulated. Organisations that collect, store, monitor and analyse personal sensitive information are governed by eight principles set out in the Data Protection Act 1998, which ‘make sure that personal information is:

fairly and lawfully processed
processed for limited purposes
adequate, relevant and not excessive
accurate and up to date
not kept for longer than is necessary
processed in line with [the individual’s] rights
secure
not transferred to other countries without adequate protection’.

Personal sensitive information must only be obtained and held where consent has been given, and only then when it is of relevance to the provision of a service. Data must be safeguarded by technical and organisational measures, for example, password-protecting electronic information, and storing paper-based records in lockable cabinets or cupboards. It is important that data are accurate and be kept up to date, and should be disposed of following the elapse of a reasonable time.

‘Experience shows that anonymous monitoring leads to a better response rate – because individuals are often concerned about disclosing personal information.’ Where it is not possible to collect information on an anonymous basis, for example, when tracking the progress of individuals, confidentiality must be guaranteed and reports of such exercises should be anonymised so that individuals cannot be identified. It is important that personal information is only provided when necessary and only where appropriate.

Documents such as application forms and CVs should not include sensitive information. Information such as disclosure of a specific impairment should be used by occupational health services to assess an applicants’ physical and mental ability to practise as a doctor, and not to influence the admission selection procedures regarding academic performance and personal qualities.

Developing disability equality

Disability equality must be a central component of all equal opportunities policies and strategies in the medical profession. This requires leadership from the GMC, as well as commitment at the most senior levels. There have been a number of recent initiatives aimed at improving disability equality within the National Health Service (NHS) such as Improving Working Lives (IWL) and positive action. These initiatives are NHS-wide, however, and are not sufficiently focused on providing disability equality for doctors and medical students which may lead them to believe that these initiatives are not relevant to them.

It is important that equal opportunity policies are developed and kept up-to-date and that disabled people are consulted about, and involved in, their on-going development. This commitment must extend throughout all organisations with strategic and operational responsibility for doctors and medical students and cover all aspects of education, training and employment. It is important that all organisations clearly set out their equal opportunities policies with respect to disability, and that these policies are communicated to all members of staff.

It is important to acknowledge that in addition to addressing disability equality among doctors and medical students, the required actions and adjustments relating to education, training and employment can have a significant impact upon service provision for disabled patients. Improvements in patient care should result directly from the adjustments and policies put in place within healthcare organisations and also indirectly through having a workforce which supports and includes a greater number of people with impairments. In this way the workforce will better reflect the user population, meaning that it can relate to the needs of disabled patients and create a more responsive service. This is further discussed in the BMA publication Disability equality within healthcare: the role of healthcare professionals (BMA, 2007).