Your personal attitude, and the attitudes of your friends, family and colleagues will have a profound effect on your work and home lives.
My own visual impairment has been present since birth, but did not restrict me. My personal attitude has always been that I will try - if I succeed, I succeed; if I don't, I'll re-think.... but there's no way I was going to give in without trying.
It wasn't until my condition deteriorated whilst an SHO that I suddenly found myself being referred to as "disabled". I hadn't changed; but others' perceptions of me had significantly altered. Somehow, it was expected that I would have lost my determination and ambitions along with my eyesight. Assumptions were made about my abilities and career prospects. I found myself being referred to in the third party with decisions seemingly being taken out of my hands. If I wasn't careful, the prophecy would have become self-fulfilling. When your peers and support network continually highlight your different-ness and difficulties, it can become all too easy to take on their preconceptions and loose your self-belief. It isn't easy. I still have bad days when everything seems too much of a struggle.... but the good days do increase in number.
My advice would be to:
- try and maintain your self-belief and positive-ness
- be honest with yourself
- take your time to assess your own goals, training needs, abilities, strengths and weaknesses - remembering these may change over time
- make a plan - or series of plans
- what is possible at the moment?
- what if things get worse?
- what if things improve?
- be confident when you present your ideas, needs and plans to your Deanery / Trust / Occupational Health Physician
- for a more positive response, present solutions rather than problems
- don't try and do everything on your own - other people are there and should assist you; but remember that you are the person who knows yourself best
- in the first instance, try to adapt your work to suit you. Long term, it may be necessary for you to adapt to a different type of work, or different means of working - but take your time over these decisions.
Stairwells, uneven flooring, awkwardly placed pillars, narrow doorways..... we can all think of examples of buildings where accessibility is not optimal. Even simple things like adequate lighting can transform a person from being incapable of working to someone capable of carrying out their job unaided.
Employers of greater than 15 people are expected to provide reasonable adjustments under the Disability Discrimination Act. The DDA is also invoked within buildings accessed by the public.
Adaptations may include insertion of ramps instead of steps at doorways; widening of doorways to allow wheelchair access; provision of toilet facilities for disabled individuals; changing the position of light switches etc. to be within reach; altering desk heights or position; provision of special seating ....... The list really is endless and is dependent on each individual's job, job setting, impairment or disability and how "reasonable" the adaptation that is required is considered to be. It is very worthwhile exploring the options with a specialist advisor (e.g. via Access to Work), and undergoing an individual needs assessment so that all eventualities are considered.
IT developments have advanced significantly over recent years, allowing people with a wide range of disabilities to be able to freely access computerised resources.
Ergonomically designed keyboards, computer mice and wrist supports are simple measures available from the high-street that can make painful hands and wrists a lot easier to bare. Other simple measures that should be available for everyone include ergonomically designed, well lit workstations with appropriate seating - back/neck support; height adjustable.
If glare from a monitor is a problem, consider trying a flat-screen.
Voice recognition software allows direct translation of spoken letters / clinic summaries / presentations into written format - helpful for those with visual impairments, dyslexia, upper limb pain or limited hand dexterity.
Screen magnification software packages make life easier especially since more and more patient information and results are being stored in computerised databases.
Speech-output software can again assist in visual impairment and dyslexia. There are many different programmes available - some combined magnification and speech-output; some stand alone programmes. Some programmes can cope with graphics and/or internet use, whilst others are much more basic. I'd advise you to "try before you buy" to find which best suits your individual needs. Advice is also available from 1) specialist assessors contactable via Access to Work; 2) local agencies or charitable organisations where you may be able to view demonstrations of equipment; 3) online e.g. Abilitynet or Webable.
There may be conflicts with local software e.g. your hospital's results reporting package or X-Ray viewing software. In our experience, most of these are resolvable locally or by contacting the manufacturers directly.
Don't forget simple measures such as in-built spell-check on standard PC programmes, or the ability to alter a programmes appearance. e.g. MS Word will allow you to change the size of menu icons (Tools menu ® Customise ® icon size); change format to a blue background with white text (Tools menu ® Options ® General tab ® blue background / white text tick box); check Spelling & Grammar as you type or at the end of a document (Tools menu ® Options ® Spelling and Grammar tab)
Windows XP has an inbuilt magnifying glass and Narrator (which will read out screen content), and on-screen keyboard (useful if conventional keyboard input is difficult). These work well with Microsoft programmes, but are more temperamental with other software - but worth a try before purchasing expensive specialised software programmes. They can be accessed by Start button ® Accessories ® Accessibility ® Magnifier or Narrator or On-screen Keyboard.
It is also possible to change the general appearance of the Windows operating system (Start button ® Control Panel ® Accessibility Options or Display or Mouse) - alternate colour schemes, font & icon sizes, cursor size/colour/blink rate, cursor trails, system voices, keyboard short-cut keys etc etc are all easily programmable.
Other considerations include:
- Alternate input devices (e.g. if finger/hand dexterity is poor or movements are painful)
- Braille keyboards
- Braille printers
- Specialist dyslexia orientated software - can spell check, provide speech output and/or alter colour schemes.
- MP3 file creation software - it's possible to scan in or acquire text from internet / programme files and use the MP3 software to convert written text into an audio CD.
Gadgets and Gizmos
Just because a gadget is available, it doesn't necessarily make it easy to use in your job setting. How will patients or colleagues react? How will you feel about displaying your disability by using an aid? It is sometimes difficult, sometimes amusing, sometimes an ice-breaker. For example, in out-patient clinic when patients have noticed my magnifying glass, they've offered to read out their GP prescriptions for me. On ward rounds, I've given countless consultations regarding different types of magnifying glasses and low vision aids (LVA) and have made many a referral to the LVA clinic simply because I know it exists whilst others haven't encountered it. Then again, you will always encounter someone who will challenge you on your use of an aid. From my experience, this has tended to be a colleague rather than a patient. Often reassurance is all that is required. Once you are seen to be using your gadgets successfully and performing your job well, the questioning soon abates.
Accessible Medical Equipment
Little in the way of specialist medical equipment for the disabled doctor exists at present. However, sometimes it pays to source accessible equipment that hasn't been designed with doctors in mind, but that might, never the less, be useful. It's sometimes a case of thinking laterally, or employing the skills of inventive friends, or just trying out a succession of different pieces of equipment until you find one that suits your requirements.
Medical Supplies companies are beginning to market devices for patient use (e.g. sphygmomanometers and BM monitors), and are taking into consideration the practicalities of marketing products to patients with specific needs.
Monitoring blood pressure
- Large, well colour contrasted display on aneroid sphigs
- Easy-grip handles and release buttons on aneroid sphigs
- Digital displays
- Voice output monitors
- Monitoring blood sugar or INR
- Digital large-screen displays
- Voice output monitors
- Loop systems
- Adaptable to use with hearing aids
- Easy / quick release designs
- Velcro fastenings
- CCTV adaptors available that project image onto a TV/monitor for easier viewing
- Digital displays
- Audio output
Don't Forget Your Other Lives
Whilst returning to active employment or maintaining a chosen career pathway is a focused goal for many, don't forget about your life outside of medicine. Think about ways in which you can continue to enjoy your previous hobbies, holidays and activities. Consider taking up new or different interests that might be more "do-able" if previous hobbies seem unachievable. Tempting though it might be to try and spare family and friends from experiencing your distress, it does usually help to talk through your thoughts and feelings; the old adage of two heads being better than one is often true and problems can sometimes be resolved more easily than anticipated.