The importance of good occupational health support

This anonymised account reflects the views of an individual, and not the General Medical Council.

A doctor embarking on their core medical training reflects on the reasonable adjustments that give them a good work-life balance, the ones they had to fight for, and how they deal with questions from curious colleagues.

Creating a sustainable working pattern

I entered medicine via a graduate entry degree, having already completed a PhD. I have now completed foundation training and secured a core medical training post at the hospital where I worked in my first year as a doctor - I am thrilled to be working at this hospital again as I felt both appreciated and supported whilst working there.

I have a condition that impacts my mobility and causes fatigue as part of cardiac complications.

During my first year of foundation training I had to reduce my on-call duties. Occupational health encouraged me to do so, they insisted that my quality of life outside of work mattered and helped me to create a sustainable working pattern. The only person who gave me a hard time was me.

I have undertaken my training less than full time (LTFT) with most rotation at 60%, working 3 days a week. I genuinely couldn’t manage a full rota, even without on call duties. Had occupational health been unsupportive of pausing my on call duties, I may well not have been able to continue my training. I am now working 4 days and also managing more of my on call duties.

The majority of my experience as a junior doctor with a disability has been positive, both in terms of colleagues and in particular patients. I know from talking to other doctors that I have been lucky to have good occupational health support. I have had one run in with an occupational health doctor who had never met me before, was not familiar with my condition and tried to discourage me from using a wheelchair. He tried to insist on a reasonable adjustment for me to be solely based on the ward, which meant missing handovers and other important meetings, all to avoid the need for a wheelchair. This utterly misses the point of occupational health - if I am comfortable using a wheelchair and it allows me to undertake my role more completely, it is a positive.

Accessing specialist equipment

At the end of my first year, I started to use a wheelchair part-time to enable me to manage all the standing and walking required. Access to this sort of equipment is one aspect of support for junior doctors that urgently needs improvement. Understanding how the government Access to Work grant works and how to arrange equipment has been generally lacking.

Furthermore, doctors can find themselves having to request the same specialist equipment when they move Trust, because Trusts want to retain equipment purchased for the doctor. Even getting the equipment within a single Trust can be challenging. As a trainee you rotate every four to six months, and in my experience this means no single department feels responsible for the bill. People didn’t know who should pay and it was made clear to me any equipment would not go with me when I moved to the next Trust as part of my training. To make this even harder, I discovered I was expected by Access to Work to pay four sevenths of the cost of the wheelchair as I only work three days a week. 

I believe that Health Education England and local deaneries should make arrangements to fund equipment so that trainees can keep it with them throughout their training. I was ‘lucky’ that in the end my condition reached a stage where I could access an NHS wheelchair as I needed it outside of work, but it shouldn’t be a battle through uncertainty and passed bills to access equipment.

Dealing with the constant questions

Using a wheelchair as a doctor has been an interesting experience. Whilst colleagues never make deliberately negative remarks, I have dealt with constant questions. At times these are insensitive, often displaying a lack of understanding of disability.

I get regularly asked ‘what have you done to yourself?’ or ‘so what happened?’, I genuinely don’t mind being asked about my situation, assuming the timing and question is appropriate. But I’d appreciate ‘do you mind if I ask?’ and prefer if people wait until they know me, or at least introduce themselves first.

Extra questions arise because I mix use of my chair with walking, even the fact that I can stand surprises people. It is interesting to consider this attitude of disability as binary - I am either paralysed or completely fit and well, which is indicative of a problem with medical and nursing training. After all, this lack of understanding is also conveyed to patients, who perhaps then aren’t prompted to consider if using a wheelchair part-time might transform their lives for the better.

Patients seem to really appreciate that I am a doctor and a wheelchair user, whilst some have opened up to me about health concerns or practical struggles. They instinctively know I have an insight into their side of the bed.