Georgia Gray: Disability and medicine—a case for inclusivity

I had been asked by the registrar I was shadowing to examine a patient’s abdomen. Midway through palpating, the patient stopped me, mildly outraged and pointed to my hand.

She asked me what it was, my shorter stub of a right arm, missing all my fingers. I was taken aback and offered a weak explanation and, unsurprisingly, she refused to let the examination continue.

Before I came to medical school, I had convinced myself that incidents like this were going to be a day to day occurrence. Explaining my disability, apologising for it, and moving on to a less patient facing part of the ward. I mention this interaction, however, not because of its regularity. Instead, I am in my final year of medical school, and this has been the first and only time I have had a truly negative comment about my hand.

It had often been a game of mine with my friends and family to come up with more and more fantastical explanations for my hand. Shark bite, medical experiment gone wrong, attacked by a bear—I had a plethora of what I thought were excellent retorts to questions over my hand growing up. Yet very simply I was just born missing my right hand, with my forearm bones fused. No fun, brave story for me unfortunately. 

I have never required the use of a prosthetic or adaptation growing up and this was a point of stubborn pride when I was a child. Wearing a prosthetic felt like compromising my independence, as if I would have to put on an adaptation to feel whole, or able to do the same things as my friends. Medical school challenged that for me. Even before I was admitted, discussions were had over how I could overcome seemingly inevitable barriers and what physical adaptations would be put in place to meet the standards required of all junior doctors.

This initially felt like a conversation I wasn’t a part of. I didn’t want to change the way I worked in my day to day life if I didn’t have to. I have my own way of doing things slightly differently; for instance, there is an intricate way of tying shoelaces involving an elbow. Naively, I hoped that this wouldn’t be any different for practical skills—cannulation, venepuncture, suturing. I was convinced that if given the right time and teaching, I could come up with similarly adapted ways of doing these skills. 

Fortunately, my medical school listened, and through the kindness and generosity of peers and our clinical skills team, I have been afforded that time and that teaching. I’ve been allowed to practise on plastic models and friends alike until I feel wholly comfortable with the way I can competently complete a practical skill. Yet passing clinical training in a fictitious environment is very different to practising on patients. Just because I was able to do so on a plastic arm, did not mean I could take blood from a patient who may take one look at my hand and refuse. I had seemingly answered the question of whether I could complete a task without adaptation, but the fear remained as to whether patients would let me do so.

It came as a great surprise, therefore, that my first year and a half of clinical experience passed by with my hand seemingly unnoticed. If applying to medical school and proving I was competent had felt like a challenge, my clinical years felt shockingly simple with respect to my hand. The generosity and kindness of patients has staggered me. I have been allowed to take blood, put in cannulas, held suction in surgery, and all the while not a single person has ever refused on the grounds of my hand. All this time, and no one has ever said a word—and trust me, percussing on someone’s chest is a pretty noticeable “oh that person is missing her fingers” process.

This means something to me, and I think to the type of NHS I want to work within in the future. If I was up to the task, patients weren’t concerned with what I looked like or whether I had too few or too many fingers. Thankfully, I don’t want to be a neurosurgeon, I’m mainly interested in paediatrics and palliative care. I genuinely believe my ability to do that will not be affected by physical competency.

From applying to medical school onwards, having a disability has often felt like some form of barrier to becoming the best sort of doctor I can be. It has taken almost my entire degree to realise that this fear is wholly misplaced. Most medical students will be distinctly average the first time they attempt to take blood. But maybe there has actually been a slim advantage afforded to me by having a disability.

Indeed, most patients you see as a medical student have some form of underlying long term health condition. Heart failure, chronic kidney disease, diabetes, chronic obstructive pulmonary disease, hypertension, arthritis—any of these at a certain level become disabling and have a profound day to day impact on that person’s life. 

In the end, a healthcare professional isn’t judged by their physical appearance but in their capacity for empathy. I haven’t had to imagine the frustration of living through unsuccessful treatments or the reality of living with chronic pain. I don’t have to see the NHS from the outside, I too have encountered some unending kindnesses from a member of my healthcare team who has gone above and beyond. Equally, I have felt the frustration at a clinic appointment that refuses to arrive and felt the sting of treatment bound to improve my quality of life not meeting the budget for funding. 

So perhaps it is no great surprise that the majority of patients have never said a word about my hand. For me, and disabled medical students and healthcare professionals like me, empathising with the fate of some patients, is too close to reality to ever be difficult.

Georgia Gray is a third year medical student studying at Warwick University.

Competing interests: None declared.