Your Rights and Responsibilities as a Medical Practitioner
Neurodiversity is technically considered a disability under the Disability Discrimination Act (1995/2005) and the Equality Act (2010), which defines the criteria for disability as "an impact on normal day to day activities including ..... memory or ability to concentrate, learn or understand". Many neurodivergent individuals do not consider themselves to be disabled, and it can be very depersonalising to apply the label, and the potential concomitant medical model of disability (ie "this is a problem that needs fixing") in these cases. Advice from advocacy groups and professional support organisations suggests that the best way to support neurodivergent individuals is to speak with them about how they prefer to refer to their condition. This does not however, abrogate the responsibility of the employer to make reasonable adjustments even if the individual does not prefer to use the term disabled.
The GMC specifically mentions autistic spectrum conditions, ADHD, dyslexia and other specific learning conditions as disabilities in their document on supporting disabled learners. However they are also clear in this document that they do not provide guidance on whether specific health conditions should be declared as no specific health condition is considered a barrier to registration or practice. They offer this online tool for decision making about whether to disclose conditions during registration, which may be of use to those unsure whether or not to declare a neurodiversity diagnosis. The decision to declare a condition, either to an employer, the School, or the GMC is a very personal one and it is not within the remit of this website to offer general advice. Speaking to a local mentor, or to one of our neurodiversity champions, may be of benefit for personalised advice.
The GMC's Good Medical Practice Guidelines apply to anyone with registration to practice, including neurodivergent individuals. Reasonable adjustments are an important tool to allow neurodivergent individuals to practice medicine, and it is the responsibility of the employer to consider all requests fairly and to grant them where possible. It remains the responsibility of an individual to ensure that they are safe and professional in their practice of medicine.
Reasonable adjustments are changes or adaptations made to remove or reduce disadvantages faced by disabled employees, job applicants or examination candidates. Organisations always have to consider requests for adjustments, but they only have to make the adjustments which are reasonable. What is "reasonable" is decided on a case by case basis, but depends on the following:
- whether the adjustment will actually overcome the identified difficulty
- how practicable it is to make the adjustment
- the financial and other costs involved
- the amount of disruption caused
- the money already spent on adjustments
- the availability of financial or other assistance
Reasonable adjustments may apply to clinical duties while on a shift, the types of shift worked, non-clinical activities such as Educational Development Time, as well as postgraduate exams. An individual should never be asked to pay for their own adjustments, but is often expected to provide as part of their request details of their diagnosis, how this has an impact on the activity they are being asked to undertake, and possible solutions or adjustments that could be made to facilitate the activity. This can be a daunting process for an individual who may not know what is or is not considered reasonable, or may in more rare circumstances not be sure what adjustments might support them best. A non-judgemental conversation on both sides can facilitate understanding of both the position of the neurodivergent individual and the pressures of an organisation - key management experience! Below are provided some examples of reasonable and "unreasonable" adjustments in different areas of practice, to guide thought processes.
Examples of Reasonable Clinical Adjustments
- An individual with dyslexia to be provided with screen filters or a pair of coloured glasses lenses to facilitate their use of electronics at work
- An individual with autism to have one list a fortnight with the same named consultant during a settling in period to a new trust
- An individual who struggles with change not being moved from their planned list unless a clinical necessity arises
- An individual with a condition resulting in hyperfocus (eg. autism or ADHD) to have a jobs list where non-urgent jobs are written to provide a visual and checkable reminder of outstanding tasks
Examples of Unfeasible Clinical Adjustments
- An individual with dyslexia never having to use an electronic patient record
- An individual never having to work on call as part of their training programme
- A reduction in professional standards around communication for an individual with autism or ADHD
- An individual who struggles with change always working the same lists and never experiencing last minute changes
Examples of Reasonable Adjustments for EDT and Exams
- An individual prone to hyperfocus being given a whole day of EDT rather than a half day at a time
- An individual with autism or ADHD who struggles with interruptions being allowed to do their EDT away from the hospital, as long as they are available to attend for clinical duties if needed and have a clear plan for their use of time
- An individual with autism or ADHD being able to prepare for an examination in a quiet room without distraction
- An individual with dyslexia, dysgraphia or dyscalculia being given additional time in examinations
- An individual with a late diagnosis of a condition eligible for reasonable adjustments in an exam having previous attempts discounted or additional attempts allowed
For more information about reasonable adjustments for the FRCA and faculty examinations, see the excellent Reasonable Adjustments Policy, written by the region's own Regional Advisor for Anaesthesia, Emily Simpson.
Examples of Unfeasible Adjustments for EDT and Exams
- Waiving the requirement to sit an examination
- Addition of unlimited EDT