Developing as a medical leader with a disability during the pandemic

The Covid-19 pandemic has posed challenges for all healthcare workers: whether working with affected patients, grappling with new ways of working, or delivering new services – such as the mass roll out of the vaccination programme. For healthcare workers with a disability, the pandemic added further complexity: how to navigate shielding, ensure reasonable adjustments were provided for remote working or, for those like myself, who are deaf, how to provide the best possible care to patients despite the introduction of masks and the associated communication difficulties.

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The blanket introduction of mask-wearing, while necessary for controlling viral spread in a pandemic, was never accompanied by an equality impact assessment. I was a final year neurology registrar, redeployed to a general medical rota, when the pandemic started, and the introduction of masks made communication with patients and colleagues a struggle.

I found that leading ward rounds was easier than following instructions, and meeting as a team in a seminar room after the ward round enabled masks to be lowered at an appropriate distance, to facilitate lipreading. With progress on the development of clear masks being painfully slow, this was never going to be a long-term solution, nor one that would work for all healthcare workers who are deaf.

Not being able to communicate easily with colleagues was tiring and isolating. Raising awareness about the issue was a challenge, considering the need to reduce the viral spread in healthcare settings, but the publication of a BMJ opinion piece[1] with Dr Fatin Izagaren (a paediatric emergency medicine registrar who is deaf) did generate helpful publicity, both in the UK and abroad.

In September 2020, Dr Izagaren and I surveyed 83 healthcare professionals who were deaf, about their experience in the pandemic. The resulting paper, published in Occupational Medicine[2], highlights some concerning findings: only nine (11%) had access to clear masks, and over three-quarters were anxious or fearful of making a mistake due to communication difficulties. Half of those surveyed had felt more anxious at work since the introduction of masks, particularly among those with severe and profound levels of hearing loss. Only 19 professionals surveyed were offered an occupational health assessment to discuss reasonable adjustments, and 14 were removed from clinical roles altogether, nine of whom had no occupational health support.

While NHS England has now (as of January 2021) approved two companies whose clear masks meet the Type IIR technical specifications, this has come too late for some healthcare professionals who took early retirement, while others have found it impossible to progress in training due to a lack of flexibility with training programmes, and barriers to reasonable adjustments.

Disability should not be a barrier to success in a medical career. My own journey through medical training, while not being straightforward, has succeeded through adaption and collaboration.  I relied on a hearing aid throughout training, and now have a cochlear implant in my right ear. I was also dependent on modified items of equipment, such as an adapted stethoscope and radio microphones. But equally important was the support of colleagues who adapted their behaviour and faced me to enable lipreading, as well as patiently repeating anything I had missed. I owe a debt of gratitude, too, to those educational and clinical supervisors who saw beyond my hearing loss, and helped my confidence grow through affirmation of my clinical competence and my value as part of a team.

The NHS people plan[3], published in England in July 2020, promises a more compassionate, inclusive culture, and the need to create an organisational culture where “everyone can feel they belong”. But it stops short of referencing the needs of disabled staff members.

As healthcare leaders we all need to move beyond treating diversity as a concept, and instead challenge structural barriers to inclusion. This means calling out discrimination and ensuring colleagues with disabilities are provided with the necessary support – including access to equipment and other reasonable adjustments – to fulfill their potential in the workplace and be fully included as part of a team. There is still much work to do before everyone can feel they belong.

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[1] Grote H, Izagaren F. Covid-19: The communication needs of D/deaf healthcare workers and patients are being forgotten BMJ 2020; 369: m2372 doi:10.1136/bmj.m2372

[2] Grote H, Izagaren F, Jackson E. The experience of D/deaf healthcare professionals during the coronavirus pandemic. Occup Med (Lond). 2021;71(4-5):196-203. doi:10.1093/occmed/kqab048

[3] NHS England. WE Are the NHS: People Plan for 2020/2021—Action for Us All. July 2020. https://www.england.nhs.uk/wp-content/uploads/2020/07/We-Are-The-NHS-Ac… / (15 February 2022, date last accessed).