Hello

[Vic]

Medicine and dodgy eyes, something I can never write about ‘in brief’….

My KC first became apparent when I was 17, doing A-levels. They tried to fit me with lenses, but I had a very big fear of them, and combine that with an incident in which the lenses rubbed off the corneal epithelium, and that was it with the lenses. They set me up with some glasses as a quick-fix measure to get me just enough sight to get through the exams (and as it was too late to apply for large print papers, my school had to photocopy my exam papers to A3 size for me…) After that it was decided in the August, 3 weeks before I was due to leave for medical school, that my sight was such that it wasn’t going to be feasible, cue last-minute enforced gap year. My surgeon was very accommodating in fast-tracking me for the graft, which I had in the October. Through a combination of that and other illness, I had 6 months off and then worked for 6 months, and finally got to medical school the following year.

Unfortunately, I encountered problems with the medical school 6 weeks in. They have very stringent health guidelines (written by the General Medical Council, but the onus is on the medical school to enforce them) regarding ‘fitness to practice’. I think it has a lot to do with today’s society of blame-culture, but the medical school are extremely over-zealous in rooting out anything that could be perceived as a problem with the guidelines. The visual requirement is that doctors have to have driving standard vision. Which is 6/12 binocular with correction. We had to submit a pre-admittance health form which asked everything under the sun, including sight questions, but somehow mine managed to get overlooked until I encountered my first fitness to practice assessment. At my medschool (Birmingham) all students are required to annually submit a declaration, including the statement that they have driving standard vision. At this time, I was still trying to get a decent correction post-graft, and didn’t. Cue a long investigation on the behalf of the medschool FTP committee, letters to surgeons, you name it, and them saying I would need to withdraw… I am told that they had only a few years before had problems with someone else with a different sight impairment and had their knuckles rapped for allowing the student to stay training, which in part explained the energy they put into my case. However they can’t get rid of me that easily, I argued the case that this was vision that was *hopefully* going to improve with time now I’d had the graft, and they relented. But it wasn’t all bad news, during my first year GP training, I had a lovely GP tutor who was one of the few tutors I have ever explained my sight problems to. She actually went as far as to write to the medschool off her own back about how I managed to get round the sight difficulties, and how it hadn’t been a problem. Bless her, she was an awesome lady.

I had my rejection episode right in the middle of my first year exams, vision reduced to hand waving overnight, so failed some exams as couldn’t see them. Highly entertaining taking a three-hour exam when you are on hourly pred forte, and every hour you have to be escorted out to reapply drops… I had to make the university aware so I could resit, and to explain why I had done quite so badly. They were marginally more understanding than at the beginning of the year, but had to go through FTP assessment and fight my case again. Thankfully at this point, combined with some sutures unravelling changing things a bit, I managed to get corrected to 6/12 with glasses, which I had for just over a year.

I did my first year of clinical medicine (ward training) last year. It’s pretty tough going in some ways, as a lot of medicine is attention to detail. Partly patients’ expressions and body language, partly observing clinical signs. There is an emphasis placed on ‘general inspection from the end of the bed’ to look for detailed clinical signs from a distance. I find I just can’t see that level of detail without getting close up, and I tend to get written off as inobservant because I can’t explain the real reason is my lack of vision and not failure of attention to detail. Which hurts me in a lot of ways, because it’s not the truth, but I can’t let on that it’s due to sight difficulties. I think in a lot of ways it’s a bit like how I’ve heard people describe learning to drive; medicine is an art, you learn the right way to do it, and when you’re being marked by the consultant in an exam you go to great pains to show that you’re ‘checking your mirrors’ / standing from a distance to observe. But in practice there are ways round things; when I’m taking blood, I just need to get a bit closer to the patient to visualise the vein clearly, I stand closer to the patient to observe facial features etc. Assisting in theatre I do find difficult, because you physically can’t get close to visualise what’s happening, for obvious sterile field reasons, and from a distance I can’t see the detail in the anatomy.

Medicine is great fun and hugely challenging and an amazing privilege to study; I find it really rewarding - but it’s tough when you’re on top form, never mind when you have added difficulties such as sight. The usual rules of being accommodating to disabilities do not apply. You have to be prepared to fight your case when needed, and ‘suffer in silence’ rather a lot, and you have to be extremely determined to get there, but it’s definitely possible!

[Louise Pembroke]

Oh Vic you have my respect, you've had to struggle so hard and it's going to continue to be hard. I really admire your determination and SO want you to get through your initial training because once you're though that and in your first SHO post I'm assuming it will be easier in some respects. I can't believe there are no sight impaired doctors in the world, but obviously I wish your sight to improve so that life gets easier for you.
I know what you mean about missing visual cues in others, as a patient [without my lens] other people can think I'm being rude if they smile and I just stare through them as I couldn't see it. Surgery must be really difficult, from my ODA days an instrument can be momentarily held closer to the face to see which it is, but you can't put your face in the patients abdomen to see the anatomy! God that's hard. I just wish the school would work with you, but that's medicine, it's not a caring working environment, it doesn't take care of it's workers so you have to fight it all yourself. Take support here Vic because we're rooting for you all the way.
Do you have any idea what branch of medicine you would like to work in?

[Andrew MacLean]

Vic



You hang in there! Your experience will give you an interesting take on Medical Law and Ethics!

Meantime, everybody here is with you.

Andrew

[Amarpal]

Hi Vic, thanks very much for the reply. I'm inspired by your determination.
That was a great help All the best for the rest of your training.

[jayuk]

Vic

That is some determination you have that!...excellent post you made!

So, where are you right now in terms of your future career path?.....

How long have you had the 6/12 corrected vision now?

J

[Val G]

Hi Vic

I have first hand experience of the West Midlands Eye Centre, I have been a patient there for 6 years and had a graft in December, my consultant is Mr P McDonnell. I have been totally happy with all aspects of my care. It is also very convienient (sp?)for me as I work in Pathology on the same site (City Hospital)
I'm attending the meeting on Saturday, may see you there if you make it!

[Vic]

Thanks Val, that's really good to know. Hopefully I'll be there on saturday. I did my first clinical placement at City Hospital last year.

Jayuk - I'm finishing off my BSc at the moment, starting my 4th year of medicine (5th year at uni) in June, so 2 more years to go. I managed to get the 6/12 vision about 2 and a half years ago, and the ungrafted eye hadn't changed much until the last few months where the vision's started to decrease.

Not sure what area of medicine I want to go into yet, definitely written off surgery for the obvious reasons (although i have to say that becoming the world's first sight impaired brain surgeon could be a fun challenge!!). I'm possibly looking at general practice, possibly paediatrics, although no doubt that will all change.

Thanks everyone - it's really good to have some solidarity and support from people

[Andrew MacLean]

Actually, Vic, one of the advantages of a clinical education (there have to be some advantages) is that the student has a wide range of fields available at the end of the degree.

Among the blessings that you will bring to any field of medicine in which you practice will be the determination you have shown as you progress through university, the resilience and the skills you hve developed to rise against adversity.

Andrew