Photo: Hush Naidoo Jade Photography/Unsplash
- Last week, a medical doctor with 100% visual impairment knocked on the knocked on the doors of the Supreme Court. The doctor had cleared NEET PG and wished to specialise in psychiatry.
- The petitioner was examined by a committee of the NMC in January 2022, where five experts opined that the petitioner would not be held eligible.
- The board had three experts who themselves framed the guidelines that they upheld, and were in direct conflict of interest. No doctors with disabilities were part of this committee either.
- There are many examples from around the world of doctors with disabilities being admitted into the medical profession, but the NMC is still stuck with the technical standards of 1979.
For a long time, the medical profession has crushed the dreams of passionate learners with disabilities of becoming doctors. Though there was a 3% reservation for students with disabilities in MBBS, it was only reserved for mobility disabilities of the lower limbs. Though “low vision” was a specified disability even in the Disabilities Act 1995, because of the unconscious bias of a single ophthalmologist from a premier institution, low-vision candidates were considered incompetent to become doctors in the disability quota.
The same expert framed the new National Medical Commission (NMC) guidelines for candidates with disabilities in MBBS in 2018 post the new Rights of Persons with Disabilities Act 2016 (for 5% disability quota), once again declaring low-vision and blind candidates ineligible for disability quota in MBBS. It took the Supreme Court of India to challenge this tubular vision of these experts without the lived experience of disability, and for the first time in India, a low-vision candidate with disability was granted MBBS admission in the disability quota in 2018. The Delhi high court used the same judgement to allow a candidate with hearing impairment to pursue MBBS.
Last week, a medical doctor with 100% visual impairment knocked on the knocked on the doors of the Supreme Court. The doctor had cleared NEET PG and wished to specialise in psychiatry. The NMC again entrusted the single-experts to make these policy decisions and used the same MBBS guidelines to notify them as Postgraduate Medical Education Regulations (Amendment) 2019. Moreover, the petitioner was also examined by a committee of the NMC in January 2022, where five experts opined that the petitioner would not be held eligible.
Who were these experts? Despite the fact that the matter was before the NMC’s Postgraduate Medical Education Board, it was chaired by the President of a different board, who was also a member of the Committee that developed the MBBS guidelines. The five-membered board had three experts who themselves framed these guidelines, were in direct conflict of interest, and upheld their own guidelines. No doctors with disabilities were part of any of these NMC committees, and experts without disabilities closed the doors for doctors with disabilities who had survived the inaccessible system without any reasonable accommodations during medical colleges, only to be let down by these policymakers.
The question is, can a blind doctor become a psychiatrist? The Bombay Psychiatric Society gives the best paper award in the name of the late Dr L.P. Shah, who was professor and head, Department of Psychiatry, at the prestigious King Edward Memorial Hospital. Dr Shah was visually impaired and had the same diagnosis as the petitioner in the current Supreme Court case.
The Centre for Excellence and the National Institute of Mental Health & Neurosciences (NIMHANS) in Bangalore have awarded an MD Psychiatry degree to a doctor with visual impairment (same diagnosis as the previous two) who has also completed four years of senior residency at the same institution without posing a risk to patient safety.
The former director of NIMHANS, who was also president of the Medical Ethics Board at NMC, forwarded the visually impaired psychiatrist’s name twice as the best employee for the National Awards for Persons with Disabilities. Ironically, the NMC expert who nodded against the petitioner as an NMC expert was the external examiner for this NIMHANS psychiatrist with visual disability and passed him with flying colours.
With total blindness, the late Dr Y.G. Parameshwara completed his MBBS at Karnataka University and was appointed as a faculty member in pharmacology at Bangalore Medical College, where he later retired. In addition, the pan-India organisation of health professionals with disabilities in India has among its members various doctors with visual disabilities, some of whom are still practising.
Globally, doctors with disabilities are not seen as a threat to patient safety (unlike in India). Dr Ruta Nonacs has a visual disability and was chided by the dean: “Do you plan to complete medical school?” She not only has an MD and a PhD but is currently a psychiatrist at Harvard Medical School. Dr Bonnielin Swenor is a shining example of how to ‘lead with your science, not with your visual disability’. She has founded the Johns Hopkins Disability Health Research Center in the US, thereby shifting the paradigm from living with a disability to thriving with a disability.
In the UK, Alexandra Admas is the first deaf-blind student admitted to a medical school. There is acceptance of blind psychiatrists in the US among both health professionals and patients. For eight consecutive years, David Hartman was ranked first in a survey among health workers and nurses. Patients preferred a blind psychiatrist and felt more comfortable sharing more of themselves when they weren’t being watched.
The Chief of Psychiatry at the University of Wisconsin says of the blind physician Tim Cordes that he has detected fatal blood clots that others had missed using only his sense of touch. No, doctors with visual disabilities do not have a sixth sense. With reasonable accommodations (mandatory under disability law), they thrive equally with others. Intermediaries, or “visual describers” helped him with placing a tube in a patient’s windpipe correctly the first time as well as assisted with the birth of a baby.
A chiropractic school in Iowa denied a blind man’s continuing case as he did not have “sufficient vision” to undertake “radiograph review”. The matter went to the Supreme Court of Iowa in Palmer College v. Davenport in 2014, where the court emphasised that other medical schools have admitted successful blind students. The court ruled in favour of the sighted assistant as an intermediary to allow the blind applicant to matriculate.
The NMC is still using the outdated technical standards of 1979. Even the US changed them to “where a candidate’s ability to observe is compromised, they must demonstrate alternative means/abilities to acquire and demonstrate the essential info conveyed in this fashion”. The competency-based curriculum that NMC has now adopted is based on the premise of “what” students must demonstrate rather than “how” they must demonstrate it.
There are plenty of doctors with disabilities in general and quite a few doctors with visual disabilities in particular in India who should be the real experts guiding policymakers. Disability is now viewed under the human rights model of disability, with inclusive equality underpinning non-discrimination and reasonable accommodation. It’s high time the NMC adopted these principles in medical education while considering lived experience as an expertise.
Dr Satendra Singh is the founder of ‘Doctors with Disabilities: Agents of Change in India’ and co-chair of International Council for Disability Inclusion in Medical Education. Views are personal.