Policy responses and statements

Name of organisation:

Disability Rights Commission

Name of policy document:

Guidance to Illustrate "Good Medical Practice"

Deadline for response:

14 September 2006

Background: This guidance is an interpretation of the General Medical Council’s (GMC) ‘Good Medical Practice’. It is intended to be useful to disabled people generally and to patients and employees in health services. It is particularly important for doctors on the register, whether they work in the NHS, the private sector or other healthcare professions to be aware of the important difference they can make to the way services are delivered to disabled people. A high proportion of service users and their families are disabled people so this document is key to aiding doctors to understand how they can improve service delivery to this group of people.

This guidance will help disabled people to understand the terminology in ‘Good Medical Practice’ and how it might apply to them. It will also give doctors and other healthcare professionals’ practical guidance on how they can meet their obligations to disabled patients and colleagues under the Disability Discrimination Act 1995.

Throughout this document, the DRC uses bullet point references from Good Medical Practice, followed by explanations of what the terminology might mean in practical terms for a disabled person. It does not however cover every such point from GMP as several are not relevant.

The notes therefore follow the section headings of Good Medical Practice, followed by those bullet points from each section where an illustrative example is relevant.

The document is a working copy so does not represent the DRC's policy/views at this stage. The document will eventually be a web based document, when it will be possible to highlight different bullet points, which is why it is not in chronological order.

The DRC asked consultees to consider each illustration and focus on three main areas:

1. What you understand by what the illustrations are telling you?
2. What if anything confuses you and/or you disagree with?
3. Any suggestions/things you would like adding?

COMMENTS ON
DISABILITY RIGHTS COMMISSION
GUIDANCE TO ILLUSTRATE "GOOD MEDICAL PRACTICE"

The Royal College of Physicians of Edinburgh is pleased to respond to the Disability Rights Commission on its consultation on Guidance to Illustrate "Good Medical Practice".

The College welcomes the fact that the Disability Rights Commission is highlighting the importance of disability issues in relation to medical practice, as the care and treatment of every patient as a person with individual needs is central to good medical practice.  The current on-line version of the GMC’s “Good Medical Practice” does allude to special needs of all patients, but the provision of extra examples or illustrations of the needs for a biopsychosocial approach is helpful.  Doctors, like all other service providers, must comply with the Disability Discrimination Act directives, but this document should also be useful to medical students and providers of undergraduate education.

The College has the following points regarding the scope and content of the document.

1. The focus of the document is the special needs and difficulties of the disabled person. Healthcare professionals of all disciplines will benefit from advice to help them design procedures and agree treatment regimes that fit different needs and lifestyles, quite possibly developed over years of adjustment.  Patients will be experts at living with their particular disability, and taking due account of this will secure improved compliance with treatment and better outcomes.

2. It is important that doctors have the opportunity to participate in disability equality awareness training and that this is relevant to clinical care rather than delivered in isolation.  This will help establish appropriate professional practice.

3. The terms “disabled person”, “disabled people” and “disabled patient” are perhaps used excessively (eg 16 times in the introductory three and a half pages).   In the past, there has been criticism that this term reinforces stereotyping and phrases such as “people with disability” has been preferred as an alternative.  The College accepts that the DRC uses this terminology already in other documentation and that it is probably necessary, but wonders if it is worth considering reducing the frequency.

4. At the top of page 2, a list is given of those who can be included as disabled people.   While the authors state that it is not meant to be exhaustive, it might benefit from the addition of Acquired Brain Injury and Stroke.  These conditions are among the most common causes of severe and lasting disability. The College is unsure why the phrase “People with HIV, Cancer or Multiple Sclerosis from the point of diagnosis” is used.   Many such individuals would not consider themselves to be disabled and there are many other incurable conditions with poor prognoses.

5. In the illustration cases (and echoing point 2) above, it might be useful to consider using a stroke patient with a language problem or someone after head injury with cognitive impairment as an alternative for the frequent references to people with learning disability in the examples given.  This is not to detract from the importance of the latter group, but while people with learning disability often have an informed carer or advocate attending the surgery or clinic with them, this often does not apply to individuals with acquired cognitive or communication difficulties.

6. With regard to the illustrated examples on page 4 onwards, most are appropriate but the wording can be confusing and the College offers the following specific comments.  

Para. 1 a: 

Text:  “What this can mean in practice for a disabled person is that the doctor should ask the patient about their condition before examining them.  The doctor needs to take account of the disabled person’s impairment but to not the detriment of the patient”.

Query:  This seems to confuse the “condition” with the “impairment”.  A suggested alternative wording might be: 

“What this can mean in practice for a disabled person is that the doctor should ask the patient about their current complaints or symptoms before examining them.  Account should be taken of the individual’s impairment or disability, but 2 important practical implications should be noted.