Disabled Doctors: We Don’t Want You!

While medical students all around the world are being trained to serve and practice indiscriminately regardless of their patients’ race, religion, belief, sexuality, political divides, social and health statuses, future Malaysian medical students are being denied their right of entry into a medical programme based on their previous criminal offences and their health status. In a time when the country is suffering from brain drain, the Malaysian Medical Council has chosen to implement a new guideline that will send away bright future doctors to other countries to seek greener pastures.

I read with disbelief the news report ‘Tougher entry for med students’ that appeared in The Star, Thursday, 12 March 2011.

According to the report, the new requirements include the need for applicants to declare “…if they had been found guilty of any criminal offence or suffered from any serious physical or mental illness or serious communicable diseases. If found to contravene any … they would be disqualified from entry into a medical programme.” There were some other requirements pertaining examination but I ignored that bit. I read the lines several times to make sure I got the meaning right and when I thought I had got the right message those two lines were supposed to imply, I felt horrible.

As I did not want to appear to be jumping to conclusions, I followed the link at the end of the report to get more details. I was not satisfied with the limited information given in the news about the new requirements. What does the Council mean by “criminal offence”? Road traffic summonses? And what constitutes “serious physical or mental illness”? How serious is serious? And who decides the degree of the seriousness? And what scale are they using to quantify the so-called seriousness? Seriously, Malaysians have been screaming for transparency for years!

My decision to give the Council the benefit of my doubt ended up in disappointment. I was taken to a five-page document called Minimun Criteria & Qualification for Entry into a Medical Programme that did not shed any light to my questions. The new guideline offers no details whatsoever as to what they mean by “any criminal offence(s)”. Nor does it specify what constitutes “serious physical or mental illness”. The new guideline offers no provisions with regards to applicants who are already undergoing treatment for their illnesses and are already deemed stable nor do they mention whether they will take into accounts opinion from a doctor, be it the applicant’s own doctor or the one working on behalf of the Council, with regards to the applicant’s capability to undertake the course. Surely those sitting in the Council (who are doctors themselves) are aware that the care of most chronic physical and mental illnesses involve managing the symptoms rather than curing the diseases. In fact, the guideline offers no justification at all why the Council would directly disqualify those with criminal offences, serious physical or mental illnesses, or a communicable disease. Talk about being prejudiced.

I found it unacceptable that a national guideline, one that not only has the bearing on the quality of candidates accepted into one of the most (if not the most) important and critical academic programme (and later profession) but would also affect the future of some of the country’s brightest individuals, fails to include those important details. The lack of such defining details would be disastrous as it would allow the guideline to be misinterpreted and abused. As it is, our country has already more than enough legal documents and national guidelines being misinterpreted and misconstrued to suit one’s needs.

Having said that, my grouses towards the new requirements extend beyond its lack of details and definitions. I found the Council’s demand that all entrants should declare their criminal and health statuses a breach of an individual’s privacy and their temerity to say that they are going to disqualify from entry those who contravene the requirements an act of serious discrimination.

Under the UK Equality Act 2010, any parties i.e., schools, universities, employers, insurance companies, etc., are not allowed to discriminate applicants based on nine protected characteristics and they are age, disability, gender reassignment, marriage and civil partnership, maternity and pregnancy, race, religion or belief, sex, and sexual orientation.

Under the same act, a person “has a disability if he or she (a) has a physical or mental impairment; and (b) the impairment has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities.” Given the definition, the term “disability” also covers those with serious communicable disease(s). The Act stipulates that any employer or higher education institution (I’m focusing on work and education here as the Council is the umbrella body that governs both medical students and doctors in Malaysia) could not and should not discriminate applicants based on the nine protected characteristics.

In a specific section covering education in a higher learning institution, the Act stipulates that

“the responsible body of an institution must not discriminate against a person (a) in the arrangements it makes for deciding who is offered admission as a student; (b) as to the terms on which it offers to admit the person as a student; (c) by not admitting the person as a student.“

By using an entrant’s health status to disqualify him or her from entry into a medical programme, the Council is committing a serious form of discrimination.

In fact, the Act itself prevents any party from even asking about an applicant’s health status to begin with. In a specific section related to work recruitment, the Act stipulates that

“A person (A) to whom an application for work is made (in this case the Council) must not ask about the health of the applicant (B) (a) before offering work to B, or (b) where A is not in a position to offer work to B, before including B in a pool of applicants from whom A intends (when in a position to do so) to select a person to whom to offer work.“

Following what is said in (b), this means that the Council has no right to enquire about applicants’ health statuses as they are not yet accepted into a medical programme, the pool in which the Council can offer a job.

The only provision in the Act that allows any party to ask about one’s health status is to see if there are any specific needs for the responsible body to prepare and make ready in order to allow their employees or students to carry out their job or study effectively despite the disability. They cannot, however, upon receiving knowledge of an applicant’s health status, use it as a reason to deny him or her from being offered a job or a place to study, as what is being said in the Council’s new guideline. In fact, it is the responsibility of both employers and higher education institutions to make sure there will be reasonable adjustments to accommodate employees or students with disability and that their failure to comply with their duty to make adjustments is considered as a form of discrimination.

According to the British Medical Association in its publication Becoming a doctor: Entry in 2011, “Freedom from infection with a serious communicable disease is therefore not an absolute requirement for those wishing to train as doctors; however, a student with such a disease may be restricted in their final career choice.” Yes, every student who has been accepted into a medical programme will have to inform about their current health status to ensure that the school can take appropriate action, when needed, when it comes to certain part of the course works that would increase risk of exposure either to the students or the patients they come into contact with. Just because an applicant is HIV positive, he should not be denied his chance to study whatever he wants given necessary precaution is taken. As of now, students and doctors with communicable diseases are not allowed to take part in exposure-prone procedures (EPP) to prevent cross infection and there are various branches of medicine that do not require one to take part in EPP. Being a general practitioner does not involve cutting open people’s gut and this might be suitable for the student to consider as his future career. Yes, the Council has the duty to the public to make sure their doctors will not become major health risks themselves but their capacity should be in the advisory aspect with regards to what the student or doctor can or cannot do. To simply use the criterion of having a communicable disease for reason to disqualify is irresponsible and unfair.

The same principles can be found in the UK General Medical Council (GMC) publication Medical students: professional values and fitness to practice. The section Health and fitness to practice stresses the point that “health conditions and disabilities will not raise fitness to practise concerns, provided the student receives the appropriate care and reasonable adjustments necessary…” and these reasonable adjustments are, by and large, shared responsibility of both the student and the institution. It is true that another GMC publication Tomorrow’s Doctors states, in Student selection section, that “students admitted will pass any health and other checks (such as criminal record checks) required by the medical school’s fitness to practise policy.” However, the health checks are to make sure that students have the necessary immunization level to various communicable diseases to protect them in their course work, not as a criterion for disqualification.

I am no medico-legal expert and I admit that going through the Equality Act 2010 gave me a throbbing headache but I am also speaking from the point of view of a third year medical student who has had the privileges to come into contact with patients with various disabilities (physical, mental and those with communicable diseases) in the UK where the Act is practised and uphold.

I have worked with a community mental health nurse who happens to be dyslexic. His learning disability has not stopped him from his passion to help other people going through some rough times dealing with mental illnesses and his job is made easy by the fact that his employer has accommodated to his special need by providing him with a special keyboard and as such.

I have also worked with general practitioners whose pool of patients largely includes those with depression and anxiety disorder and they are at risk of being fired for their health statuses. It is shocking that, while doctors here use the Equality Act to advocate on behalf of their patients, some doctors sitting in the Council are taking the opportunity in which that we lack an act that protect one’s equality, to discriminate against those with illnesses from becoming doctors themselves. It is sad that our Constitution only protect its citizens’ right to equality only from the fronts of religion, race, descent, gender and place of birth. And even that is not upheld in its entirety.

I cannot believe that the Council considers the new guideline as an “improved set” when the core changes done only prove how backward the Council is. Rather than calling for a major improvement to look after and protect the welfare of medical students and doctors, the Council has chosen an easy way to escape at the expense of those unfortunate enough to suffer with illnesses by denying them their rights. It is irresponsible for a recognised medical council to impose restrictions on those with mental illness or a communicable diseases simply based on old prejudices when it should know those prejudices are generally public misconceptions and that there are measures that can be taken to resolve the issues. At the time when our country is suffering the worst level of brain drain, how can the Council come up with such a discriminatory guideline that will result in more medical practitioners leaving the country because of it intolerant and unfair policies?

According to the report, higher education institutions, local and abroad, are to adhere strictly to the requirements or the Council will withdraw their recognition of the medical programmes offered at those institutions. The Council president, Datuk Dr. Hassan Abdul Rahman, also says that applicants have to abide by the new regulation if they want to be eligible for registration with the Council once they have graduated. Talk about subtle threatening here.

I wonder how the Council is going to find common grounds with most UK institutions that do not follow such criteria for disqualification. I am not sure where I am standing now. I will be graduating from an institution that is not following the guideline and I wonder if that means I will not be eligible for registration with the Council. If I cannot register that means I cannot practise in the country and I will have to drag my stethoscope and doctor’s bag to some other country that does not discriminate. Wait, there is the UK for that. If the MMC does not want to accept me, the GMC will probably be more than willing to accept me indiscriminately. I guess that is not so bad a deal now!

Alas, my grouses will remain grouses. I have been putting my arguments using legislation and national guidelines used in the UK (and it is not entirely because I think they bear more prestige and validity; it is because those are what I am using for my study purposes) and those hardly have any equivalent documents in Malaysia. So I guess not much will change unless there will be a major shift in our legislation to promote for greater protection of human rights and equality.

P.S.: Speaking about ‘tougher’ requirements, getting grade B in SPM requires one to simply skip all the lessons and memorize the previous exam marking schemes. Now that applicants know that they only need to get at least B, I guess we will be seeing a lot of our students getting just 20 Bs rather than 20 As in the future!

Idzwan Husaini is your typical over-critical Malaysian who loves finding a reason to criticize just about everything and everyone. His schizoid third lives happily in a secret make-believe utopia where equality is the religion of the day while his anankastic third spends time in the so-called reality obsessing over how humanity is going down the drain and trying to save the world by criticizing in a compulsive manner believing he is the only one who can do a perfect job at it. His narcissistic third spends his time cherry-picking the few people with beautiful physiques (and hearts, of course!) to be saved from reality into his secret utopia. Well, he was born that way.