DocsWithDisabilities Podcast Ep 7: Alexandra Adams

Alexandra Adams

In part one of our interview, we talk with Alexandra about her formative experience as a patient, her desire to be a doctor and the process of applying to medical school. Alexandra and Dr. Meeks also discuss navigating accommodations in the UK and the US and the respective views about #DocsWithDisabilities in these countries.

Episode 7, Part 1, Transcript 

DocsWithDisabilities Podcast #7, Part 1

Alexandra Adams

 

Doctors with disabilities exist in small but measurable numbers. How did they navigate their journey? What were the challenges? What are the benefits to patients and to their peers? What can we learn from their experiences? My name is Lisa Meeks and I am thrilled to bring you the Docs with Disabilities podcast.

 

Join me as I interview Docs, Nurses, Psychologists, OT’s, PT’s, Pharmacists, Dentists, and the list goes on. I’ll also be interviewing researchers and policy makers that ensure medicine remains an equal opportunity profession.

Joseph Murray:                     

Welcome to a very special 2 part international episode of the docs with disabilities podcast. I am Dr. Joe Murray, a practicing psychiatrist and an associate professor of clinical psychiatry at Weill Cornell Medical College. I will be guest narrating this podcast.

The DocsWithDisabilities Podcast had the unique privilege of recording in the UK  this summer where Dr. Meeks met up with Alexandra Adams. In a lovely cottage in the adorable town of Windsor, right outside of London, they talked about Alexandra’s formative experience as a patient,  her desire to be a doctor, and the process of applying to medical school.

Lisa Meeks:                            

We're going to heat up some tea and because we're in Great Britain, we're going to switch now to the lovely cakes that you brought.

(Tea sound effects)

Lisa Meeks:

Alexandra, why don't you introduce yourself to our audience.

Alexandra Adams:     

Thank you Lisa. I'm Alexandra Adams. I'm a fourth year medical student studying at Cardiff. And I'm visually in hearing impaired, so I'm classified as deaf-blind. And as far as I know, I am the first deaf-blind person to be studying medicine in the UK, which is exciting, but it also very nerve wracking and not being able to have people I can really relate to, I guess. I'm looking for support and advice as I go through medical school. But I always knew I wanted to do medicine, and I knew that I wanted to go down a career that was sort of helping others. And I guess in some ways that was to do with my experiences of being in hospital sort of in and out when I was younger, not so much due to my vision and hearing, but I had other problems, such as stomach issues that actually had me in hospital for a year and a half when I was 17.

And I was a swimmer on the GB swimming team and I had sponsorship for the 2012 Paralympics, so that was one side of my life. Then obviously on the other side of my life I was studying to get to medical school, but unfortunately, as I said, I ended up in hospital for a year and a half and I had 20 or so stomach surgeries in that year alone. And consequently, I never went back to swimming, unfortunately. 

But I did learn one thing when I was in hospital and that was what made a good doctor and what made a bad doctor. That's why we're down in medical school. That's why we are doctors, because we want to help people. And there are many ways of doing that.

You don't see that on the other side of the pillow when you're sort of observing your colleagues so much. It's so much more paramount when you're the patient in the bed. And I remember every single day these huge crowd of doctors would come along on the ward round, and the medical students trailing behind them. They would look at the notes and they would mumble back and forth and say, “Well, this is what we're going to do,” and stuff. But they never spoke to me. They never addressed me. And it was almost as though there was an invisible line at the end of the bed and they wouldn't look up and introduce themselves. And then they would just move on. They would go onto the next patient and I'd be sat there in bed, still not knowing what was gonna happen, what the next stage of treatment was.

Joseph Murray:                     

Alexandra’s view of doctor’s was about to change. In this moment, the ability of a doctor to connect with her patients using three little words would prove to be the catalyst for Alexandra’s future career.

Alexandra Adams:                 

There was this one person, this one junior doctor that came back and she looked at me and she said these three really important words, which I think are the most important words when you're a doctor. And they were, are you okay? And of course I wasn't. And I burst into tears. I said, no, I don't really know what's going on. And then she just put her hand on my shoulder and she said, “I know how you feel.” I've been there, I've experienced being in hospital for a very long time, at a similar age to you. And it was at that moment I realized she had empathy and she had a lot of it.

And this empathy, I would have once I was out of the hospital myself. And it was something very special to be able to give to patients in the future. From then on I obviously had all my surgeries and I came out and I had to restart education because I was behind. And I had to have rehabilitation and stuff. So I ended up going to a school for the blind for my last two years. Academically it was really difficult because you're at a blind school and yet the staff as much… as kind as they are and as supportive as they are, they told me time and time again, “Don't do medicine. Don't go into medical school. There are no other blind people going down that route. So we don't want you to get hurt because you're just not going to be able to do it.” Being stubborn in this case was the best thing I could have ever been because when I'm stubborn, I do the complete opposite to what people tell me to do. So in this case when people were saying, “Oh, don't apply to medical school. You'll never be able to be a doctor.” What did I do? I applied to medical school.

Joseph Murray:                     

Next, Dr. Meeks and Alexandra discuss the process of applying to medical school, the various levels of openness to disability, and their views on resilience.

Lisa Meeks:                

What was that process like for you? Applying, knowing that you had this dual sensory impairment. I'm sure you did your homework beforehand and recognize that there was no one. And I can't think of anyone that could serve as a mentor or help you identify the potential hazards as they are sometimes called.

Alexandra Adams:     

Exactly. So I did always have this in mind because my parents were really supportive, but they also kept telling me, “Are you sure you really want to do this? We have no new proof, new evidence if you say, to say that this is possible.” But I don't know. There's just something about an instinct that, when you have it, you have to go with it. And I think at that time I just somehow knew that I could do this. I could find a way.

Obviously I knew that I wouldn't become a neurosurgeon doing intricate brain surgeries. That was out of the question. But I could be a psychiatrist. I could sit down and talk to people and sort of devise the right medication for them. I could be a palliative medicine consultant. I could work with patients and their families in a very holistic approach. So I knew that there were ways, but to be sure I got in touch with lots of medical schools well in advance of actually applying to medical school just to make sure that, when it came to it, when I would do my exams, that I did have a possible route afterwards. I just remember one summer, actually we went to about six or seven medical schools, my mom and I, driving up and down the country. Some were really lovely. I had to say to them, “Look, how do you view people with a disability studying medicine? Are you able to support me?” And some sat down and said, “Look, we’ll need to establish it in greater detail, but then we can see what we can do.” But I can also remember going to some open days where after sort of the introductory lecture, I’d just go up to the person speaking and just say hello and introduce myself. “I'm hearing and visually impaired and I really want to do medicine.” And I just remember this one lady, she’d go, “Absolutely not. No, we can't deal with disability. It’s just too much. It's not for people like you.” And then I just remember saying to my mum and dad, “Let's not even bother looking at accommodation because this isn't the medical school I'd want to go to.”

Lisa Meeks:                

So I hear you talking about this and what was going through my head was resilience, resilience, resilience, resilience. You call it stubbornness, but I would equate it to resiliency, which is what we're looking for in medicine. And I have argued that if what we want are resilient, creative practitioners of medicine that are patient focused, that you would be hard pressed to find someone who is more qualified than a qualified applicant or student with a disability. That by the nature of having a disability, they've had to be flexible and adaptive and resilient.

Alexandra Adams:     

I mean, as a disabled medical student, I think people often forget that actually, most of the time, I have to spend 100% more time trying to be better than everyone else because if I'm working at my normal baseline, people don't see me as a medical student. They just see me as a visually and hearing impaired person. So we do have to work so much harder than everyone else. And like you said, we have gone through those additional experiences of hardship or whatever, that’s given us life lessons and life experience to help us a little bit more along the way. I have got loads of friends who have literally just gone through medical school and it's been a breeze. I mean, I don't want to put it down. Medical school is hard. It's hard for everyone, but it is harder, arguably, for people who have disabilities. And I think people forget that until they get to their years when they're actually a qualified doctor and then they're faced with the slightest problems and then they break down.

And yes, resilience is really important. But resilience is a very big word in medicine, and I think there is only so much resilience you can take and have before you burn out. And we all know that that's another very big topic in medicine, particularly here in the UK. And I worry that if we continue to go down the resilience line, that we're all just going to crash at some point, regardless of whether we've got a disability or not. And I can tell you now, I've very recently… I think I have well very nearly tipped the edge with that because I've had some really tough experiences the last few months actually where I've just said this is enough. There is only so much we can take without that support net around us.

Joseph Murray:                     

The conversation now turns from resilience to becoming a superstar student. Let’s listen or read along as Dr. Meeks and Alexandra discuss the idea of having to be “better than everyone else” just to be included in medical school.

Lisa Meeks:                

I think you bring up a good point, and I want to explore this further with you about having to be better. I hear this from a lot of students and a lot of physicians. I find that a lot of physicians with disabilities either have amazing output, whether that's academic output in publication or they have just this amazing demeanor that's working well. Their patients love them, and they're meeting all the expectations. But there is this kind of amplification of either the personality or the performance that seems to occur in physicians with disabilities who are doing well. And I wonder if that is developed as a coping mechanism, either to be nicer to everyone or to be more engaging socially or to be better academically, but that you have to do something. You have to have one of these three things to have people believe that you're capable or look at your performance or your role first before they think about your disability.

Alexandra Adams:     

Yeah, I completely agree. And actually I think it is because there's a fear that anything that goes wrong or anything that's not perfectly right, we have an immediate, obvious excuse that people can blame on, which is our disability. Cannulation for instance. If there were two students like myself and another student who was completely slighted and not hearing impaired, and we both missed the vein, then for the other student it would be like, “Oh, don't worry, you just need more practice.” Whereas to me it would be, “Oh, it's because you're visually impaired.” It's that immediate assumption that it's down to the disability and that's the reason why we have to be so much more perfect.

Alexandra Adams:     

I feel that most of the time, I can't be myself. I'm not comfortable doing things the way I was doing them before I went to medical school. And when you're almost on show, if you like, you have to be perfect. I mean we all know that there is no perfect doctor. There is no perfect medical student.

Joseph Murray:                     

Accommodations on the Objective Structured Clinical Exams (the OSCE’s) are becoming standard practice for medical schools in the US, but barriers remain in the UK. Listen, or read along, as Dr. Meeks and Alexandra discuss the two big barriers to full inclusion with the OSCE’s and their respective solutions.

Alexandra Adams:                 

Technically I should have a little extra time because it takes me a little bit longer to read the scenario before the exam station. And then to come in and just sort of get my bearings. So we all know that when you come to see a patient, the first thing you do is you wash your hands. I know that, everyone knows that. But then if you can't find the hand gel to wash your hands, you are wasting five minutes of your time trying to look for it. And of course when you are being timed at that examination station, you're at a disadvantage, not because you're thinking, “Oh, I forgot to wash my hands.” It's because I couldn't see where the handwash was. And so, I haven't really been supportive that well in that sense. And people have said to me, “Well, you are at an advantage to other students if you get additional time.” I'm not because those other students don't have a visual hearing impairment. So it's really tricky, but it's different in every medical school.

Lisa Meeks:                

In the US, we have... we call them the OSCE’s, the objective structured and standardized patient exams. And since our podcast is really focused on helping people identify their roadblocks and then work around them, we've just identified a big one, right? The clinical structured exam that occurs in medical school. And I know that there's a lot out there written about how to afford extra time or reasonable accommodation to those exams. But for me, the simpler approach and the more eloquent perhaps approach to this might have been to have you stay in one room and rotate the patients through so that you could acclimate to that room in advance. And you would know, just as part of having been oriented to that room, where everything was so that you could get on with the history and physical, the exam.

Alexandra Adams:     

I mean I just got very excited then because I had such a good idea, but it's so simple. And I did actually ask, not to be in the same room and the patients come in, but I asked for something very similar in my exam last year. I said, can I be in a separate hall for the rotations? And they said no, because again, that would be putting me at an advantage over other students. So of course they put me on a separate rotation, but they put me in the same hall. So my timings were different from other students. So when the horn was going on to say move on, that didn't apply to me. So I had to carry on whilst I had all this background noise of students moving to different stations, and that in itself was a really big distraction. And it just really didn't work. And I mean, luckily we didn't have an OSCE exam this year, but the big exams are next year.

Lisa Meeks:                

What you've just identified is another really big barrier. Think about the student who has additional time for testing, and that then carries over into the OSCE and they have additional time to read the door notes. They go in and they have this alarm going off that says you have two minutes. The anxiety that it evokes sometimes can cause additional cognitive disruption where the ability to focus gets lost because you're so worried about getting things done on time, even when that indicator of time doesn't apply to you.

So just simply turning down the speaker in that particular room when the student is in there can really be helpful. Or you could have a knock at the door that indicates you now have five minutes left. Something that is appropriately timed for that student. And I want to point out, when we talk about extra time, we're not talking about a half an hour or more with the patient. We're talking about a matter of minutes, usually less than three minutes. I have a very hard time when people argue that it's an advantage to somebody who, because of disability requires additional time just to meet the same standard as somebody without a disability. That three minutes could be such an advantage to someone who has to use adaptive or assistive technology to read or find different things in the room is absurd. Then when you go out into the real world practice, you would find a mean number of minutes that a patient takes going through a physician schedule. But that physician is not going to maintain 10 minutes, 10 minutes, 10 minutes, 10 minutes across all patients. It's going to vary. And there's no appreciation for the normal variance that occurs in the real world.

Alexandra Adams:                 

It's because people can’t imagine people like myself in the real world of medicine. They just don't think it’s possible. It's just so frustrating. And one big thing they forget too is that when you are in the real world medicine, you're working in teams. There isn't, like you said, that set number of minutes for each patient you see. If you’re struggling or thinking, “Oh I need an extra pair of hands or I need a second opinion,” there are nurses, there are staff around to help. I know obviously that's not possible in the exam itself, but it's so true. And going back to having to use additional tech, I have a really good stethoscope actually. It’s a wireless one called Thinklabs. I got it from the US actually, and it's fantastic, but it means that I have to switch on my hearing aid special setting. Then I have to switch on my stethoscope, and then I have to switch on the streamer and that takes a good minute or two. And if you take that off the timing that everyone else has, it doesn't take other people to switch a normal stethoscope on, two minutes. So it's little things, it’s just not considered. But like you said, you can't apply that to the real world.

Lisa Meeks:                

In that time constraint, you're actually performing faster than your peers because of the time that it’s taking you to do the setup. So you're actually performing better when given these time constraints, which takes me back to this idea that you have to be better, and you think about, well, why does a student with a disability think they have to be better? Because there are several situations where you are called on to perform at a higher rate just to prove that you can be there, with all kinds of environmental reinforcers that you shouldn't be there.

Alexandra Adams:     

Yeah. Yeah. And you know, there's enough pressure that is being a medical student or being a doctor. You have so much responsibility, but when you've got that disability is even more pressure. And that constant stress… Am I doing the right thing? Am I keeping up with everyone else? It's really debilitating. I spend, I'd say, about 90% of my time every single day doing admin and trying to find my corner because of my disability. It's really draining, and people don't always think about that. Most people go to med school or go do their job and then you come home and they're able to wind down. I can’t wind down. When I come home, I'm constantly questioning, how can I do that better? And then that goes back to saying, we need that mentorship. We need those support systems for, in these cases, to say, “Okay, so this happened or I am feeling that added stress at the moment. Can you help? Or how did you cope with it?” So yeah, when you're on your own in this, it's really hard. It's really hard.

Joseph Murray:                                 

Alexandra did get into medical school, her scores were higher than needed to gain admissions and while the medical schools were willing to work with Alexandra, they also required her to perform tasks far in advance of her peers to prove her abilities, which proved very stressful.    Eventually, Alexandra would enter the wards where she would be faced with a similar situation and three powerful words would bring her full circle.

Alexandra Adams:                 

It was really difficult though because we did have the occasional placement. The medical school to some degree tried to help with this by almost exposing me to the clinical environment beforehand, but not the real clinical environment, sort of the simulated clinical setting. But instead of sort of doing it informally and sort of bringing me in and seeing, “Okay, so, this is what you'd be expected to do, this is how you do it.” I was almost thrown into the deep end, like I am with everything else, unexpectedly. They basically said do this and do it in an exam situation. And as a young naive medical student, that was quite scary, very stressful. Again, pressure to be in this exam situation, expect to know everything and again, be perfect, be better than everyone else at that stage. So in that sense, I was a little more ahead than my other peers because I had already been exposed to sort of female catheterization from year one. Not that I needed to, but the way that it was done because of my vision and hearing impairment, it almost scared me to the point that actually, it was this sort of self fulfilling prophecy where I didn't want to go to clinical skills. I didn't want to do some of my hands on stuff because I was worried that if I did the slightest thing wrong, and someone was watching me, that was me done. But the point that no other medical student in my year had been introduced to this skill. So, there was so much pressure.

Back to when I was talking about the junior doctor who showed me how skull on the ward round and said, “Oh, I know how you feel.” I remember going on ward and as a medical student recently and there was a patient and she was very quiet and I could just tell, I could just sense that something wasn't quite right. And again, a large group of us are huddled around the invisible line of the bed, and I was one of the medical students muttering in the notes, and then we moved on. Not once did the lead doctor talk to the patient though and say, “This is what's going to happen.” And she just seemed really upset. And so I remember at the end of the ward round, when everyone dispersed and went off and did their own thing, I went back to the patient and I shut the curtain. I sat down and I said, these three words, “Are you okay?” And of course she burst into tears and she wasn't. And turns out that she had just been stepped down on to the ward from intensive care and she said, “No one knows how I feel and what I'm going through.” And I just said, “I know what you're going through because I've had 15 admissions to intensive care. And I knew exactly how she was feeling, how traumatized she was, and I was able to say, “It will get better.” I think she really appreciated that. And I didn't need any vision for that. I didn't need any hearing. I didn't need any knowledge of blood test or x-ray results. I just needed to sit down and just tell her that everything was going to be okay based on my personal experience. So, I think it's really sad because we often forget what medicine really is a little bit deeper. And we focus so much on the clinical stuff, we focus so much on, you've got to look like a doctor, you've got a sound like a doctor, you've got to act like a doctor that actually we forget that we're all just human beings and, regardless of whether we have a disability or not, there is so much we can offer.

Joseph Murray:                     

I’m Dr. Joe Murray and it’s been a pleasure guest narrating this podcast. Be sure to subscribe to the DocsWithDisabilities Podcast and tune in tomorrow for part 2 of Alexandra’s interview.

Kate Panzer:  

This podcast is a production of the University of Michigan Medical School, Department of Family Medicine, MDisability initiative. The opinions expressed in this podcast do not necessarily reflect those of the University of Michigan Medical School. It is released under a creative commons, attribution noncommerical, nonderivative license. This podcast was produced by Lisa Meeks and Kate Panzer.

 

*This podcast was created using excerpts from the actual interview and is representative of the entire conversation. Interviewees are given the transcript prior to airing. Some edits may reflect grammatical and syntax adjustments for transcription purposes only.

Episode 7, Part 2, Transcript 

 

DocsWithDisabilities Podcast #7, Part 2

 

Alexandra Adams

 

 

Alexandra Adams, Part 2: The Power of Social Media

Introduction: Lisa Meeks

 

Doctors with disabilities exist in small but measurable numbers. How did they navigate their journey? What were the challenges? What are the benefits to patients and to their peers? What can we learn from their experiences? My name is Lisa Meeks and I am thrilled to bring you the Docs with Disabilities podcast.

 

Join me as I interview Docs, Nurses, Psychologists, OT’s, PT’s, Pharmacists, Dentists, and the list goes on. I’ll also be interviewing researchers and policy makers that ensure medicine remains an equal opportunity profession.

Joseph Murray:                     

Welcome to part 2 of the interview between Dr. Meeks and Alexandra Adams. As you’ll recall, Dr. Meeks had the pleasure of meeting up with Alexandra this summer, just outside of London, where they talked about Alexandra’s experiences as a deaf-blind medical student. In this second part of the podcast, Dr. Meeks and Alexandra discuss the power of social media to bring people together, crowd source information, and find mentorship from anywhere in the world. Alexandra shares her experiences coming to the US to find a medical environment where disability was often a normal part of the narrative.

Lisa Meeks:    

I want to go down the path of talking about social media and for our audience to share with them how we met, which I'll never forget. I was in Ann Arbor. I was leaving a meeting from the medical school and I was just probably irresponsibly walking and tweeting. Between meetings, that's when I am able to kind of scroll through Twitter, and I saw a post that someone had shared about you using the Hashtag that we had started at UM. And I read your story and I had gotten to the parking garage. I remember stopping and immediately looking to see if I could message you, if your Twitter was open to messaging, and messaged you and got a response right away. Thank you. And I think I had tweeted out, I have to meet this person. I have to interview this person. And we obviously got connected and are doing our interview, but I was fascinated because, in the rich diversity and beauty of what I have been privy to, so a wide range of practitioners, I had never in all of my experience met anyone who would have been classified as deaf-blind. And I found it so interesting and so exciting that if this was a possibility, that literally there are endless possibilities, right? And as I thought through the concept of having a visual and a hearing deficit and how you might navigate medical school, I began to understand how this could potentially happen. And it brings me to the question of... this awareness is building. What is the power of social media? And how has social media played an influence on what you thought you could do, how it has impacted you since and how it's helping to navigate the roadblocks as they pop up.

Alexandra Adams:     

I got Twitter just before Christmas of 2018 and like I said to you earlier, I have not looked back since because you put things up where you say, “Oh, I'm really struggling because I have this disability. I'm in this year of medical school.” Then people just sort of pop up on your newsfeed who you never knew existed. And they say, “Oh, I've been through that experience before. I know someone off someone off someone who has a similar disability and is going down the same route. And it's so comforting and reassuring. Not just because you think... there's someone else that I can go to and ask for advice. But again, it's just that proof. It's the evidence that it's all possible and that you are doing the right thing and I shouldn't be regretting going down this route. And because of that, I don't feel so much on my own. I mean, it is still really difficult in medical school because I am, as far as I know within my own medical school, I am the only person with a hearing and vision impairment. And because of that, it's really hard because when I'm up there on my own and I've had a really bad day, I can't really go to anyone about it. The medical school doesn't really know how to support me because again, they've never had a deaf-blind medical student come to them. But then, and I can't honestly remember whether this was through social media or whether it was just through going on the web, but I remember reading an article a while ago about a blind doctor in America and I started looking into this.

Lisa Meeks:                

Stanley Wainapel?

Alexandra Adams:                 

Yes, Stanley Wainapel was one of them. And there was a Tim Cordes, there was John Rizzo.

Lisa Meeks:                

Nat Gleason.

Alexandra Adams:                 

Yeah, there were so many. And they started popping up, one after the other. And I'm thinking, wow, but they're not just visually impaired, they're completely blind and they have less vision than me. And yet they've had years and years of practice as a physician. So, I sat down at that point and I said, I need... like you said, wanting to meet me. I very much wanted to go meet these people to see in person, excuse the pun, to see what they were doing and how they were doing it. And, it was probably one of the very few missions, if you like, that my parents that actually said, “Go on, we support you doing that.” Cause normally I'm galavanting across the world and they’re terrified. But this had a purpose and it would give me answers for my future career. So I think it was summer of 2016 that I just started doing a few emails, messaging some of the hospitals, some of the universities that they had graduated from, trying to be a detective almost and workout where they were now and how I'd be able to get a hold of them. And long story short, I ended up going out to the US and spent a few weeks in New York City and San Francisco, shadowing with these completely blind doctors and also a completely deaf doctor as well in San Francisco. And it was just... it was eye opening. It was eye opening. It was amazing. Cause I mean, Dr. Stanley Wainapel for instance, he just had... he had the most perfect answer to everything. All of my problems. He was a just amazing.

Lisa Meeks:                

He’s so bright and funny. He’s so funny. 

Alexandra Adams:                 

So lovely and so funny. And he said to me... he said, go and ask next time you're in the hospital, ask all the doctors you see that have got glasses or contacts lenses, and ask them to remove them. Are they still able to insert the cannula, interpret the X-ray, etc.? And the answer is probably no, they can't. And actually I think people without an official visual impairment if you like, they forget that actually most of the equipment we use nowadays in medicine are visual aids. Therefore I have the exact same right to have additional visual aids to help me to do the same as everyone else. It was a very empowering trip, and I came home just knowing for absolute sure that I can do this. I can be a doctor with a vision and hearing impairment. Deaf-blind, we didn't know anybody else who was deaf-blind and doing medicine until recently. I think there was a doctor studying in the Netherlands. And she replied to one of my tweets and just said, I'm a deaf-blind doctor in the Netherlands. I'm thinking, wow. So I actually messaged her the other day and said, “I'd love to be able to go out at some point and see how you do it,” because I think it's so important to connect with these kind of people.

Lisa Meeks:                

Absolutely.

Alexandra Adams:                 

Because the thing is, it's a spectrum and no one realizes that. When I said, “Oh, I'm visually impaired,” to someone, they think, well, you're either completely sighted or you're completely blind and you’re nothing in between. And the same goes with deaf-blindness. How visually impaired, how hearing impaired are you, and it does sort of determine what you can and can't do and what support you need and what you don't need. So I'm really excited to hopefully be able to meet this person at some point.

Joseph Murray:                     

Alexandra was thrilled to make these connections in the US and reports that during her time in New York and San Francisco she experienced a renewed faith in the ability to practice as a doctor with a disability. She also discovered mentors, who would not have been available to her without the power of the internet and social media. As we know, mentorship is a critical facilitator of success for underrepresented medical students, and with so few doctors with disabilities available, social media may be the catalyst that connects and promote the pipeline of medical education for students with disabilities.

Lisa Meeks:    

That brings me to the conversation about mentorship and as you know, the podcast is designed around this idea that the more we share information, the less detective work someone like you will be doing in their living room by themselves trying to piece together whether this is possible. Instead we want to share... bring together all of the individuals who have gone through medical school or going through medical school, collect data from these interviews, and use that to inform guidance and asynchronous mentoring, if you will. In-person mentoring is wonderful. So if you have the opportunity to meet individuals or visit them and shadow them, certainly that's lovely. But also for the student who is unable to do that and so they could log on to either a website or listen to a podcast that is on a topic that is specific to their need. So having someone who can help you navigate the system or who understands what you've been through, who can support you through the process is critical. And so what these individual physicians have done for you in welcoming you to the US and having you rotate with them, it's a wonderful example of mentorship. And it seems like you came back to the UK with this renewed passion and thought process that absolutely this is possible. And so for you, I imagine that when you went and had this mentorship experience in the US, when you came back to the UK, was that something that you were able to report to medical schools as you were going through the process.

Alexandra Adams:     

Yeah, and that's also another reason why I went out there, not only to sort of give myself answers but to come back and say to medical school, “Look, this is how these guys are doing it. This is how you can support me.” It was almost to sort of go back to them and say, “Look, this is a norm in the US, so we need to make it a norm here in the UK and elsewhere in the world.” In some ways it almost backfired slightly because nothing really progressed. There's only so much medical school can do when you're in that little bubble, if you like, in the education system. When you go out onto the wards, you're with anyone essentially. You’re with any doctors, you're in any hospital. And for those people who don't know it's possible, they don't know I’ve been out in the US and I've met these blind and deaf doctors. They will continue treating me as though I shouldn't be there.

So I remember on my first day of placement, actually last year I had a doctor come up to me and say, “Imagine if you're a patient, would you want a disabled doctor treating you? Absolutely not.” And then they sent me home. And then I remember a few days later, I had another doctor come up to me and say, “Well, what are you doing with the patient's cane?” And I said, “Well, I'm really sorry. That's my cane. I'm blind.” And he kind of looked up and down in disgust and said, “I don't want you touching any of the patients.” And it was just a lack of understanding, a lack of insight again, excuse the pun. It's shocking, but I didn't see any of that in the US because it's more of a norm. There are way more blind and deaf doctors out there it seems. And therefore because it's a norm, because it's been seen as a possible thing, people are accommodating. There is the technology, there is the kindness, there is the mentorship, the support systems. And we don't yet have that here. And that's why I think social media is really important because it's... certainly for me anyway, it's been a base where I can actually turn to on days where I come home and people have said some things sort of not so nice on placement. So we've got a long way to go, but it's definitely going in the right direction.

Joseph Murray:                     

We wrap up this second podcast with a discussion about the biggest barrier in medical education, which is consistent across both countries — a lack of understanding regarding what is possible. Dr. Meeks and Alexandra circle back to the discussion about the power of social media to serve as an educational tool and resource, and they end with a discussion about Alexandra’s incredibly impactful project, “Faces of the NHS.”

Lisa Meeks:    

So you are on the wards now.

Alexandra Adams:                 

Yes.

Lisa Meeks:                

And it sounds like the biggest barrier has really not been interacting with the patients or anything really medicine focused. It has been reactions to you or perceptions about what you can and cannot do versus an actual clear understanding of what you can and cannot do.

Alexandra Adams:     

Yeah. It's been... I can tell you now that the biggest barrier through medical school so far has not been my disability. It’s been the ignorance of people and the lack of support. And that's not in a malicious way because when I say this, most people are thinking, “Oh, you know, it sounds really bad,” but they're not trying to be hurtful in most cases, I think. It's just this lack of understanding, lack of norm in our culture for supporting a medical student with a disability. So yeah, that's been the biggest barrier for me.

Lisa Meeks:    

I would agree. And I think that's a parallel in the US. That people are not malicious with their intent, when things go wrong with a medical student, or there are unforeseen barriers. I think it is... I feel like I say this all the time, but people don't know what they don't know, and there's a lot of education that needs to be done and to get people up to speed. But I think the social media campaigns that are occurring all over the country are a great mechanism for spotlighting people with disabilities who are out in the world doing things. We have ours with medicine, the DocsWithDisabilities, but I know you created one of your own. Can you talk about that?

Alexandra Adams:     

Yeah. So essentially it had gotten to a point in med school and I just remember someone coming out to me and saying, “Well, you don't look like a medical student. You've got a cane, you've got hearing aids.” And I went home that day. I don't look like… you know, is there an image behind being a doctor, being a nurse, being a porter, etc.? And obviously the answer's no. But I feel like in this day of age, there is this stereotype of having to, like I said earlier, to look like a doctor, to sound like a doctor, to act like a doctor. And I wanted to do something that would break down this stereotype because it is just not needed in this day of age. So I came up with the idea of this campaign, which is called Faces of the NHS, and it's essentially where I'm going around the UK and I'm taking portrait photographs of everyone who works for the NHS: past, present, future. And along with these photographs, there is a backstory. So a story about themselves, how they got into the career that they're doing, what they enjoy, what they're doing to enjoy and what they get out of it. And the whole idea is to represent diversity and to celebrate it. And to show that, actually we are all really different. We're not going by this very set image. And that we should embrace this rather than knock it down, if you’d like. It’s very exciting. I only really started it officially beginning of 2019 so I started...

Lisa Meeks:                

That's amazing because I've seen the campaign and to listen to you say that you just started it in 2019. It's incredible what you've accomplished.

Alexandra Adams:                 

I'm surprised myself as to how far it's come. And I think it's down to social media, being able to put it up on Twitter and Instagram, on Facebook, and it's being spread. More and more people have actually… I began messaging people saying, “I'm doing this. Would you be interested in being involved?” Very quickly, this turned around to the point that I'm getting 10 or 11 messages every single day of people across the UK just saying, “How can I get involved with your project?” So really exciting and I'm hoping… the goal, the end goal is over the next few years to get thousands of, and I don't know whether this being too optimistic here, but at least a few hundred of these portraits and stories. I'm putting it into a really big montage and then into one big image and showing that we are a diverse healthcare system. A bit like humans of New York, but humans of the NHS. And we have the stories as well. And actually I did have this idea further down the line to do some podcasts as well, like we're doing here, to talk to some of these people that have got involved in the project. And just to hear their story a little bit more because we've become experts at judging people by the minute we meet someone, just by what they look like, their face, let’s just say. And by whatever external characteristics they have. So for me, it's: she's got hearing aids, she's got a cane. Oh, mind made up already. We mustn’t do that. We need to know the stories behind these people to really appreciate them, kind of join their journey into what they're doing in the NHS. And I think that's really special.

Lisa Meeks:                

I think it’s incredible. You did something with the GMC. You were part of a campaign of theirs.

Alexandra Adams:                 

The welcomed, valued? Yes. I know that they have been trying to change the guidelines or you know, sort of mold them, if you like, so they’re better suited for medical students and doctors with disabilities and long term health conditions. Now I know that when I started medical school, the idea was that students with disabilities, they could qualify at the end of their course. But if there was any field that they were unable to do because of their disability, so i.e. there was an amputee that was unable to do CPR, then they would still be able to qualify as a doctor, but they just won't be able to do the CPR side of things. That has since changed. So in the UK we are expected, regardless of whether you have a disability or not, to be able to do everything. So I will have to do some surgery at some point. I will have to be an emergency medicine. I will have to do the visual things. I'm very… I probably will struggle with. And I feel that that's made it sort of more exclusive. It’s kind of excluded people with disabilities cause there are going to be so many things that a lot of us can't do. Not because of a disability necessarily, but because there's just not one of our strengths. So I believe that they're trying to change that now, to ensure that they are supporting students a little bit more. But it's really difficult. Nothing is straight forward in life. So I have a vision impairment. My needs and things I struggle with are not going to be the same as someone else who's visually impaired. The same goes for people who are in wheelchairs or people who have got muscular conditions, psychological conditions, anything. So again, it's something that is progressing in the process, but it's got a long way to go.

Lisa Meeks:    

Can you tell our listeners how they can follow you on social media and how they can find your...?

Alexandra Adams:                 

So you can follow me on Twitter @Alexandra_DBMed. And also @FacesoftheNHS. On Instagram, you can find me @AlexandraElaineAdams and also @facesofthenhs. And on Facebook, I am Alexandra Adams and Faces of the NHS. I’ve got my two accounts, and actually I'm hoping that some point over this summer to set up a website for Faces of the NHS because I currently have a backlog of about 300 photographs I've got to get through, so I've just been so behind with it all, but I'm hoping to put it up on there so if people wanted to contact me for that project, then that's the way to go. If it's just anything else, then find me on one of the Alexandra accounts.

Lisa Meeks:    

Well, you're an absolute delight and person and I will be following your story. And as you rotate through the wards and you find new challenges that I am positive you will address head on and overcome, keep us informed so we can continue to get that information out to students who are going through the process. And it may just be a moment where they're thinking, I can't do this. This is just too much. We want to use the beautiful power of social media and crowdsourcing information to get the accommodations, the assistive tech, the workarounds, the simple, beautiful way of adjusting into the hands of those who need it, so that they can navigate the pathway more clearly. And without as many barriers as those who have come before them.

Alexandra Adams:     

Absolutely. And you know, I want to be able to give to people something that I didn't have at the very beginning of my medical school journey. And that is that support network, that mentorship. So if there are any of you out there that need some... Just even to chat to just to get some advice, then please just contact me on social media and I'd be more than happy to talk things through. Thank you so much, Lisa. Lovely to meet you.

Joseph Murray:                     

I’m Dr. Joe Murray and it’s been a pleasure guest narrating part two of this podcast. Be sure to subscribe to the DocsWithDisabilities Podcast and tune in November 26th when the DocsWithDisabilities podcast interviews Dr. Satendra Singh, a medical doctor, noted disability activist, and medical educator whose work is changing education, law and perceptions of disability in India.

Kate Panzer:  

This podcast is a production of the University of Michigan Medical School, Department of Family Medicine, MDisability initiative. The opinions expressed in this podcast do not necessarily reflect those of the University of Michigan Medical School. It is released under a creative commons, attribution noncommerical, nonderivative license. This podcast was produced by Lisa Meeks and Kate Panzer.

 

*This podcast was created using excerpts from the actual interview and is representative of the entire conversation. Interviewees are given the transcript prior to airing. Some edits may reflect grammatical and syntax adjustments for transcription purposes only.