Transcript Disability

Dr Elizabeth Howard MRCGP
Define Disability
 Impairment
 Disability
 Disability Discrimination act defines a disabled
person as someone who has a physical or mental
impairment that has a substantial and long –
term adverse effect on his or her ability to carry
out normal day-to-day activities
Disability and Work
 Discrimination illegal
 Best Candidate
 Reasonable adjustments
 Grant for adaptive equipment
 BEST not to lose Job
Are These Disabilities?
 Hypertension
 Coronary artery disease
 Diabetes
 Cancer
 HIV
 Multiple sclerosis
 Severe facial disfigurement
 Chronic fatigue /ME
Disability and the Surgery
 You are feeling ill,
 You feel you need to see a doctor today.
Wake up
Get out of bed
Telephone surgery + negotiate
urgent appointment
Wash & Dressed
Negotiate stairs, have breakfast
Walk down path, cross the road,
Get on bus, pay fare, get off at
correct stop
Check in at reception
Respond to call system
Find Dr , communicate needs,
get on couch to be examined
Got to chemist
Sign and pay for prescription
Sort out medicines
Choose and book a hospital
appointment
ADL involved in seeing a doctor














Wake up – see, set, hear alarm
get out of bed
Telephone surgery
Negotiate for appt
Get washed and dressed
Stairs, Breakfast and take medicines
Walk down road, cross road
Get correct bus -+ pay fare, Get off at correct stop
Check in at reception
Call system
Find, communicate with Dr / get on examination couch.
Go to chemist
Sign / pay for prescription – you are not automatically exempt
Get your hospital appt – choose and book
Disability and the Surgery
 You are feeling ill, you feel you need to see the doctor
today.
 You have a ‘hidden disability’, you are fiercely
independent and not ‘housebound’ so do not expect to
get a home visit. Your relatives are at work.
ALERT Colleagues
 Use Yellow flags or alerts for communication issues
 Hard of hearing/ deaf
 Part sighted / Blind
 Memory impaired- agreed contact
 Unable to read/ write ( safety – embarrassed)
 Priority 1 – wheelchair users for neurological reasons,
 hoists / lifts at home
 if abdo ‘pain’ – may just sweat or faint
Consultation Room
Dependence vs. Independence
 Impairment
 Other disabilities ( e.g. hearing + sight)
 Personality – self reliant vs. dependant
 Depression / anxiety
 Opinions in community
 Willingness to be seen with aids
 Ability to afford better aids
 No two the same !!!
Pride and Prejudice
Hearing
 Hearing aids – ‘Don’t want to look like a retard’
 When did you last see one?
 Mobiles: Adjust ring tones, Alarms – test first !
 Modern fire alarms in public buildings
More severe
 Sensory SS -Yew tree lodge /RNID shop (exempt VAT)
 Alarms that are loud, vibrate (pillow) / flash vibrate,
FIREALARMS , doorbell baby monitor gadgets
 Text phone
Part sighted/ Blind
 Optician best correction – eventually none
 Only 1 in 3 registered ( consultant – social services )
 part sighted - 3/60-6/60
 blind – <3/60 unable to perform work
 Tax allowance, training stick/ Braille/ audio books, blue
badge, TV licence, travel permit/ taxi card
 Low vision aids
 Tel: Big buttons, speech dialling, verbal orders for meds.
 Guide stick – sensory SS , awareness/ help
 No on bus? Blind spot in ARMD large
 Guide dog – only young workers/ physical disabled
Yew tree Centre
 Sensory Disability social services
 Registered blind/ deaf
 Mock up kitchen with gadgets, fire alarm, baby alarm,
 Freedom pass – Speech ? Sight/ Hearing ( if cannot
drive – blue badge
 White stick training
Physio, OT, Speech therapy
 Tools for independence
 Require compliance
 Why can’t I have a wheelchair, then my son can push
me around!
Driving – v important
 DVLA rules for driving
 Car
vs. Minibus / bus/ HGV
 www. DVLA – medical rules
 Sight < 6/9 corrected
 < 3/60 one eye ( - may consider after 1 yr)
 Night blindness
 Visual defect
Blue badge & Motability
 Blue Badge – EU
 Allows parking on yellow line/ in disabled space 3 hrs
 NOT always free parking
 Congestion zone free
 Too many around – easy or confused GP’s?
 Form :appalling – amputees
 Able to walk 50 yds unaided without stopping for
severe pain / breathlessness
 Motability – swap for highest mobility DLA
Prescriptions
 Medical Exemptions include
 Cancer requiring continued medication
 ESA/ Tax credits / income support
 Not exempt - prepay if more that 14 scripts a year
- back repeat sheet on FP10
Dr Elizabeth Howard
Managing Absence
 Plan return to work from start
 Have they talked to their employer?

Re-deployment / adjust role
 What activities does their job involve
 Do they like their job?
 Best to move job not lose Job
 6m off <50% return to work. Over a year few return. Legally dismiss
1yr
 Depression – only off in severe / short time, planned return part of
recovery may be difficult to get them to return the longer they are off
Medical certificate – Risk: benefit
---Therapeutic intervention --Benefits
 Protection from physical
harm – e.g. post open
laparotomy
 Space to make initial
recovery from SEVERE
depression / mental heath
 Public health/ infection
control
Risks
 Forced into sick role
 ‘msg: work is dangerous ‘
 Loss of confidence , self
esteem, role in society
 fear of return esp. depression
 Stress
 Loss of income
 Delay in qualification
 Tension
 with boss / colleagues
Med 3
 Needed for 8th day onward
 ( short term absence : self certificate from
employer/ private )
 CONSULTED that day/ previous day
 PROSPECTIVE
 CLOSED specific date up to 14d
 ‘OPEN’ certificate 2w, 4w,
 should officially be closed with a final
date to return but usu only adhered to by
some employers
 REMARKS
 Continuous claim
 Able to work: part time, light duties, from
home ............rehab back into work advice
legal obligation to employer. Can remark
on adjustments to work without signing
off !!
Med 5
 SEEN by someone else /
you another day .
 May give up to 4 weeks
forward based on a
report less than 4 w old
from another doctor.
 Gap ?
Med 4 – Green
 Requested by DWP for prolonged time off
 good practice to keep running total
 for continuing benefits after statutory sick pay.
 MAIN DIAGNOSIS ,
 Other contributing DISABLING diagnoses
 REMARKS:
 Treatment and Progress / response, planned rx.
 On crutches.. 2 sticks/ NEEDS Zimmer frame ..
 Ability to travel 90min by public transport to centre. i.e. do they
NEED home visit / severely disabled/ taxi funded (Romford)
DS1500, Med 6 & RM7
 DS1500
 Terminal illness is defined in Social Security legislation as:
 ‘A progressive disease where death as a consequence of that disease
can reasonably be expected within 6 months'5.
 claim 'special rules'. Disability Living Allowance (DLA),
Attendance Allowance (AA) or ESA (IB)
 Med 6
 Back of med3 pad :
 Submitted to DWP with accurate diagnosis at same time as
Med3 or Med 5 if unable to enter proper diagnosis for fear of
harm to patient or disclosure to employer will cause harm.
 RM7 – not Brooklands ward
 Confidential submission to request assessment – do not need
to enter a diagnosis
ESA
ESA – EMPLOYEES support allowance (was IB)




Assess at 3m , no more certificates from GP for same condition
Right to appeal if refused
Take hosp letters + medications.
Under/ overplay according to finances/ pride / beliefs
 ESA 113 – doctors report –
 severe disability = exempt from medical exam , entered into
support group.
 Allowed to work but not obliged to
 Medical Exam :
 Qualify for ESA financial support ( was IB)
 Support group vs. help to prepare for re-entry to work
DLA vs. AA
 Age
 Assessment at home or in centre
 FUNCTIONAL HISTORY
 Care – Mobility – Duration of need
 Cancer requiring chemo/ DXT automatic now to
cover costs of illness