Equality and Human Rights Commission

This section focuses on how medical staff build successful relationships with disabled patients. Successful relationships require respect, dignity, trust, good communication and an understanding of the individual needs of patients. There are comments on the following sections of the GMC's guidance:

• Point 21.b. 
• Point 21.c. 
• Point 21.d. 

21.b. Treat patients with dignity

This is probably the most important area of concern for disabled people. Reports and surveys (including those for older people and patients generally) continue to stress the need for respect and dignity. These terms appear to be common sense but it is evident that providing respect and dignity to all is not yet common practice.

Providing respect and dignity to anyone requires underpinning knowledge and skill about their needs and requirements. For example, assisting a Muslim patient is improved when staff are familiar with cultural requirements. Treating women or men is more effective when staff are familiar with gender issues and requirements. Services which assist disabled people likewise require disability equality competence in order to provide effective dignity and respect. Disability equality competence is hardly a marginal skill and cannot be achieved without adequate and appropriate training.

21.c. Treat each patient as an individual

It is important to treat each disabled patient as an individual regardless of their impairment. For example, when treating a disabled patient in the presence of a non disabled partner, advocate, parent or child, talk face to face to the disabled patient unless there are very exceptional circumstances and the disabled patient asks you to communicate with the nominated person direct.

If a patient has difficulty in communicating do not assume that they do not understand what is being said to them. For example a deafblind person may need more time to have something explained to them but can often respond relatively quickly.

Do not assume lack of capacity to consent if the patient does not appear at first to understand. Firstly, determine how informed consent can be obtained by for example using BSL interpreters for Deaf people, deafblind interpreters or advocates for people with learning disabilities or even adapted communication aides such as voice activated soft ware.

Equally make every effort to translate an issue in simple terms but without reverting to a patronising tone of voice, or talking very loud.

A further issue is that people often make assumptions and fail to check these out with the service user. For example a wheelchair user who is going to be examined by a doctor may find it more comfortable if they are examined in their wheelchair rather than on the bed. Doctors should, wherever possible, respect the patient’s wishes and not insist on examining them on the bed just because the majority of patients are examined in this way. If they cannot stay in their wheelchair the doctor should give clear reasons as to why this cannot happen.

21.d. Respect patient’s privacy and right to confidentiality

A disabled patient’s right to privacy and confidentiality should be respected like every other patient regardless of impairment. For example, if a disabled person needs someone with them during treatment to explain things, such as an advocate, carer or sign language interpreter, this should be allowed. However if a disabled patient such as someone with a learning disability does not want to be accompanied this should also be respected.

If information is likely to be sensitive ensure that the patient agrees with the process. For example a person with a learning disability may or may not want an advocate or relative present. A deaf person who relies upon a BSL Interpreter may wish to suggest the one with whom they feel confident to share such knowledge.

It is also important to note that disabled people may prefer to use an advocate or interpreter other than there regular one if very sensitive confidential information is to be communicated to them via such a third party. Being familiar with local disabled groups and services will help you to be more aware of disability equality issues and to provide a better service/standard of care to your patients. The patient should, within reason, be able to choose the person they use for communication support.