Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act...
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Transcript of Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act...
Dr Elizabeth Howard MRCGP
Define Disability ImpairmentDisability
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 WorkDiscrimination 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 prescriptionSort 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 surgeryNegotiate for appt Get washed and dressedStairs, Breakfast and take medicines Walk down road, cross road Get correct bus -+ pay fare, Get off at correct stopCheck in at receptionCall systemFind, communicate with Dr / get on examination couch. Go to chemist Sign / pay for prescription – you are not automatically
exemptGet 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
issuesHard of hearing/ deafPart sighted / Blind Memory impaired- agreed contactUnable 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 ImpairmentOther disabilities ( e.g. hearing + sight)Personality – self reliant vs. dependantDepression / anxiety Opinions in community Willingness to be seen with aids Ability to afford better aids No two the same !!!
Pride and Prejudice
HearingHearing 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 cardLow vision aidsTel: 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 CentreSensory Disability social services Registered blind/ deaf Mock up kitchen with gadgets, fire alarm,
baby alarm, Freedom pass – Speech ? Sight/ Hearing ( if
cannot drive – blue badgeWhite stick training
Physio, OT, Speech therapy Tools for independenceRequire 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 freeToo many around – easy or confused GP’s?Form :appalling – amputeesAble 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 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
Protection from physical harm – e.g. post open laparotomy
Space to make initial recovery from SEVERE depression / mental heath
Public health/ infection
control
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 5SEEN 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
ESAESA – 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