A medical student argues how medical school falls short in supporting students with a chronic illness or disability and what can be done differently.

"They are doctors, of course, they will understand!"

I was trying to explain to my disability advisor how logistically challenging and reputationally damaging it could be for someone in my position to disclose a fluctuating and so often belittled chronic illness like migraine to so many doctors on a rotating schedule. 

'So just tell your most senior supervisor."

"Who do you mean? The consultant of the team? Head of the department I'm assigned to? Clinical School?"  

"Whoever is responsible for you."

"That's not just one person. On any given day, it could be up to 6 people. I could be with the senior medical student, intern, resident, registrar, consultant, nurses, many other people. And teams change. And I change teams almost weekly. Would you like me to disclose my medical history to the entire hospital? And every potential future employer in the state?"

"But they are doctors..."  

I left this meeting incredibly frustrated. I'm a pretty open person and I’m more than happy to chat about my migraines (with a side of freshly suspected neurodivergence) and how unaccommodating medical school is during a coffee break. But when the doctors I’m working with haven’t even taken the time to learn my name, why would I make such a disclosure?  I was also a bit shocked that I needed to explain the course, the strictness of faculty, and what actually happens on placement. It was as if they've never had a medical student with a disability, chronic illness, or mental illness ask for help before despite the numerous times their email has been advertised to us. 

It had taken me a year to book a doctor's appointment. A year to book this disability advisor's appointment. I could only attend because of a well-timed pandemic where students were removed from placement, so I was reliably available during business hours without it being deducted from my attendance. In the past, I was called into meetings with my supervisors to discuss that I was almost below the attendance requirement.  In these meetings, I have been accused of "partying too hard" or "being reckless with my sleep hygiene." Even though I do not drink alcohol, I do not party, and I prioritise sleep over everything to avoid migraines. My absences were getting the ‘college party girl edit’ despite having dragged myself to see my GP every single time I had a migraine, even on weekends. I did this just so I had a ‘convincing paper trail’ if I ever ended up in the professionalism meetings they threatened me with. 7/10 migraines I went to placement anyway because of the attendance requirement. 

It was as if they've never had a medical student with a disability, chronic illness, or mental illness ask for help before despite the numerous times their email has been advertised to us.

I've never sat an exam without the right side of my head throbbing, with a pile of triptans and antiemetics sitting in front of me. Squinting at the paper, desperately trying to decipher the questions, I just make snap decisions when shading the bubbles. I hope that whatever cells in my brain are still functioning will grasp enough of the information from my years' worth of study to make my stabs in the dark, correct. Thankfully, I'm not the competitive type, so even if I get a high proportion wrong, I just need to clear the hurdle requirement and make it to the following year. 

Aside from exams, my triggers for migraines revolve entirely around placement. Not the job or the stress or rushing around. It’s the not eating, not drinking, early mornings, long days, late nights, no days off because your weekends are spent juggling life, catching up on assignments and studying for exams. In other words, completely preventable and avoidable. 

Most accommodations suggested for my circumstances are standard practice for most university students in most courses at my university and could reasonably be implemented to benefit all medical students. An up-to-date unit guide with learning objectives to have a blueprint to follow if I fall behind or want to get ahead over university breaks. Standardised course materials such as textbooks or agreed-upon clinical guidelines to understand the depth and know that I am meeting the scope. Recorded lectures with captions that can be paused when I need to take a break. Not requiring live attendance or participation in zoom lectures where staring at a computer screen for hours triggers a migraine.  Food, water, and bathroom breaks on placement. Clear and consistent guidelines for reasonable lengths of shifts and end times for students on placement. The ability to schedule doctors', psychologists', and specialists' appointments without worrying about attendance at placement or professional image. Correct and timely administrative information from faculty regarding examination format and instructions, so if I need to request accommodations, I could.  As well as timely information for placement to reduce stress regarding short term relocations, finding affordable rental accommodation, organising access to medical services and and avoiding losing employment due to late announcements of placement locations, rotation allocations or weekly schedules of compulsory classes.  

Since medicine, for most, is a lifetime vocation, we all will become a doctor with a medical condition, even if we were specimens of ideal health when we commenced medical school. So why, as a student, does it feel like medicine objects to the idea that doctors could be sick in any way that wasn't a direct result of being in the hospital? Like picking up a cold from a colleague or gastro from the paeds patient or burn out from exploitative working conditions and unpaid overtime. Those illnesses are all expected and acceptable —well perhaps aside from burn out— and everyone juggles the work to accommodate, but the same is not done for those with chronic illness. 

It's a worthwhile investment to create a workplace environment that promotes everyone's physical and mental health and to have mechanisms in place to easily make accommodations for those with disabilities, chronic illness, or mental illness. We should foster a culture of accommodating each other's needs in the workplace no matter how temporary or long term. That begins with ensuring appropriate support is available for medical students who are disabled, have a chronic illness, or mental illness in medical school.