We are all equal ........ but some are more equal than others!

The General Medical Counsel (GMC) in the UK is addressing some issues around doctors training and the question of disability…..how to balance between equality and fitness to practice? Are we all equal? And can my medical history, mental status, circumstances affect my ability to do my job or is this discrimination?

 There are no easy answers – as usual –  and as I think about the issue, I think this affect not only medical education but all walks of life. To be a police officer I have to be certain weight and height, not discrimination against overweight people but practical requirement to be able to catch the cheeky mugger as he runs like the wind in a busy shopping centre. I can not role on a wheelchair expecting to be offered a job as an airhostess not because of disability but because it will not be safe for me or the passenger in my care if I am not mobile quick enough to evacuate in case of an emergency.

I don’t want to see a doctor who needs more help and support than all his patients! I equally don’t want to see people rejected from jobs just based on their skin colour or gender or because they simply ‘don’t fit in’.

In this seesaw, I feel that equality is becoming a huge issue and almost all other factors seems to be forgoten. I think there are few questions to consider with any job;

-        Can I still do the job?

-        Am I a danger to myself or others?

-        Will my ideas, beliefs, mental status, medication etc get in the way of my professional judgement?

Equality, yes sure, great and wonderful but let us keep the balance on this seesaw and make sure that fitness to do the job is considered too.

Science or what?

The buzz words in medicine at the moment are about "evidence based" and "controlled studies", we need to prove everything and research everything in a "controlled" way, to the extent of this paper here on the effectiveness of parachute in preventing death. Here is the summery of the paper, you can read the full paper on the BMJ.


BMJ 2003;327:1459-1461 (20 December), doi:10.1136/bmj.327.7429.1459

Hazardous journey

Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials Gordon C S Smith, professor1, Jill P Pell, consultant2

1 Department of Obstetrics and Gynaecology, Cambridge University, Cambridge CB2 2QQ, 2 Department of Public Health, Greater Glasgow NHS Board, Glasgow G3 8YU

Correspondence to: G C S Smith gcss2@cam.ac.uk


Abstract
Objectives To determine whether parachutes are effective in preventing major trauma related to gravitational challenge.

Design Systematic review of randomised controlled trials.

Data sources: Medline, Web of Science, Embase, and the Cochrane Library databases; appropriate internet sites and citation lists.

Study selection: Studies showing the effects of using a parachute during free fall.

Main outcome measure Death or major trauma, defined as an injury severity score > 15.

Results We were unable to identify any randomised controlled trials of parachute intervention.

Conclusions As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute