Colin's accident and its impact on his job
Colin was attending a medical conference when he had a serious fall which fractured his skull. He was admitted to hospital immediately and received intensive treatment there for a month. By that time he was still totally deaf in his left ear and profoundly deaf in his right ear. He also had a serious loss of balance which improved very gradually.
The prospects of him returning to work as a GP seemed bleak. While he was still in hospital, friends and colleagues suggested that he consider taking up a different branch of medicine that would involve less direct contact with patients, such as pathology or radiology; but Colin did not want to lose the direct contact with his patients which for him was the most rewarding part of his job. He felt that his life was "with people, not bits of them, nor even their radiographs".
Moreover, it was natural that he should want to continue in a job in which he now had considerable expertise and to maintain a well-established practice with a loyal following of patients. From a financial point of view he could not afford a significant reduction in income. With a mortgage to pay and two children at private schools, he and his wife had substantial financial commitments. But the challenge facing him was how to communicate with patients and colleagues as a deafened GP.
The first steps in Colin's rehabilitation
No local statutory or voluntary organisation offered Colin and his family advice or support when he came home from hospital, apart from a social worker whose visit resulted in the installation of flashing lights connected to the doorbell! Otherwise Colin and his family had to cope with his deafness on their own for the first three months, while he was recovering at home.
Colin was fortunate however in having an otologist (ear specialist) as one of his patients; from him he learnt of the rehabilitation facilities available at the LINK Centre for Deafened People at Eastbourne. Nearly three months after his loss of hearing he attended the LINK Centre for a two-week rehabilitation course, and his wife joined him for the first week.
His involvement in this course gave him the opportunity to share his experience of being deaf with other deafened people. Finding out how other deafened people, who he felt were in a worse situation than his own, coped with their deafness boosted his own self-confidence and reinforced his growing determination to continue as a GP. The LINK Centre also introduced him and his wife to the rudiments of lipreading and taught them how to relax.
On his return from the LINK Centre Colin started attending local lipreading classes recommended to him by the otologist that was his patient. His lipreading began to improve, and he continued to attend these classes regularly for several years. Apart from the improvement in his lipreading, he enjoyed the teacher's stories and jokes and the social contact with other deafened and hard of hearing people, which included swapping examples of hilarious misunderstandings in conversations with hearing people.
Returning to work as a deafened GP
After his return from the LINK Centre course, Colin developed a plan of action for resuming his role as a GP. This consisted of the following main elements.
First, he recognised the difficulty he would have in lipreading his patients accurately and resumed his contact with his previous patients step by step. He started by working only with patients he knew well so that their symptoms would be easier to diagnose. When he had learnt to communicate effectively with this group, he gradually resumed the rest of his caseload. Only then did he start to take on new patients.
Because of the importance for correct diagnosis of understanding his patients' symptoms, he also developed an ingenious technique to ensure that he had followed what his patients told him. When they had described their symptoms, he summarised their account and asked them to say if his summary was correct.
Thirdly, he realised that the concentration required to lipread his patients accurately would be very tiring; so he reduced his workload by withdrawing from taking night calls -the other partners in the practice agreed to cover for him- and from working for a GP Unit for Obstetrics that he had helped to establish and run at a local hospital.
Next, he identified the specific tasks which would be difficult for him because of his deafness and asked his colleagues to do them for him. For example, he did not want to rely on a textphone for two-way telephone conversations. He considered that this would be cumbersome and slow for dealing with medical issues which might be urgent; so he arranged for his secretary to act as a "middleman" for his outgoing and incoming telephone calls to relay to the other caller whatever messages he wanted to give. In addition, on occasions when he was uncertain of his diagnosis (e.g. because he needed to use a stethoscope), he would bring in another partner to confirm it.
Then, four years after his accident, he took a course at Keele University that qualified him to supervise trainee GPs in their final year of practical training. Thereafter he took on trainee GPs every year until the year before he retired. They worked alongside him and provided valuable support by making important phone calls for him and undertaking tasks (such as using the stethoscope) that because of his deafness would inevitably call for a second opinion.
Colin's use of improved hearing aids
In addition to taking these initiatives Colin tried to take advantage of any technical advances that might reinforce what hearing he had left. Because of his medical contacts he could always get information about the latest developments in hearing aids, and in the early 1980s he volunteered to try out new forms of hearing aid that slightly improved the hearing in his right ear and so assisted his lipreading.
His decision to retire as a GP at the age of 60
By taking all these measures he succeeded in maintaining his practice and continuing to give good service to his patients. However, the daily effort required to overcome his difficulties in communicating with his patients and colleagues was exhausting, and, as there was no financial advantage for his pension in continuing as a GP beyond the age of 60, he decided to take early retirement then on health grounds. For the next 10 years he continued to contribute to the practice by undertaking minor surgery two days a week; this required far less communication with the patients. Then at the age of 70 he retired from the practice altogether, as required under NHS rules.
The impact of having a cochlear implant
A few years after he had retired, Colin decided to apply for a multi-channel cochlear implant in his left ear. Tests showed that he was suitable, and he had the operation. When the speech processing equipment was switched on, he could distinguish clearly the sounds of speech and a wide range of other sounds that had not been audible since his accident.
This quality of sound appreciation has not been maintained; a temporary loss of hearing in 1996 led to reprogramming of his speech processor, which cannot now reproduce the previous quality of sound. Nevertheless, it is clear that, if the cochlear implant had been available for Colin when he was working full-time as a GP, it would have reduced the strain of one-to-one communication with patients and colleagues. On the other hand, it would not have enabled him to use a telephone without help or to take part in group conversations.