Tips and advice for the colour blind doctor
1. Do not deny you have abnormal colour vision. Get a diagnosis of your colour vision deficiency and find out whether it is mild or severe.
2. Make yourself aware of the difficulties you may encounter in discriminating, naming and matching colours and the situations in which this happens. This is a learning process that takes time, advice and experience.
3. The difficulties you can encounter will include: seeing skin redness, pallor, cyanosis and jaundice; seeing pallor of the optic disc and distinguishing retinal hemorrhages; seeing blood in stool and vomit, interpreting colour-coded information from instruments, and work in the laboratory including the use of staining techniques in histology and bacteriology.Go to the Picture gallery to see examples of the problems colour blind doctors can experience.
4. There are ways of compensating. Doctors have reported the following: giving extra time and care to the examination of the patient; giving special attention to the history obtained from the patient; checking your examination with special investigations; and accepting help from others (ref 47). Using dark/light differences as a cue to colour can also help in certain situations, and using a coloured filter, for example in ophthalmoscopy, can help to identify retinal hemorrhages. Good lighting is also important: daylight fluorescent tubes should be used, not warm-white ones, and not tungsten bulbs.
5. Recognise that these methods of compensating cannot be expected to work in all cases. For example, the doctor may fail to detect a rash or blood in a body product by the normal process of observation. These signs are sometimes pivotal, that is, if they go unobserved the wrong course of action can be adopted with harm to the patient (ref 14). It is the unexpected sign in particular that may go unobserved.
6. When you enter medical school you should tell the occupational health physician and your tutors that you have a colour vision deficiency. When deciding on a specialty discuss your decision with someone experienced in that specialty.
7. Not everyone practising or teaching medicine is aware of the effects of colour vision deficiency in medicine. Do not accept advice from those who are not alert to the possibilities or not prepared to listen.
8. If you are already working in a specialty you might think that you should change to another that is more suitable in view of your colour vision deficiency. Experience and advice will help you make that decision.
*Coloured pencils* (pack of 12) with the name of the colour on each can be of help. They can be obtained at “Personalised Gift Ideas Ltd.” Telephone: 01294 3122777. E-mail: firstname.lastname@example.org
Advice regarding specialties
This advice is not claimed to be complete and circumstances may sometimes alter its relevance.
Primary care may not be an ideal choice. Colour is an important sign for general practitioners and several factors can lead to difficulties. GPs sometimes work alone, particularly when visiting in the home, where there will not be help from others. In addition, they will encounter a wide range of presentations and will not always have control over the conditions of observation, for example, when there is poor illumination.
Paediatrics presents similar problems and it must be realised that skin rashes and the red drum of otitis media are common. Visualising the small drum of the infant to identify redness can be particularly difficult.
Pathology uses coloured stains in histology and microbiology to reveal cells and organisms can pose problems for a colour vision deficient pathologist. However, alternative staining techniques can sometimes be used and asking help from others may avoid problems. Performing a post-mortem examination may present a problem.
Anaesthetists find that colour blindness does not present a problem when modern technology is used. Pulse oximetry, for example, solves the problem of detecting cyanosis (ref 29).
Ear, nose and throat surgeons have to detect signs of inflammation, which may present a problem to the colour blind. One surgeon wrote that “the subtle changes of blue/pink/red, particularly the flamingo pink of Schwartz (in otosclerosis) would be difficult to distinguish if colour blind” (ref 26). This is a rare condition, but otitis media and otitis externa are common (refs 25, 40).
Dermatology may not present as many problems as might be expected, probably because lesions are often large and textured; however, faint macular rashes and rashes in racially pigmented skin are likely to cause difficulties (ref 43).
Ophthalmology requires small retinal haemorrhages to be seen and distinguished from small melanin spots. It also requires evaluation of the pallor or redness of the optic nerve head as well as observing inflammation of the conjunctiva and skin of the lids. General ophthalmology is probably better avoided by those with a severe colour vision deficiency but may not be so much of a problem in surgical ophthalmology. Protans (with a red deficiency) will have the further problem that a filter will not help them in distinguishing melanin spots from haemorrhages in the retina.
In obstetrics and gynaecology the detection of fresh blood can be important as a sign. For example, postnatally, red instead of brown loquia suggests retained products.
In endoscopy there is some evidence that there can be difficulties in observing certain abnormalities (ref 33, 55, 56). Colour plays a major role, particularly in observing flat red lesions. Doctors have reported difficulties in making this type of observation and some studies have confirmed this (ref 56).
In surgery little information is available about problems due to abnormal colour vision. One doctor wrote that during surgical procedures he had great difficulty discerning where muscle fibres ended and tendon fibres began, and that the same thing applied to other structures and concluded that he was not suited to a career in surgery (ref 58). A Plastic and Hand Surgeon informed this website that one difficulty was that he had seeing the red laser point of the mobile C-arm x-ray machine against the green surgical drapes in theatre – solved by blue drapes, or a colour seeing registrar. The comments of surgeons would be welcomed.
Neurology. A neurologist with colour vision deficiency claimed that neurology was “a great choice” for a doctor with colour vision deficiency (ref 23). But another neurologist reported that due to his deficiency he found difficulty observing Kayser-Fleischer rings (personal communication; 2009 Professor Andrew Lees). These rings are found at the outer edge of the cornea and indicate Wilson’s disease. As they appear either green or brown the difficulty is not unexpected. The neurosurgeon may find difficulty during operation in inidentifying the edge between normal brain tissue and tumour. It can depend on distinguishing between grey and pink.