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Many people have lost their job opportunities due to chronic diseases. The picture shows a job search diagram

Word count: 6523, reading time: about 11 minutes

Introduction：These chronic diseases have not made them lose their ability to work, but they have made them lose the opportunity to work.

Author |YiMagazineDeng Yiyun

In June 2023, after seven years of study and two years of regular training, medical student Liang Lu Nuan passed the recruitment examination of Xiamen Hospital of Traditional Chinese Medicine with the first place in the written test and interview. However, during the pre-employment physical examination, Liang Lu Nuan was rejected for employment because he was diagnosed with Hashimoto's thyroiditis.

"I studied medicine and I know what Hashimoto's thyroiditis is. It has no impact on my work and life. I think it is unreasonable to reject me for this reason." Liang Lu Nuan still finds it hard to accept the experience of being rejected a year ago.

Li Zhiying, who carries the thalassemia gene, also encountered a similar situation. She applied for the civil service examination for seven consecutive years and finally won the first place in the written test and interview this year, but a week after completing the physical examination, she received a notice that she failed the physical examination. Li Zhiying, 31 years old this year, has been working for many years and currently has a stable job in a public institution. She applied for the civil service examination just to give herself more options, but she still feels regretful and incomprehensible. "The work experience of the past few years has proved that I have the normal ability to perform my duties. Why can't I pass the civil service recruitment?"

Physical examination is usually the last hurdle in the job search process, and is just a routine step in the eyes of most candidates. However, in recent years, there have been a number of candidates who have been rejected for failing the physical examination. The reasons for rejection are often chronic diseases such as Hashimoto's thyroiditis, diabetes, and hypertension. As the physical examination requirements for candidates become more stringent, such standards are no longer limited to the recruitment process of civil servants. Some institutions, state-owned enterprises, and even private enterprises are also referring to the physical examination recruitment standards for civil servants. As a result, job seekers like Liang Lu Nuan and Li Zhiying have found that chronic diseases that have almost no physical symptoms in daily life and have never affected them have now become obstacles to their job search.

Which diseases will be “kept away”?

The basis for the rejection of Liang Lu Nuan and Li Zhiying's employment came from the "General Standards for Physical Examination for Civil Servant Recruitment (Trial)" (hereinafter referred to as the "Physical Examination Standards") and the "Operation Manual for Physical Examination for Civil Servant Recruitment (Trial)" (hereinafter referred to as the "Operation Manual"). These two regulations were promulgated by the former Ministry of Personnel and the former Ministry of Health in 2005. The physical examination items and standards in civil servant recruitment must be implemented in accordance with these two regulations.

The picture shows a screenshot of the "General Standards for Physical Examination for Civil Servant Recruitment (Trial)"

The "Physical Examination Standards" lists 21 conditions that can be judged as unqualified for the physical examination, including organic heart diseases such as rheumatic heart disease, blood diseases, tuberculosis, severe chronic gastrointestinal diseases, endocrine system diseases such as diabetes, third-degree simple goiter, obstructive gallstones or urinary stones, etc. Liang Lu Nuan suffered from Hashimoto's thyroiditis, which was not among them.

The Operation Manual has made more detailed implementation rules for these 21 items. For example, for blood system diseases, the Operation Manual lists 8 common diseases, including anemia, polycythemia, white blood cell diseases, and leukemia, and clearly states that in plain areas, if the hemoglobin content of adult males is less than 130g/L and that of females is less than 115g/L, they can be diagnosed as anemia. Except for iron deficiency anemia caused by certain reasons, they are considered unqualified for physical examination. Li Zhiying checked the Operation Manual and found that the hemoglobin index she checked was 110g/L, which was lower than the qualified standard.

Regarding Article 16 of the Physical Examination Standards, "Third degree simple goiter is disqualified", in addition to the explanation of the article and the key points of diagnosis, the Operation Manual also specifically lists "Notes" - hyperthyroidism, goiter secondary hyperthyroidism, Hashimoto's thyroiditis, thyroid cancer and high-functioning thyroid adenoma are all considered to be disqualified for the physical examination. In other words, in the Operation Manual, more diseases are directly listed and considered as disqualified. According to incomplete statistics from YiMagazine, more than 70 diseases will be judged as disqualified for the physical examination.

Li Wanrong, a lawyer who has long been concerned about employment equality, paid more attention to the education and employment issues of people with disabilities and AIDS patients in her early years. In the past two years, she has noticed that many patients with chronic diseases are hindered in their job search due to the "Physical Examination Standards". Judging from discussions on social media, patients with Hashimoto's thyroiditis like Liang Lunuan are one of the groups most affected by the "Physical Examination Standards". In addition, patients with diabetes, hypertension, anemia and other diseases often have the experience of being "turned away" during the physical examination stage.

Chen Mengjie, a law student who is about to graduate, accidentally discovered that she had thyroid nodules last year. The results of a blood test showed that her thyroglobulin antibodies (TgAb) were high, which is one of the criteria for diagnosing Hashimoto's thyroiditis. Although civil servants were not Chen Mengjie's first choice for employment, she was still angry and collapsed when she learned that she would not be able to pass the civil service recruitment. "It was a big blow when I found out that my rights were deprived. Whether I want to take the civil service exam and whether I can take the civil service exam are two different things." Chen Mengjie told YiMagazine.

In addition, some patients whose employment restrictions have been lifted under relevant regulations may still face implicit discrimination during the job search process, such as hepatitis B virus carriers.

In 2010, the Ministry of Human Resources and Social Security, the Ministry of Education, and the former Ministry of Health issued the "Notice on Further Standardizing Physical Examinations for School Admission and Employment to Protect the Rights of Hepatitis B Surface Antigen Carriers to School Admission and Employment," which stated that employers may not require hepatitis B testing during employment physical examinations, may not require hepatitis B test reports, and may not ask whether a student is a hepatitis B surface antigen carrier. The "Operation Manual" also clearly states that hepatitis B testing is not allowed in all routine hepatitis testing items.

However, Zhao Yuxin, who has been a carrier of the hepatitis B virus for more than ten years, was required to screen for four infectious diseases, including hepatitis B, hepatitis C, AIDS and syphilis, in addition to the routine items in the pre-employment physical examination when she applied for a research and development position at a biopharmaceutical company this year. She was ultimately rejected for employment because of her positive hepatitis B surface antigen test.

Hepatitis B virus is mainly transmitted through three ways: blood, sexual contact, and mother-to-child transmission. The position Zhao Yuxin applied for does not involve blood contact, and she believes that she is not likely to be infected. According to the requirements of the former Ministry of Health, hepatitis B carriers are not allowed to work in occupations and industries that require testing, including special police positions, civil aviation personnel, and blood collection, blood component preparation, and blood supply at blood stations - none of the industries and positions Zhao Yuxin applied for are included.

Is the disease threshold reasonable?

Liang Lu Nuan has been suffering from Hashimoto's thyroiditis for seven years. As a medical student, she knows that Hashimoto's thyroiditis will not affect her normal work. Apart from annual routine checkups, she does not even use medication.

Hashimoto's thyroiditis is an autoimmune thyroiditis named after Dr. Hashimoto Saku, the Japanese doctor who first discovered the disease. It is generally diagnosed through thyroid function, thyroid antibodies and B-ultrasound. The prevalence of Hashimoto's thyroiditis is about 1% to 2%, and the prevalence in the female population exceeds 10%. A research paper published in Nature Communications by Professor Song Huaidong's team from the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine pointed out that the pathogenesis of Hashimoto's thyroiditis is still unclear and there is a lack of treatments targeting the cause.

According to Chen Mengjie's experience of seeing doctors in many hospitals, most doctors do not regard Hashimoto's thyroiditis as a serious disease. When she was seeing doctors at Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, the doctor told her that this disease does not require special attention and treatment, and it is not like hyperthyroidism and hypothyroidism, which have symptomatic drugs to alleviate the condition.

However, the medical "understatement" of Hashimoto's thyroiditis and the strict restrictions on the disease in the "Physical Examination Standards" make many patients feel disconnected and contradictory.

Most doctors do not consider Hashimoto's thyroiditis as a serious disease. The picture shows a cartoon of Hashimoto's thyroiditis

Worried that she would not be able to apply for the civil service examination next year, Chen Mengjie would pay special attention to her TgAb index, an indicator of thyroid function, every time she had a follow-up examination. In her doctor's opinion, it was meaningless to focus on only this one indicator. But Chen Mengjie knew that if only this one indicator was abnormal, she would not be able to apply for the civil service examination. "The doctor didn't seem to think the disease was serious. He thought it was unnecessary for you to care so much, but you still had to care about it. Sometimes the doctor's attitude was also a second blow to me." Chen Mengjie said.

Li Zhiying, a thalassemia patient who is also "incurable", believes that the restrictions of the relevant physical examination standards are too strict. Clinically, the normal reference range of hemoglobin for adult women is 110-150g/L, while the "Operation Manual" considers that it is unqualified if it is lower than 116g/L. "I may not be diagnosed with anemia in the medical sense, so why is it abnormal when I apply for a civil servant?" In addition, thalassemia is a hereditary disease. There are currently no drugs or mature gene therapy methods. Guangdong, where Li Zhiying is located, as well as Guangxi and Hainan are high-incidence areas of thalassemia. Data from the 2019 baseline survey of the Guangdong Province Thalassemia Prevention and Control Project showed that the thalassemia gene carrier rate among the registered population in Guangdong was about 16.8%. According to the "Physical Examination Standards", these people are naturally not eligible for civil service positions.

Lawyer Wen Haibo told YiMagazine that the "Physical Examination Standards" and "Operation Manual" are authoritative normative documents issued at the national level. Their purpose is to select high-quality talents with excellent comprehensive conditions for the country. However, with the passage of time and the progress of medicine, some backward contradictions have gradually emerged, and some regulations are out of touch with real life.

In the Operation Manual, Hashimoto's thyroiditis is defined as "an autoimmune disease that may be accompanied by other autoimmune diseases such as Sjögren's syndrome, systemic lupus erythematosus, rheumatoid arthritis, etc." It also states that "this disease is more common in middle-aged and elderly people and rare in young people." However, in recent years, the age of onset of Hashimoto's thyroiditis has gradually become younger. Many of the Hashimoto's thyroiditis patients that Chen Mengjie has come into contact with are young people in their twenties, and 80 to 90 percent of them only discovered that they had the disease during the final pre-employment physical examination. This also indirectly confirms that Hashimoto's thyroiditis has no obvious physical symptoms. Liang Lu Nuan said that in clinical experience, it is rare for patients with Hashimoto's thyroiditis to have combined immune diseases such as Sjögren's syndrome and systemic lupus erythematosus.

In Li Wanrong's opinion, regulations like the "Physical Examination Standards" that explicitly restrict the employment of patients with certain diseases are not reasonable. She believes that everyone is an independent individual, and even if they suffer from infectious diseases or other serious diseases, they should be "analyzed on a case-by-case basis" and the employer should judge and decide based on the individual's situation. Setting a universal standard at a macro level to directly exclude some people is equivalent to depriving them of their right to employment.

Chen Mengjie, who majored in law, believes that the purpose of establishing physical examination standards is to screen for diseases that affect the ability to perform normal duties, and its starting point is reasonable, but some clauses violate the intention of its establishment. For example, the ability of most patients with Hashimoto's thyroiditis to perform their duties will not be affected. In addition, the understanding of diseases is a process of development, and the corresponding standards should also change with the times.

In fact, the "Physical Examination Standards" and "Operation Manual" have undergone two major revisions in 2010 and 2016, relaxing some standards. For example, in the 2010 revision, the 1-fold limit in the "Operation Manual" was changed to 2-fold, "It is generally believed that serum ALT exceeding 1 times the upper limit of the reference value indicates inflammation, necrosis and liver damage of liver cells"; in the 2016 revision, the heart rate range that can be considered qualified after excluding pathological changes was changed from "50-60 beats or 100-110 beats per minute" to "heart rate less than 50 beats or greater than 110 beats per minute."

However, most of the revisions are still adjustments in the language, such as deleting the sentence "Hepatitis B carriers who are excluded from hepatitis through examination are qualified" in Article 7 of the Physical Examination Standards, and changing "blood diseases" in Article 3 to "blood system diseases". In general, the progress of the revision of relevant regulations is relatively slow. In the eight years since 2016, there have been no new revisions to the Physical Examination Standards and the Operation Manual.

The company's "concerns"

Another more serious problem is that the "Physical Examination Standards" and "Operation Manual" that were originally only applicable to civil servant recruitment are actually being referred to in a wider range. The Xiamen Traditional Chinese Medicine Hospital that refused to hire Liang Lu Nuan does not fall within the scope of application of the above regulations. According to the observations of several interviewees and related content posted by netizens on social media, in addition to civil servant recruitment, some public institutions, central enterprises, state-owned enterprises and a few large private enterprises also refer to the "Physical Examination Standards" to screen job seekers.

In theory, recruitment is a two-way selection process between job seekers and employers, and employers have the right to set certain screening criteria. From the employer's perspective, it is understandable that HR wants to recruit employees with good health and avoid potential risks. An HR of a state-owned enterprise told YiMagazine that when recruiting, the company will pay attention to whether the job seeker has a particularly serious disease or the possibility of infecting colleagues. Some jobs may require employees to work night shifts or short-term work with high intensity, and some patients with diseases should not be too tired.

"Some serious blood diseases and visceral diseases may directly lead to sudden death. Chronic diseases such as hyperthyroidism may make employees easily tired, unable to concentrate on work, and even make mistakes at work. Although these are only possible, companies will still try to avoid risks." An HR of a private enterprise told YiMagazine that his company will focus on routine blood and urine tests when looking at the physical examination reports of job applicants. If there are obvious abnormalities, they will require a re-examination and confirmation of the medical history. They will only hire after ensuring that the job applicant's illness or major surgery experience will not affect their current job.

Since the only national-level normative documents on pre-employment physical examinations are the "Physical Examination Standards" and the "Operation Manual", employers have no other references. Wen Haibo said that it is costly for employers to formulate a comprehensive and systematic physical examination standard on their own. Therefore, if employers want the recruitment process to be open, transparent, standardized, reasonable, and legal, they can usually only directly refer to the "Physical Examination Standards" and the "Operation Manual" to implement it.

A few local governments have issued general physical examination standards for the recruitment of local public institutions, and most of these standards have been modified and adjusted based on the "Physical Examination Standards". For example, the "General Physical Examination Standards for Public Institutions in Guangdong Province" added "thalassemia, which does not affect normal work, is qualified" in the blood disease section, and deleted the requirements for vision and hearing in the "Physical Examination Standards".

In actual practice, different regions and employers have different degrees of strictness in their physical examination results, so job hunting has become a gamble of luck. Chen Mengjie said that thyroid disease is usually diagnosed by doctors after palpation. If no problems are found during palpation, the patient can be "lucky" to escape.

From another perspective, the fundamental reason why employers use strict physical examination thresholds to screen job seekers is that the job market is oversupplied. Even if an employer screens out a qualified candidate due to a failed physical examination, there are still many excellent candidates waiting to fill the position. The above-mentioned private enterprise HR revealed that after he posted a recruitment assistant position with a monthly salary of less than 5,000 yuan on the recruitment platform, he received 40 to 50 resumes in two days.

Judicial embarrassment

After preparing herself mentally for the possibility that she might not be able to work in Xiamen in the future, Liang Lu Nuan decided to sue Xiamen Hospital of Traditional Chinese Medicine in July last year.

In the first instance, Liang Lu Nuan believed that Xiamen Traditional Chinese Medicine Hospital's refusal to hire her on the grounds of the "Physical Examination Standards" and "Operation Manual" was unreasonable and constituted employment discrimination. She pointed out that the scope of application of the "Physical Examination Standards" and "Operation Manual" was civil servant recruitment, while the "Interim Provisions on Public Recruitment of Personnel in Public Institutions" only stated that applicants must have physical conditions that meet the requirements of the position. In addition, she also submitted various honors she received while studying at university and during regular training to prove that she was competent for the job and that Hashimoto's thyroiditis would not affect her work.

The court of first instance ultimately ruled that the reasons Liang Lu Nuan put forward for employment discrimination by the employer were insufficient and rejected the lawsuit. Liang Lu Nuan continued to appeal the verdict, and the court of second instance also stated that the facts of the first instance were clear and announced that the original verdict was upheld.

Before filing the lawsuit, Liang Lu Nuan and the public interest lawyer who assisted her had anticipated the outcome of losing the case - the employer announced the recruitment selection criteria in advance, and the job seekers signed up for the recruitment exam and implicitly agreed to the recruitment process and criteria. From a procedural point of view, there was no problem with the employer's operation. Wen Haibo and Li Wanrong also told YiMagazine that in similar cases in the past, there were basically no cases where the plaintiff won the case, and the best result was that the two parties reached a mediation settlement.

According to Li Wanrong, the Constitution of the People's Republic of China, the Labor Law of the People's Republic of China, and the Employment Promotion Law of the People's Republic of China all have relevant provisions on employment equality and employment discrimination. Article 26 of the Employment Promotion Law stipulates that employers recruiting personnel and professional intermediary agencies engaging in professional intermediary activities shall provide equal employment opportunities and fair employment conditions to workers and shall not implement employment discrimination. From the perspective of legal effect, the above laws are all superior laws to the Physical Examination Standards. Li Wanrong believes that the formulation of the Physical Examination Standards conflicts with the superior laws, and it directly excludes the equal employment rights of some patients with diseases.

However, in the actual judicial process, it is difficult to win a lawsuit against an employer based on this. Wen Haibo pointed out that the court's decision is "within its comfort zone" and there is no risk for the court to determine the rationality of the employer's practice according to existing normative documents and procedures. On the contrary, from a legal perspective, the court can also support the plaintiff's lawsuit request, but there are certain risks. "At present, only when the regulations such as the "Physical Examination Standards" are changed, the judge will have a more reasonable basis for the judgment." Li Wanrong said.

In recent years, many NPC deputies and CPPCC members have suggested revising the "Physical Examination Standards". Li Wanrong has also written to the National Health Commission, the Ministry of Human Resources and Social Security, the General Office of the State Council and other departments for two consecutive years to make suggestions, but has not received an effective response.

Before filing the lawsuit, Liang Lu Nuan and his lawyer had already foreseen the outcome of losing the case. They insisted on using legal means because they believed that only in this way could more people pay attention to the problems in the Physical Examination Standards. "If we don't file a lawsuit, many people may acquiesce that similar things rarely happen, and they will not think that the Physical Examination Standards infringe on their rights." Liang Lu Nuan said.

Reluctant to deal with

There are only a few people like Liang Lu Nuan who have the courage and determination to take legal action. Most people who are rejected for employment due to illness often consider themselves unlucky and look for new job opportunities. After being rejected, Zhao Yuxin felt sad, but she did not want to spend time and energy to defend her rights. Later, she successfully passed the recruitment of another pharmaceutical company - this company did not require hepatitis B testing in the physical examination.

Wen Haibo said that job seekers first need to have a basic understanding of the law and know that their rights have been violated. At the same time, they must also consider the cost of defending their rights and the risks that may affect future employment. A job seeker once said that being rejected this time does not mean that there will be no chance next time, but once a lawsuit is filed, it is equivalent to announcing the illness to the world.

In fact, not only irreversible diseases such as Hashimoto's thyroiditis and thalassemia, but also common chronic diseases such as hypertension and diabetes are also considered unqualified for physical examinations. However, compared with the former, indicators such as blood pressure and blood sugar are relatively controllable. Some job seekers will take certain measures before the physical examination to stabilize the indicators so as to pass the physical examination smoothly. However, diseases such as Hashimoto's thyroiditis and thalassemia basically cannot control the indicators in a short period of time. Someone told Li Zhiying that she could deal with the physical examination by proxy or blood transfusion, but she did not want to take risks and cheat by illegal means.

After experiencing a downturn in the job market in the past two years, Chen Mengjie has decided to apply for the civil service examination. Compared with those who only found out that they had related diseases during the physical examination, Chen Mengjie felt that it might be a kind of luck that she found out that she had Hashimoto's thyroiditis before applying for the exam. Although there is currently no clear symptomatic drug for Hashimoto's thyroiditis, Chen Mengjie is still trying to find various ways to regulate the condition through functional medicine methods such as proper diet, hoping that the antibody indicators can return to normal before graduation in June next year. She used an Excel spreadsheet to record the changes in her indicators and went to the hospital for a checkup every three months. The doctor felt that her checkup frequency was too high, but she "had a sense of time pressure." If the indicators are still abnormal after conditioning, Chen Mengjie may still give up applying for the civil service examination. She does not have the courage to face the result of being rejected during the physical examination.

Of course, what they hope to see most is that the "Physical Examination Standards" can be revised as soon as possible. "I am 23 years old this year. I don't know if I can see changes within 12 years, before I reach the age limit of 35 to apply for civil service examinations," said Chen Mengjie.

(At the request of the interviewees, Li Zhiying, Chen Mengjie, and Zhao Yuxin are pseudonyms in this article)