Q&A: Some physicians show discriminatory attitudes toward patients with disabilities
Click Here to Manage Email Alerts
Physician bias and discrimination against patients with disabilities may contribute to health care disparities, a new study found.
The findings also revealed several other barriers to caring for patients with disabilities.
“Physicians reported feeling overwhelmed by the demands of practicing medicine in general and the requirements of the Americans with Disabilities Act of 1990 specifically; in particular, they felt that they were inadequately reimbursed for accommodations,” Tara Lagu, MD, MPH, a professor of medicine and medical social sciences at Northwestern Feinberg School of Medicine, and colleagues wrote.
“Some physicians reported that because of these concerns, they attempted to discharge people with disabilities from their practices.”
Lagu and colleagues conducted three videoconference focus groups that consisted of 22 physicians, with a mean age of 51 years. Fourteen participants were men, and 14 were primary care physicians.
The researchers found many overarching themes in barriers preventing physicians from providing proper care to patients with disabilities. These included:
- physical accommodations, such as a lack of accessibility equipment;
- communication accommodations, with almost none of the participants possessing material written in braille;
- lack of knowledge, experience and skills needed to properly care for patients with disabilities;
- structural barriers, including a lack of time with patients or increased paperwork and documentation;
- physician attitudes toward patients with disabilities; and
- lack of knowledge about the ADA.
When it came to patient transfer skills, focus groups often brought up “a fear of hurting themselves or their patients,” Lagu and colleagues noted.
“For example, one specialist physician said, ‘If I am trying to transfer the patient and they fall and hurt themselves, I am not sure what I accomplished’,” the researchers wrote.
Some physicians implied that caring for patients with disabilities was burdensome, and one said they “are an entitled population.” Physicians also reported that appointment lengths were unreasonably long and interrupted the practice’s workflow.
“Perpetuation of inequitable care for people with disabilities is inconsistent with the mission of medicine and public health,” the researchers wrote.
Healio spoke with Lagu to learn more about the study findings and how physicians can make necessary improvements to provide quality care to patients with disabilities.
Healio: What led you to conduct this study?
Lagu: In 2016, Lisa Iezzoni, MD, and I wrote a grant that purposed focus groups, a survey and development of a set of recommendations to provide high-quality care to people with disabilities. The paper that we wrote is about the focus groups. We took those focus group findings and turned them into survey questions.
After we administered the survey, we went back and looked at the focus groups transcripts. I remembered how upsetting the focus groups were to me and to the research staff who were working on the analysis of this data. I said, “There’s a huge piece here that we have not written up yet about the focus groups,” which was that physicians in the focus groups started talking amongst themselves about the fact that they discharge people with disabilities from their practices, that they use strategic wording to discharge people with disabilities. It seems so major and so unreported that we really had to write this paper.
Healio: What are the takeaways from your research?
Lagu: The takeaways are we have major problems across the board. It’s clear that this is a reflection of the problems in our health care system more generally, as well as problems in medical education, which is that we don’t receive training on care for people with disabilities during medical school.
Additionally, there’s a lack of accessible equipment. There’s a lack of procedures and policies to prepare the physician or the staff for a person who has a disability, so we don’t ask in advance if a person has a disability or needs accommodation. We don’t record in the medical record, and we don’t record it in the scheduling system.
In the face of all these problems, some doctors made a choice to discriminate, which is unacceptable and inexcusable.
Healio: Do you think more accessible equipment and training would create a significant change in the relationships between physicians and patients with disabilities?
Lagu: I still believe it’s partially about [accessible equipment and training], but it’s beyond that. It is also about discriminatory attitudes. We have to rethink the way we talk about disability amongst ourselves, the way we teach it in medical school, and the way we provide coded information about disability in clinical training situations.
Healio: What improvements could be implemented by physicians to address disability disparities?
Lagu: I do think there are some very basic things that most doctors can do. One is to learn disability etiquette. Learn how people with disabilities want to be spoken about and spoken to, learn what words are not okay to say, learn what phrases are not okay to say, and learn what attitudes are not okay to convey.
For example, the phrase “wheelchair bound” is considered derogatory. “Handicap” is not a word that anyone should use because it has a history of being a very derogatory word about people with disabilities. We should teach medical students, clinical trainees, and practicing physicians to use first-person language such as “people with disabilities” instead of “disabled person.” Use etiquette that is appropriate for the disability type and ask patients how they want to be spoken to.
It's very important that we get some of these other skills because it’s clear that we don’t even realize that we’re conveying to patients some really negative messages.