If you’ve ever felt that your doctor didn’t have time for you or turned a deaf ear to your needs as an amputee, you might not have been imagining it. According to a new paper out of the Feinberg School of Medicine at Northwestern University, discrimination against people with disabilities is shockingly common within the medical profession.
Published in the current edition of Health Affairs under the title “I Am Not the Doctor for You: Physicians’ Attitudes About Caring for People With Disabilities,” the paper asserts: “[P]hysicians’ bias and general reluctance to care for people with disabilities play a role in perpetuating health care disparities.” In part because of these attitudes, “people with disabilities are frequently not accommodated in health care settings, often receive substandard care, and in some cases are refused care.”
Not every doctor practices in this manner, of course. But a distressingly sizeable percentage of them do, according to the researchers’ qualitative study involving primary-care doctors and specialists from across the country. Such physicians not only are betraying the moral and ethical obligations of their profession but also are flagrantly violating the Americans With Disabilities Act. They’re breaking the law. And, under the cover of anonymity, they admitted as much.
But before you launch your full arsenal of fury at the docs who harbor these attitudes, save some ammunition for the health care system in which these practitioners operate. “Participants repeatedly raised the issue of limited time with patients as a barrier to providing high-quality care to people with disabilities,” the paper notes. “A rural-practicing primary care physician said, ‘“It’s hard to individualize what you need to do and make sure they understand, and you take care of their needs, in a fifteen-minute appointment.’” In addition to citing time constraints, many doctors said shortcomings in their medical training, administrative infrastructure, record-keeping systems, and/or clinical technology made it difficult to care for people with disabilities.
In essence, these doctors are saying that people with disabilities don’t fit the US healthcare system’s business model—a model that has largely been established by hospitals, insurers, government agencies, and drug companies, not by physicians. That’s not meant to excuse doctors for unethical and illegal discrimination. But doctors aren’t going to clean up their attitudes in a vacuum. The system that reinforces their biases needs to change, by creating incentives that reward equitable care.
“Physicians, administrators, and policy makers must continue to use all available tools (education, publicity, lawsuits, and policy levers) to address the negative consequences of the stigmatizing attitudes expressed by physicians in this study,” the paper concludes. As an initial step, the authors call for better education (both in medical schools and in professional development programs) about how to care for patients with disabilities. Financial enticements and deterrents will also no doubt be required. Tighter laws and enforcement mechanisms may be necessary, too.
In the meantime, individual patients have to continue advocating for themselves in one-on-one encounters with their own docs. If you’re not getting what you need from your physician—whether or not you suspect bias—don’t settle for less. Communicate your needs clearly, and be persistent in getting them met. Recognize the constraints under which your doctor may be practicing, accept that not every health problem has an easy solution, but insist on getting the level of effort and attention you deserve. See “Why Are Some Doctors So Clueless About Limb Loss?” for more on that subject.
