Study finds, despite ADA, physicians hold biases that affect care for people with disabilities
The appointment lasts only 15 minutes, and the exam room is silent but for the scratching of pen on paper.
Without a sign language interpreter or guardian/companion present, the physician and hearing-impaired patient are left with only two options. Shout to one another – with the risk of being overheard by other patients – or write down their thoughts and questions.
This, and other stories like it, emerged from a series of video conferences with physicians across a variety of specialties who have worked with patients with disabilities. The interviews were conducted pre-pandemic and the takeaways were recently compiled into a study published in Health Affairs in October.
The study’s conclusion: physicians are unknowingly discriminating against, and often underserving patients, as a result of inherent biases, lack of reasonable office accommodations or inadequate training in treating those with disabilities.
Authors identified physical, communication, knowledge, structural and attitudinal barriers faced by those with disabilities. The providers interviewed were mostly from small practices. They reported feeling overwhelmed by the pressures of the Americans with Disabilities Act (ADA) and struggling to make appropriate accommodations for patients with disabilities without help and/or extra compensation. Many physicians implied making modifications to their facilities, or even how they practice, is burdensome, referring to those with disabilities as “entitled.”
In too many instances, physicians have outright denied care to people with disabilities, or found ways to justify why individuals would not need routine screenings or procedures.
“It is very concerning because the Americans with Disabilities Act passed in 1990. And so we’ve had literally decades to set up the system to be able to care equitably for people with disabilities, but it just still hasn’t happened,” Dr. Lisa Iezzoni, one of the study authors, told NPR in an interview last month.
Iezzoni is a professor of medicine at Harvard University. She has multiple sclerosis and is reliant on a wheelchair. She has experienced her fair share of discrimination in receiving care throughout her lifetime.
While Iezzoni did not say this was ever her experience, the study includes anecdotes from doctors about sending patients in wheelchairs to the supermarket, a grain elevator or even a zoo to be weighed because their office scales could not accommodate wheelchairs.
According Iezzoni, patients with disabilities don’t speak up because they have less agency in the patient/physician relationship. They rely on their doctors for help they don’t want their physicians to be angry with them.
As long as there are biases toward vulnerable populations, discriminatory practices will remain, and there will be less incentive to comply with laws such as the ADA. The findings from this study are a reminder that equitable healthcare is still out of reach for many. At FEI, we can’t bear to accept that as the status quo, and we will continue to work diligently to provide technology solutions and services that assist in advancing barrier- and bias-free delivery of care for all.
