Anonymous Study Reveals Attitudes Which May Result in Substandard Care

A recent study reveals that people with disabilities are not treated the same as people without disabilities by many providers. The study, which was published in the Journal of Health Affairs, revealed that doctors will go to lengths to avoid providing care for people with disabilities and have taken steps such as cancelling appointments for obviously fake reasons or advising people using wheelchairs to go to a cattle processing plant or zoo to be weighed in advance of their appointment. The reasons for the avoidance varied from not having the appropriate equipment to be able to examine the patient, to the out-of-pocket expense of hiring an interpreter for a patient with hearing loss, to a disruption in practice flow because of time constraints set on physicians. One physician complained that insurance companies only allow a doctor to spend 10-15 minutes with a patient and that the care for a person with a disability takes longer than that and so they could not provide adequate care.

The participants in the study were self-selected from a random group drawn from a professional networking site. The site did not provide much data about the participant group, so the study admits that it cannot be determined if the group is a representative sample of all physicians. In addition, the participants self-selected, but for those who chose not to participate, their reasons are not clear. For example, someone who chose not to participate may simply not accept certain insurance plans. However, the study was conducted anonymously because the researchers were concerned that, if they were required to disclose, that they would not participate for fear that they would be viewed as bad people.

Several common themes were identified as barriers to care for people with disabilities. They include:

• Physical Accommodations. This includes problems such as inaccessible buildings, not having exam tables which are height adjustable, and not having equipment which can weigh individuals.
• Communication Accommodations. This includes the ability to verbally communicate with patients with hearing loss, to providing written information to patients with limited vision, as well as with providing information to and receiving information directly from the patient. Many physicians commented on the fact that caregivers relay and receive much of the information but that is a challenge when they are supposed to communicate with the patient directly.
• Knowledge, Experience, and Skill. This particular barrier seemed to be the broadest and the one of most concern. This category includes concerns by the physician of a lack of education or information regarding a certain condition as well as how any co-existing conditions affect the primary disabling condition, to concerns that the physician or their staff may hurt the patient when trying to examine them, to a lack of knowledge (and fear regarding) requirements under the Americans with Disabilities Act.
• Physical Barriers. This category is where concerns regarding time constraints on patient interaction and care as well as the requirement to individualize the care were recorded. There was also a consensus that electronic medical records do not provide for adequate documentation so that physicians and their staff have advance knowledge of a patient’s disability which meant that they could not plan accordingly.
• Attitude. Some physicians that participated indicated a negative attitude towards people with disabilities and used inappropriate slang terms for conditions. Others indicated that they often thought people with disabilities exaggerated problems which made care burdensome.

The purpose of the study was to simply examine attitudes that physicians had towards care for people with disabilities. While the sample size may not rise to statistical relevance, the themes and problems mentioned by physicians were echoed by people with disabilities who were interviewed. Unfortunately, many people with disabilities feel as if they are receiving or have received substandard care based on physician and medical office staff attitudes.

The question arising from the study is what should be done about the existing prejudices and barriers that result in substandard care. While there is much that may potentially be done within the medical system, those changes may take years. For a person with a disability now, it is critical to be aware of the possible barriers so that they can be overcome and considered in advance. For example, a person who has difficulty in communicating can bring a translator or interpreter to an appointment. Or, if transferring is a barrier, bring a person who can assist with a transfer to the appointment. While it seems burdensome to ask a person with a disability to make additional arrangements simply so they can access the care they need, the substandard medical care that may result for failing to make their own accommodations is much worse.  

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