Gita Pensa, MD, Jason Rotoli, MD and Cori Poffenberger, MD
- Disabilities are common and our health care system is especially difficult to manage for disabled patients and their advocates.
- Disabilities affect 25% of the U.S. population and more than one billion people worldwide.
- Ableism is discrimination that favors able-bodied people.
- Disabled patients are less likely to be able to access preventative care, more likely to avoid care due to cost concerns, and less likely to have a primary care provider.
- Disabled patients are more likely to utilize the ED than abled-patients.
- There are many examples of implicit bias in treating disabled patients that can lead to inferior health outcomes:
- Conflating physical and intellectual disability.
- Infantilizing language or tone, meaning speaking to disabled patients in a manner that is not age appropriate.
- Failing to recognize that assistive devices are the patient’s personal space and should not be touched or controlled without the patient’s consent.
- Focusing excessively on the disability regardless of the presenting complaint.
- For example, we might anchor on a urinary tract infection in a patient with neurogenic bladder presenting with abdominal pain before adequately considering alternative diagnoses.
- Disabilities have a medical model and a social model.
- The medical model of disability defines disability as the result of an intrinsic physical condition that disadvantages the individual.
- The social model of disability says that societal barriers cause the disability rather than the individual’s differences.
- The culturally deaf community does not view their deafness as a problem, but rather having a common language, culture, and set of life experiences.
- Cultural humility is a concept of having self-humility in how other cultures are viewed.
- Person-first vs identity-first language
- Person-first language means you describe the person as someone with a disability rather than a “disabled person.”
- Identity-first language is preferred in some communities.
- The autistic community prefers the term “autistic person” instead of “person with autism.”
- The deaf community prefers the term “deaf person” instead of “person who is deaf.”
- The word “handicapped” is not an appropriate term to describe a disabled person.
- In describing bathroom stalls and parking spaces “accessible” is a better term since the accommodations make that space more accessible to the person.
- Other examples of specific language to be aware of:
- Avoid the terms “suffering from” and “afflicted by”
- Instead of “wheelchair bound” us “wheelchair user” since a wheelchair is a tool of mobility and freedom.
- Instead of “hearing impaired” say “deaf” since the deaf community does not consider themselves to be impaired by their deafness.
- If uncertain, ask for preferences regarding language accommodations.
- Our experts offer the following advice:
- Start by presuming that the patient is able to participate in their care rather than assuming they are not capable of making decisions.
- Do not make assumptions about sexual activity or defer genitourinary exams when indicated.
- Do not feel that the patient’s personal assistive equipment prevents a full exam from being performed.
- Ask rather than assume.
- Ask a patient who uses a wheelchair how they prefer to transfer to a gurney.
- Ask a person who is blind if they would like your arm for guidance.
- Training in emergency medicine should include curricula that address the treatment of patients with disabilities.
Raghu V. - August 9, 2021 6:10 PM
I listened to this with an open mind, and had a patient last night who was deaf. Triage spoke to him in writing. I asked him if we could use ASL. He was so happy. It took time to find the ipad with it, then find a charger, then charge it, it did not work; then had to find another, the patient waited awhile. But it was worth it. The patient really appreciated it. It was more dignified. Thanks for this podcast, it opened my eyes and I think made me do better medicine. Raghu Venugopal