Disabilities Bias

Disabilities Bias

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.

PEARLS

• • 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.

PEARLS

• 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.