By Amy Norton HealthDay Reporter
TUESDAY, Oct. 4, 2022 (HealthDay News) — More than 30 years after the Americans with Disabilities Act (ADA) was passed, some doctors harbor prejudices against people with disabilities and even actively avoid accepting them as patients, according to a news report. study finds.
In focus group discussions with about two dozen American doctors, the researchers found that many said they lacked the knowledge and skills to care for patients with disabilities. Even basic physical accommodations, such as accessible buildings and medical equipment, were a problem.
When asked how they measure the weight of a wheelchair user, some doctors said they sent the patient to a supermarket, grain silo or zoo.
A provision of the law requires user-friendly spaces for people who use wheelchairs, scooters, canes and other devices to get around. Medical providers must also provide sign language interpreters for the deaf and be able to transfer patients with disabilities from a chair to an examination table.
In some cases, doctors said they routinely find excuses to avoid caring for patients with disabilities. These ranged from “I’m not taking new patients anymore” to “I’m not the right doctor for you”.
The results, published in the October issue of the journal Health Affairs, are based on conversations with a small number of physicians.
But experts said they add to a body of work showing that many people with physical and intellectual disabilities find it almost impossible to simply get an appointment with a doctor. And when they do, they are often unhappy with their care.
The study is also consistent with everyday experiences.
“It validates the stories I hear all the time,” said Bethany Lilly, senior director of public policy at The Arc, a Washington, DC-based advocacy group for people with intellectual and developmental disabilities.
“It’s not surprising or shocking to me,” said Lilly, who was not involved in the study. “People may think this problem was solved years ago, with the ADA. It wasn’t.”
At the same time, she and other experts said the problem runs much deeper than individual doctors with bad attitudes.
“It’s a system problem,” said Dr. Tara Lagu, the lead researcher on the work.
For one thing, medical school and postgraduate training don’t prepare doctors to meet the needs of patients with disabilities, said Lagu, a professor at Northwestern University Feinberg School of Medicine in Chicago.
Another significant issue, Lagu said, is insurance reimbursement, which doesn’t account for the longer appointments that are often needed for patients with more complex needs.
Doctors in the focus group called it “unreasonable” and “ridiculous” to expect the standard 15-minute appointment to be sufficient for patients with disabilities. They also complained about financial barriers to providing appropriate equipment or other services. A primary care physician described hiring a sign language interpreting service, but found that the practice was losing money at every appointment the service was used.
This doctor is not an anomaly.
An “unacceptable” response
“Studies show that the vast majority of deaf signatories do not benefit from an interpreter,” said Dr. Michael McKee, co-director of the Center for Disability Health and Wellness at the University of Michigan.
Instead, he said, these patients are usually given a pen and paper; in other cases, family members provide interpretation.
“It’s unacceptable,” said McKee, who has hearing loss himself and uses a cochlear implant.
But like Lagu and Lilly, he said the responsibility for providing quality healthcare to people with disabilities cannot be shouldered by doctors alone.
All health care providers and staff, McKee said, need adequate education, training and resources — and that involves many “actors,” including health care systems and communities. insurers. Doctors, nurses and other providers are already overstretched, he said.
“To expect doctors to handle all of this is unreasonable,” McKee said. “We need a systems overhaul.”
On the insurance side, he said, “better billing models” that take into account the complexity of an appointment are a potential way to help.
Regarding education, the three experts said medical schools and residency programs clearly have a responsibility to better prepare physicians. But there is also a need for continuing education for physicians already in practice.
Lilly also noted the lack of a central resource for physicians seeking assistance in better accommodating patients with limitations. She mentioned the Job Accommodation Network, a free service that advises employers on workplace accommodations and employment issues for people with disabilities.
“A similar resource for physicians might be helpful,” Lilly said.
Another solution, she and McKee say, would be greater involvement of people with disabilities in health care — both on the care side and in shaping health care policy and practice.
Much of the population suffers from some form of disability, Lagu noted, and yet it is a group that is excluded from the discussion of health care disparities.
“It’s just not acceptable,” she said.
SOURCES: Tara Lagu, MD, MPH, professor of medicine and director of the Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago; Michael McKee, MD, MPH, associate professor, family medicine and co-director, Center for Disability Health and Wellness, University of Michigan, Ann Arbor, Mich.; Bethany Lilly, JD, senior director, public policy, The Arc, Washington, DC; Health Affairs, October 2022
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