Presenter: Lisa M. Meeks, PhD, MA, the University of Michigan
[The following blog was generated by Doug McKell]
Dr. Meeks’ presentation focused on faculty and students’ roles in becoming aware of the importance of including disabled physicians and addressing ableism in medical education. She emphasized the need for anti-ableist training and policies to support disabled physicians as they can benefit everyone culturally by increasing empathy and innovation. Her presentation focused on individual and system initiatives to address our cognitive mindset limitations, which prevent us from being genuinely inclusive of providers with disabilities. Dr. Meeks challenged us to consider the manner and extent to which the healthcare system must be reformed. She shed light on the issue of regulations and accreditation standards not recognizing the contributions of healthcare providers with a disability, thus hindering institutions from implementing changes.
Dr. Meek asked the attendees three questions: How do we help students navigate these? Is there a way to help instill resilience or guide students to self-identify resilient qualities that will assist them as they move through medical education? Are there unique ways we can alter the system to help students, and are there other adjustments to think about to help students in this new age?
Dr. Meeks’ presentation began with a simple exercise: She asked everyone to write down what they think of when they hear or read the word “disability.” She reminded everyone that we all have subconscious cognitive scripts (ideas, beliefs, and emotions). These are modeled for us when, for example, we watch our parents or caregivers to see how they interact with other people or when we go on to school, and we’re taught what to think about what is “normal” and what is “not normal.” These cognitive scripts help us quickly organize our thoughts and actions by reducing our cognitive load when faced with multiple activities, persons, situations, and expectations. They are created by our individual experiences with different types of people and situations. Sometimes, they work for us to manage our social world successfully, and sometimes, they work against us by creating artificial boundaries in our social expectations of other people’s abilities.
Dr. Meeks asked the attendees to fill in the blank with their first reaction to three clinical scenarios: 1. A physician with ADHD is likely to (fill in the blank). 2. A physician who’s a wheelchair user will (fill in the blank). 3. A physician with dyslexia will (fill in the blank). She then described the work of her research team using AI to list the common synonyms for the term disability, and they included cognitive impairment, incapacitation, intellectual disability, limitation, restriction, damage, disadvantage, and incapacity, which are all very negatively charged words. She noted that AI uses data from every published information source, including general commentaries, cultural histories and stories, behavioral norms, academic research, and social media. It is accessing all of this data and organizing the ideas we, as humans, have publicly shared. She noted that the result is a disturbing and humbling reflection on what society believes about disability.
Dr. Meeks narrowed her focus to a core issue that affects all disability work: the concept of ableism. “Access Living” defines ableism as discrimination of and social prejudice against people with disabilities based on the belief that a regular body and mind are preferred, and it’s the preferred body and mind that society places this value on. At its heart, it’s rooted in the assumption that disabled people require fixing and that their disability defines them. As a result, we often hyper-focus on the disability, which may be the first thing we consider when working with a patient, a medical school applicant, or a resident. It may be the only thing we see when working with a learner. In this way, ableism generalizes people with a disability, observable or hidden, and reduces them to a limitation. It is very similar to acts like racism and sexism, where we take entire groups of people and assign them to a lesser value, creating harmful stereotypes with negative descriptions. The misconceptions that go with these generalizations significantly limit our understanding of individuals based on either being classified as disabled or by their diagnosis. Dr. Meeks challenged the attendees to recognize how disability ableism contributes to oppression in our healthcare systems and our healthcare education spaces because ableism is looking at an idealized mind-body relationship and assigning more positive value to it than what is the reality of a dialable person’s actual abilities.
Dr. Meeks shifted her discussion to inequities in the healthcare system due to disability challenges based on stereotypes and limited accessibility. Poor health outcomes of people with disabilities are due to systemic healthcare inequities and not due to their disability. Research evidence shows that people with disabilities are less likely to get regular health screenings and more likely to experience diagnostic overshadowing, defined as dismissing their symptoms by relating them to the person’s disability. That is why we often miss diagnoses in people with disabilities.
Dr. Meeks then shifted to describing the benefit of having disabled doctors, disabled nurses, disabled physical therapists, and other disabled healthcare providers for patient care, which can help reduce some of the existing poor health outcomes for patients with disabilities. Her research group has built a healthcare delivery model for improved disability services using contact theory. The core concept is that interaction with a student or a professional with a disability challenges your perception of people with disabilities and what they’re capable of in a unique and personal way. It directly confronts the ableism belief that people with disabilities are unemployed (or unemployable), that they have a poor quality of life, and that they’re all unhappy. In her research service, when healthcare trainees work, learn, and socialize with persons with a disability, this process challenges the trainee’s stereotypes and assumptions, i.e., limitations, about people with a disability. This is a counter-narrative to this very embedded, deeply ingrained ableist construct. In the process, everyone will begin to think differently about people with disabilities, and doing so will help inform and improve patient care.
Dr. Meeks then described some advantages of training disabled physicians and other health professionals. First and foremost is increased empathy. Her research has demonstrated that in a training situation where empathy erodes over time, for abled trainees, empathy doesn’t erode for disabled physicians and disabled individuals. It may be that the experience of having a disability and being driven to become a healthcare professional because of that experience allows that person to have more empathy because they’ve been there. She reported that disabled clinicians talk all the time about being on both sides of the bed or both sides of the stethoscope. Disabled physicians contribute to innovation, and many hold patents for devices they developed from their experience of receiving care that improves\ care-providing experiences for patients and their physicians.
About 9.3% of undergraduate medical education learners and about 11.8% of medical residents, but only 3% of physicians are identifying as disabled, meaning there’s a tremendous drop-off in self-reporting. When Dr. Meeks and her team researched this issue, they found that physicians with disabilities are subject to a higher frequency of being mistreated, both by patients and their peers, which adds to and exceeds the existing professional and personal stress in our physician population. They found that physicians with disabilities are more burnt out due to the current ableism belief system and lack of education for those in leadership positions. She reported that many individuals in leadership positions don’t fully understand disability or the benefits of having disabled practitioners and don’t have the education or resources to fully understand how to support their physicians and other disabled health practitioners. Additionally, disabled physicians and other health professionals are experiencing a lack of accommodation. On the bright side, their research showed that when people have accommodation, it mitigates their intent to drop out of caregiving.
Dr. Meeks concluded her presentation by stating that, as a society, we have created idealized values, norms, and traditions of what are considered normal abilities, i.e., necessary, in medicine and healthcare that we routinely reinforce. Similarly, our structures and systems are designed to reinforce these, limiting our disabled providers. In many ways, the ablest beliefs, actions, and the words we use are unconscious. But it doesn’t matter whether it’s an unconscious or intentional action, as it still has a significant impact on our learners, and some of that impact includes low numbers of qualified disabled practitioners. As a result, fewer disabled but qualified people apply and are admitted to medical schools, resulting in fewer disabled but qualified individuals practicing medicine. These low numbers are due to incorrect beliefs about disabled students and their needs and the lack of accommodation process. It is also a result of the assumption that disabled people are not going to be part of our professional communities, which then creates fewer individuals with higher-degree career expectations or lowers career expectations for potentially great healthcare professionals with disability. Her final suggestion was to continue our education about the potential for individuals with all types of disability to flourish in healthcare. Ask questions when you don’t know the answers, as most disabled people want you to ask them to reach a better understanding of how to provide the most
effective support possible.