Disability Bias Among Health and Medical Practitioners
Disability Bias Among Health and Medical Practitioners
There is a paucity of research pertaining even to general health and medical practitioner bias regarding disabled patients, let alone disabled people experiencing pain. From what is known, though, general prejudices about disabled patients are widespread in the health and medical fields.
In one study analyzing explicit and implicit disability bias among over 20,000 people involved in providing direct health and medical services, only 25% of respondents were identified as “truly low prejudiced” in which both explicit and implicit bias scores were low (VanPuymbrouck, Friedman, & Feldner 2020). The majority of practitioners had low explicit bias scores but high implicit bias scores favoring non-disabled people.
Unsurprisingly, disabled participants, or those with disabled friends or acquaintances, which accounted for slightly under half of respondents, had lower explicit and implicit bias scores. Participants with a disabled family member, which included just over one-third, also had lower explicit and implicit bias scores, as did general trends in lower scores among women and younger participants.
In another study of over 700 practicing U.S. physicians less than 60% of respondents strongly agreed with the statement, “I welcome patients with disability into my practice” (Iezzoni et al. 2021).
While the majority of participants were men, those who responded affirmatively were predominantly women, similar to results in the previous study. The likelihood of participants answering affirmatively also decreased as the number of years physicians were in practice increased.
Over 80% of participants also believed that significantly disabled people have a worse quality of life as compared to non-disabled people, despite lacking evidence supporting the veracity of this belief.
This long-standing bias that disabled people experience lower quality of life than non-disabled people due to measures of “function” is a charged point of contention for many disabled people and disability rights advocates (Janz 2019). Activists rightly protest that defining health, and therefore quality of life, as a measure of function is misinformed, and inherently prejudiced.
Recent analysis has further found that, out of over 700 U.S. physicians, 35% had little to no knowledge of their legal responsibilities according to the Americans with Disabilities Act (ADA) (Iezzoni et al. 2022). More than 70% also gave incorrect answers pertaining to whose responsibility it is to determine reasonable accommodations as per the ADA.
A lack of formal education and training being perceived by physicians as “a moderate or large barrier to caring for patients with disability” also corresponded to the likelihood of physicians having little or no understanding of their legal responsibilities.
There are over 60 million disabled people in the U.S., equal to approximately 25% of the total population (Disability Impacts 2020, CDC 2018). Disabled people are the largest marginalized demographic in the U.S.
Yet despite significant bias and general lack of understanding, health and medical practitioners are largely bestowed legal and social power to arbitrate who is and is not considered disabled, and how disabled people’s lives are and are not valued.
The urgent need for increased—or any—health and medical practitioner education about disability is obvious.
One such program was initiated at the University of California San Francisco (UCSF) medical school in 2018, requiring first year medical students to take a two hour class on disability and ableism from a sociopolitical perspective that included disabled people in its development (Borowsky, Morinis, & Garg 2021).
Both directly after the training and one year later students confirmed that their understanding of disability and confidence in treating disabled people had substantially increased as a result of what they learned.
While this is an encouraging outcome, there is a very long way to go for competent and equitable health and medical care for disabled people.
On the whole, practitioners are largely underprepared to effectively interact with disabled patients, to say nothing of disabled patients experiencing compounded conditions such as acute or chronic pain. It is also crucial that education includes a range of different disabilities that require varied skill sets, which further change across different life and development stages.
Disabled people should not only be the subject of education, but at the helm of teaching health and medical practitioners. Furthermore, systemic and structural changes to provide access support for more disabled people to become practitioners and take positions in other leadership roles is necessary for real justice and equity to be realized.
Thank you for reading!
For further reading check out these articles:
Are We Equipped to Care for People With Intellectual, Developmental Disabilities?
Knowing with the Disability Community: Building a Disability Standpoint for Health Policy Research
For more about medical bias, read my posts:
Would you like to support more articles like this?
Become a business, organizational, or individual unshamepain.com sponsor by donating anywhere from $2-$100+ each month. Contact me to learn more or to make a one-time donation. Any amount helps! Thank you.
Sources
“CDC: 1 in 4 US Adults Live with a Disability.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 16 Aug. 2018, https://www.cdc.gov/media/releases/2018/p0816-disability.html.
Borowsky, H., Morinis, L., & Garg, M. (2021). Disability and Ableism in Medicine: A Curriculum for Medical Students. MedEdPORTAL, 17(1), 11073. https://doi.org/10.15766/mep_2374-8265.11073.
“Disability Impacts All of Us Infographic.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 16 Sept. 2020, https://www.cdc.gov/ncbddd/disabilityandhealth/infographic-disability-impacts-all.html.
Iezzoni, Lisa I., et al. “Physicians’ Perceptions Of People With Disability And Their Health Care.” Health Affairs, vol. 40, no. 2, 2021, pp. 297–306., doi:10.1377/hlthaff.2020.01452.
Iezzoni, Lisa I., et al. “US Physicians’ Knowledge about the Americans with Disabilities Act and Accommodation of Patients with Disability.” Health Affairs, vol. 41, no. 1, 2022, pp. 96–104., https://doi.org/10.1377/hlthaff.2021.01136.
Janz, H. L. (2019). Ableism: the undiagnosed malady afflicting medicine. Canadian Medical Association Journal, 191(17). https://doi.org/10.1503/cmaj.180903.
VanPuymbrouck, Laura, et al. “Explicit and Implicit Disability Attitudes of Healthcare Providers.” Rehabilitation Psychology, vol. 65, no. 2, 2020, pp. 101–112., doi:10.1037/rep0000317.
