According to a new study published in Health Affairs, physicians may be hesitant to treat patients with disabilities, citing several barriers to care such as a lack of physical accommodations, limited knowledge or skills, and inadequate communication methods.

Physicians report negative attitudes towards patients with disabilities

As of 2016, more than 61 million Americans had a disability. Although the Americans with Disabilities Act (ADA) of 1990 mandates equal access to health care services, many people with disabilities continue to report difficulties accessing care and are less likely to be satisfied with the care they receive.

"Everywhere I looked, there were disparities," said Lisa Iezzoni, a professor of medicine at Harvard University, who has multiple sclerosis and uses a wheelchair. To better understand the root of these disparities, Iezzoni proposed directly asking physicians how they felt when a patient with a disability came to their offices.

For the study, Iezzoni and colleagues recruited physicians, both in primary care and other specialties, through Sermo, a professional physician social networking site, to be part of three focus groups. The participants were then interviewed through video conferences about their views and experiences with caring for patients with disabilities.

In total, 22 physicians were part of the study, and their mean age was roughly 51 years. They were also protected by anonymity since only first names or nicknames were used during the interviews.

During the video conferences, the physicians identified several barriers to care, including:

• Physical accommodations
• Communication accommodations
• Knowledge, experience, and skills
• Structural barriers
• Attitudes towards people with disabilities
• Knowledge of the ADA

All participants acknowledged that their practices had physical barriers, including inaccessible buildings and equipment. For example, one rural primary care physician said, "I know for a fact our building is not accessible."

The participants also acknowledged difficulties communicating with patients with vision or hearing impairments. None had written materials in Braille, and only a few had written materials in large type. Oftentimes, they relied on caregivers who came in with the patients to receive and relay information instead.

Many physicians also reported structural difficulties, including a lack of time with patients, burdensome documentation and paperwork, difficulty coordinating care, and a lack of communication about the needs of people with disabilities.

Some participants also expressed negative attitudes and beliefs about people with disabilities, often implying that providing care for these individuals was burdensome. One specialist said that people with disabilities "create a big thing out of nothing," while another said they "are an entitled population."

A few physicians also said they denied care to people with disabilities or attempted to discharge them from their practices. "You have to come up with a solution that this is a small facility, we are not doing justice to you, it is better you would be taken care of in a special facility," one participant said.

When it came to the ADA, almost all participants said they had little to no training on the law and how it impacted their practices. Overall, the researchers found that participants' "attitudes about the ADA were apathetic and even adversarial."

'I almost couldn't believe it'

Tara Lagu, a professor of medicine and medical social science at Northwestern University and one of the study's authors, said she was stunned by the findings. "It was so shocking, I almost couldn't believe it," she said.

However, people with disabilities said the attitudes of the doctors in the study "rang all too true," the New York Times writes.

For example, August Rocha, a 27-year-old man who has Behçet's disease and uses both a walker and a wheelchair, said he has often been turned away by doctors. "Some will find every excuse not to see you," Rocha said. "They will say, 'Our machinery isn't good enough for you. Maybe you shouldn't come in.'"

Still, Rocha said he is reluctant to complain since "[y]ou want the doctor to be on your side" and they might tell other physicians that he is a difficult patient, making it harder to get care.

According to Lagu, there are no easy solutions to these health disparities, but there are changes that could help improve the situation at least.

For example, the National Council on Disability proposed health care systems include disability in the data they collect about their patients to better track the disparities in treatments and outcomes. "We have data on racial disparities because health systems are forced to collect data on race," Lagu said.

In addition, Iezonni said more accessible equipment, including exam tables with adjustable heights and scales that can handle all patients, as well as communication accommodations for patients whose hearing, vision, or speech is impaired, are needed.

Overall, these changes are just a start, and to combat discriminatory beliefs about disability, "I know for sure that we have to change the culture of medicine," Lagu said. (Lagasse, Healthcare Finance News, 10/20; Kolata, New York Times, 10/19; Lagu et al., Health Affairs, accessed 10/21)