Several years ago, while in my second year of medical residency, I was in my wheelchair in line at our hospital cafeteria. A man who came behind me gave me a warm look. After a few moments, he looked down and politely asked, “You look like you are doing pretty well. When are you going to be discharged?”
I paused as my internal debate swirled. How to reply? Anger? Disdain? I settled on a measured approach and said, “Actually, I work here.”
These kinds of encounters occur frequently for those of us in medicine who don’t fit society’s profile of a prototypical doctor. In this instance, rather than noticing that I was an early 30-something, confident female with a stethoscope around my neck and a badge reading “Dr. Blauwet,” my wheelchair was the only thing this man saw. Moreover, he equated my wheelchair with illness and vulnerability, rather than empowerment.
Moments like this beg the question — what do people expect doctors to look like? Although we have come far since the days when medicine was dominated by tall, Caucasian men with white hair, it is clear that physicians are still profiled. Almost all physicians who are female or from marginalized racial and ethnic backgrounds relate stories of patients mistaking them for a nurse, janitor or other uniformed staff. Recently, the story of Tamika Cross, MD, brought this issue to light after going viral on social media. During a flight from Detroit to Houston, passengers were asked, “Is there a doctor on board?” Although Cross, a black, female gynecologist, offered to assist the injured passenger, flight attendants questioned her credentials and qualifications and rejected her help, seemingly based only on her appearance.
While it’s less discussed, people with disabilities who are trying to build a career in medicine are similarly dismissed. Although people with self-reported disabilities account for 15 percent to 20 percent of the adult population in the United States, a survey of medical school deans (reported in May 2012 in Academic Medicine) demonstrated that students with physical or sensory disabilities represented less than 0.5 percent of graduating medical students. That proportion becomes higher, reaching 2.7 percent, when students with attention deficit hyperactivity disorder, learning disability or psychological disability are also included in these figures, according to a survey reported Dec. 6, 2016, in JAMA.
It is also important to note that disability is often under-reported for fear that it will be perceived as a sign of personal weakness — a finding published July 2015 in Academic Medicine. We would find this degree of disparity unacceptable when considering other personal attributes. Imagine if the representation of women in medical school deviated far from 50 percent. Women physicians would be rattling the cages and demanding change. Unfortunately, for a variety of reasons, the response from the disability community has been more muted.
I believe that a diverse physician workforce helps reduce bias among physicians and improves patient care. Many patients seek to have a physician with a cultural lens that is similar to their own. It is important, then, to note that almost all patients will encounter disability at some point in life. In fact, those of us within the disability community often joke that everyone else is “temporarily able-bodied.”
Disability is unique in that it can be transient or permanent, and the incidence of disability is directly correlated with aging and the presence of chronic disease. For those rare souls not personally touched by disability, it is almost assured that a close family member or friend will be impacted. Does it not make sense, then, to assume that physicians who have a personal experience with disability would bring to the table a heightened level of empathy toward patients, and thus be a healthy and positive addition to our workforce?
I remember my experience in medical school and the poignant moments when I realized I was transitioning from patient to physician. One of my primary motivations for choosing a career in medicine had been my early experiences with the health care system. I injured my spinal cord at a very young age and, even then, had a canny sense of which doctors were truly empathetic versus simply going through the motions.
As a medical student, I couldn’t escape the irony of being back in a hospital, a very familiar environment, but with a completely different lens. That long wait time for an outpatient clinic visit, frustrating to patient Cheri, was suddenly very understandable to medical student Cheri. When sitting in class learning about the basic tenets of neurology, I understood the physiologic causes of some of the symptoms I had experienced as a result of my spinal cord injury. Although it is true that knowledge is power, it can also be disquieting: Learning statistics such as rates of depression and the shortened life expectancy in people with spinal cord injuries gave me pause.
So, where do we go from here? Several initiatives are underway to both increase the presence of people with disabilities within the medical profession, and also to enlighten all medical trainees about the importance of understanding the social context of disability to provide better patient care. A new report from the Association of American Medical Colleges, Accessibility, Inclusion and Action in Medical Education, provides an updated framework for optimizing the potential for learners with disability in a health care environment.
Ultimately, we are striving to normalize the presence of people with disabilities in medicine and debunk what is traditionally called the medical model of disability in which disability is seen merely as a diagnosis, a pathology or an individual flaw. This must be replaced with the biopsychosocial model of disability in which disability is understood to be a complex interaction between the individual and his or her environment, inclusive of personal factors (for example, resilience and motivation) and external factors (for instance, accessible ramps and bathrooms).
Increasing the representation of people with disabilities in medicine is one important piece of the solution. Building on the success of prior social media campaigns such as #ILookLikeASurgeon, the hashtag #DocsWithDisabilities was developed as part of an advocacy campaign from the University of Michigan aimed at bringing more of these stories to light and normalizing disability across the medical profession.
As a physician with a visible difference, there are many days I am personally impacted by this — some good, some bad, all interesting. This often becomes dinner table conversation for me and my husband, who also has a disability. We have discussed a concept that I believe rings true for all physicians who have a defining characteristic that sets them apart and puts them at risk for being profiled negatively: invisible –> visible –> invisible.
People with disabilities used to be invisible, a result of lack of public access and very high societal stigma. As the disability rights movement progressed and key legislation was enacted to define our rights, we became more visible in society. It would be ideal, however, to again be invisible, but in a much more empowered way. This new form of invisible would be one in which access is so ubiquitous and stigma so low that entering a patient room would not turn heads or even elicit a response. People with disabilities would, in fact, not stand out in the profession, but would rather be a common sight in all health care environments.
It is time we recognize that the human condition is not perfect. Our profession must continue to strive to mirror the population we serve and to normalize disability, as well as all differences — both visible and invisible. By doing so, patients and providers alike would feel more welcomed and valued, and be the better for it.
Cheri Blauwet, MD, a Stanford medical graduate, is an assistant professor of physical medicine and rehabilitation at Harvard Medical School, an attending physician at Spaulding Rehabilitation Hospital and the Brigham and Women’s Hospital director of the Kelley Adaptive Sports Research Institute. She is a three-time Paralympian, seven-time Paralympic medalist and two-time winner of the wheelchair divisions of the Boston Marathon and the New York City Marathon. She serves on the board of directors of the U.S. Olympic Committee and as chair of the International Paralympic Committee Medical Committee. Contact her at email@example.com or on Twitter at @CheriBlauwetMD.