Physicians in focus groups reported making statements such as ‘I am not the doctor for you’
More than 30 years after the passage of the Americans with Disabilities Act (ADA), people with disabilities report having a difficult time accessing health care and often find that doctors’ offices refuse to accommodate them. Now, a new Northwestern Medicine study of national practices published in Health Affairs reports that physicians may be choosing to deny care to people with disabilities, and some use discretionary excuses to strategically discharge them from their practice.
Scientists from Northwestern University Feinberg School of Medicine, in collaboration with colleagues from University of Massachusetts and Harvard Medical School, conducted focus groups with physicians drawn from a national database. Physicians who participated in these groups expressed bias toward people with disabilities, and a substantial number of participants reported that they make strategic choices to deny care to people with disabilities, the study found. This includes making statements such as “I am not taking new patients,” “I do not take your insurance,” or telling the patients they need specialized care and therefore, “I am not the doctor for you.”
“Our body of work suggests that physician bias and discriminatory attitudes may contribute to the health disparities that people with disabilities experience,” said corresponding study author Tara Lagu, MD, MPH, director of the Institute for Public Health and Medicine’s Center for Health Services and Outcomes Research at Feinberg and a professor of Medicine in the Division of Hospital Medicine and of Medical Social Sciences. “We need to address the attitudes and behavior that perpetuate the unequal access experienced by our most vulnerable patients.”
Additionally, physicians in the study described a lack of knowledge about how to provide accommodations for people with disabilities, and some expressed adversarial attitudes toward the ADA, saying the legislation “works against physicians.”
“The ADA is a key facilitator of autonomy and independence for people with disabilities,” Lagu said. “The physicians’ attitudes toward the ADA were upsetting and disappointing.”
The ADA requires all medical practitioners to provide “full and equal access to their health care services and facilities” for people with disabilities. This includes building accessibility, such as creating spaces that are designed to be user-friendly for everyone, including people who use wheelchairs, canes and mobility scooters; assisting with transferring patients from chair to examining table; and providing sign language interpreters and other accommodations. Prior studies have reported that people with disabilities have difficulty obtaining appointments with physicians and are known to receive less preventive care than their non-disabled counterparts.
“Meaningful improvements in access to high-quality care for people with disabilities will require a multipronged approach and should include changes to medical education, efforts to increase the presence of accessible equipment and changes in our approach to physician reimbursement,” said co-author Carol Haywood, PhD, research assistant professor of Medical Social Sciences at Feinberg. “At Northwestern, we are working to lead change through research and also through advocacy and improvement efforts such as the Disability Advocacy Coalition in Medicine, patient safety and quality efforts at Northwestern Memorial Healthcare, and the NM Champion Network Disability Chapter.”