“People with disabilities working in health care inform better care & access” – Dr Lisa Meeks
August 14, 2019
Worldwide there's a growing movement advocating the need to acknowledge and make place for doctors with disabilities. One of the leading voices of that movement is Dr Lisa Meeks, currently Assistant Professor of Family Medicine at the University of Michigan Medical School. She is also the former President of the Coalition for Disability Access in Health Science and Medical Education, Principal Investigator on the Association of American Medical Colleges (AAMC) report on disability in medicine, former lead for the disability inclusion movement at the University of California, San Francisco and a leading expert in the US on disability in medicine.
Dr Meeks is also a vocal supporter of Doctors with Disabilities in India which has challenged the admission guidelines regarding disabled medical aspirants. In an email interview, she tells NewzHook about the practices followed in the US and the rich perspective that doctors with disabilities bring.
NewzHook (NH): One of the primary reasons the Medical Council of India cites for the 80% disability cut off is patient safety. Is there a basis to that and how is this concern addressed in the US?
Dr Lisa Meeks (LM): In the US, patient safety is reviewed under the Federal Code of Regulations (28 CFR 36.208), which states,"In determining whether an individual poses a direct threat to the health or safety of others, a public accommodation must make an individualized assessment, based on reasonable judgment that relies on current medical knowledge or on the best available objective evidence, to ascertain the nature, duration, and severity of the risk; the probability that the potential injury will actually occur; and whether reasonable modifications of policies, practices, or procedures or the provision of auxiliary aids or services will mitigate the risk."
As you can see it is a very individualized assessment that MUST take into account whether or not any accommodations could mitigate the risk and whether or not there actually IS a risk, or if prejudice and stereotyping "ideas about disability" are the cause of the fear. You could conceivably be 80% in the domain of ambulating (walking) yet your hands, mind, thinking are all intact. Ambulating can be done via other mechanisms, like a scooter or wheelchair or other electric device, for example we have docs who use Segway's to ambulate long distances.
NH: What is the system followed when it comes to medical aspirants? And are people with sickle cell disease or blood disorders banned?
LM: In the US best practice would be student-led disclosure followed by a robust interactive process that is individually based and takes into account required competencies and progressive accommodations including assistive and adaptive technologies. We focus on the required competency, not on the method utilized to achieve the competency, which may be different-and equally effective and safe. Sickle cell disease or other blood borne pathogens are not disqualified, indeed there are specific guidances that protect this from happening including the following: https://www2.ed.gov/about/offices/list/ocr/letters/colleague-201306-504-title-vi.pdf
The same case by case approach under the CFR would drive the evaluation for whether or not someone is safe. This varies by the competencies (what a student must do) and can vary within specialty (surgery/OB-GYN/family medicine). If viral loads are low students would be able to continue using universal precautions. If viral counts are high it may depend on the rotation.
NH: In your experience, what is the perspective that doctors with disabilities and how does their exclusion end up depriving patients and the field of medicine?
LM: True understanding of what it means to live with a disability (the majority of our patients) and a complimentary understanding of the rich life that is possible, does not occur in the absence of interacting with people with disabilities, both in general and in equal status relationships (other doctors, nurses, etc.) These relationships challenge preconceived notions about the ability of those with disabilities. As well, much progress and new technology is driven by need. Individuals with disabilities drive innovation, and these innovations are often good for everyone in society.
Finally, most individuals will experience a functional limitation in their life-time that limits or disables them in some capacity. The knowledge, innovation and respect for the individual with a disability that results from having people with disabilities working in health care and technology will inform better care and access that will help them function and continue to engage in life with an acquired disability.
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