I was a resident One afternoon, my triage paper indicated that the next patient needed a Pap smear. When I entered the room, I found a woman sitting in a wheelchair.
I smiled and tried to help her feel welcome, but I just panicked.
During my time in medical school, I was not trained to care for people with disabilities. As a resident, I didn’t even know to ask if the clinic had a height-adjustable table. All I knew was that due to my inexperience and previous training, there was no chance I could perform a Pap smear on this person today. I made an appointment with another doctor at the Women’s Hospital.
When I became a researcher, this and other similar experiences led me to investigate the disparities in care faced by patients with disabilities. Through these studies, I am strongly convinced that these disparities are not just an issue for patients needing sign language interpreters or accessible tables, but some of the worst cases faced by all patients in healthcare in the United States. Now care system.
In 2013, my research team and I called a random sample of doctors from four US cities. Each time, I pretended to be a doctor who made an appointment to see a patient in a wheelchair. Of the sub-specialists we called, 20 percent I was told that I could not handle such patients. Some were either inadequately trained or lacked staff and equipment. Some said their building was simply inaccessible, even though access to health care facilities is a requirement of the Americans with Disabilities Act (ADA).
recently, focus group Work with physicians to better understand the barriers that exist in caring for people with disabilities. Doctors in our recent survey were surprisingly outspoken, revealing serious prejudices against people with disabilities.dark report That study in November described doctors who reported using excuses to avoid treating people with disabilities. Others were more outspoken, telling patients, “I’m not your doctor.”
The attitudes and actions expressed by physicians in our recent research are inexcusable, unethical, and may be illegal under the ADA. They also underscored why many patients with disabilities have trouble finding doctors to care for them and suggested the urgent need to address disparities in access and quality of care. I’m here.
But these dramatic examples not only provide a window into the failure of the U.S. health care system for people with disabilities, they also reveal just how broken the system is for all patients.
During my time in medical school, I was not trained to care for people with disabilities. As a resident, I didn’t even know to ask if the clinic had a height-adjustable table.
For years, US doctors have complained that they are under pressure productivity index lead to Scheduled for 10 to 15 minutes and time electronic health record chart Ever since I finished work. All of these factors doctor burnout.
As patients, many of us feel how frustrating the system can be. long waiting time planned and small fragment of time Talking with a medical professional about our health concerns. Many of us, whether we need accommodation or not, Feeling low priority and invisible By our overworked doctors.
It is therefore surprising that many physicians in the 2022 survey reported that they were unable to devote extra time to providing the care and attention that people with disabilities needed due to competing demands. Of course, if doctors don’t have time to provide their patients with the services they are required by law, they won’t have time to give someone the personalized care most of us crave and need. .
When talking about health system issues, policy experts and researcherstwisted incentives“low value service,” and other terminologyThese terms essentially mean that the U.S. health care system offers generous reimbursement for procedures and expensive services such as cardiac catheterization, joint replacement, or radiology, but for counseling. It means that you are not rewarding yourself for spending time actually talking to the patient. , to diagnose a condition or co-plan a treatment approach.
In other words, the doctors in our study were simply reacting to the logic of the system. They simply weren’t because there were no incentives to treat a complex, high-need patient population, and likely penalties indeed. I’m going to do it.
I have studied this phenomenon in my professional life and have experienced it in my personal life as well. His father passed away in his 2021, and in the ten years leading up to his death, I spent days and days frustrating trying to get the care he needed. rice field. I sent the new doctor a lengthy (often unanswered) email explaining his previous visits to other doctors. I called a sub-specialist and hoped they would coordinate care among themselves or at least review his medications to rule out confounding symptoms. I think he was overwhelmed, but he had no motivation to figure out how to simplify his regimen.
My father does not have a disability and was never denied care, but the system still let him down. And while many of us may be able to tolerate sporadic or brief visits when we are young and healthy, with any luck we will need care that our current system cannot provide. is a matter of time.
There have been small efforts to bring about change. Ideas include compensating doctors or health systems to provide. value-based care (tying the payment for treatment to the patient’s state of health) or coordinated care (Pay for the time spent matching provider and patient goals). These efforts are commendable, but far from a huge need.
In practice, these programs may compete with, or at least co-exist with, incentives to see more patients, perform more procedures, schedule more surgeries, and order more invasive tests. U.S. healthcare institutions will be participating in programs that coordinate care and prevent hospitalizations while most care is provided and reimbursed in a toll-service environment that rewards more procedures and hospitalizations. I’m having a hard time with this.
My father does not have a disability and was never denied care, but the system still let him down.
Because of this strain, programs aimed at shifting incentives and increasing coordination of care do little to improve patient experience, reduce physician burnout, improve outcomes and reduce costs. Nor have they. Bigger and better solutions, participation from both large and small health care systems, and payers and insurers such as Medicare looking for new and innovative approaches to providing, billing, and documenting care. need a willingness to consider. Obviously, the patient’s opinion and the doctor’s consent are also required.
The US healthcare system is letting us all down.The most vulnerable among us are truly suffering and unable to get the care they need, but even the most casual users accessing the system for ankle sprains and health check-ups are on the rise in U.S. Health. They experience care as infuriating and even dangerous. And the workers, doctors, nurses, therapists, technicians in the system? suffer, that too.many people simply resignation.
Patients and physicians should work with health care and political leaders to implement systems to prioritize patient health, reduce burdens on physicians and providers, and improve the experience of accessing and receiving care. Need to redesign.
Dehumanizing healthcare experiences described by patients with disabilities clarify:
Tara Lagu, MD, MPH is a pharmacist, hospitalist, and medical services researcher at Northwestern University Feinberg School of Medicine in Chicago.