Exploring issues relating to disability cultural competence among practicing physicians

Abstract

Background: Many factors contribute to the well-recognized health care disparities experienced by persons with disability, including failure of physicians to understand the lives of individuals with disability. Disability cultural competence considers physicians' ability to meet the social, cultural, and linguistic needs of this population.Objectives: To assess physicians' understanding of disability cultural competence and attitudes towards patients with disability. Methods:Qualitative analyses of open-ended individual interviews averaging 41 minutes with 20 Massachusetts physicians from 5 different subspecialties, in practice for 8-51 years. Interview recordings were transcribed verbatim for conventional content analysis.Results: Most participants defined disability using medically-focused concepts rather than concepts that recognize how social factors contribute to disability. All participants used disability culturally-competent language, such as "person-first language," at some points throughout their interviews. However, most participants also employed language that is now considered unacceptable or archaic, such as variations on the word "handicap," "wheelchair-bound," describing persons with disability as "suffering," and calling persons by their health condition (e.g., "COPDer"). Participants mentioned persons with mental illness and intellectual disability as particularly challenging, especially around communication and performing even routine tests or examinations. Recommendations for improving care included better listening to patients with disability and seeking their views about their care.

Exploring attitudes about developing cancer among patients with pre‐existing mobility disability

“…Participants' recommendations for other persons with pre‐existing mobility disability who develop cancer suggested that people recognize the importance of personal awareness of health status and care needs, placing responsibility on patients to prepare for appointments (i.e., preparing informed questions for clinicians) and feeling comfortable switching care teams to ensure sufficient accommodations. Participants concurred about the importance of self‐advocacy, especially given erroneous assumptions and attitudes about disability that may permeate care settings 23 . Attitudinal barriers can impact clinician‐patient trust, affecting patient satisfaction with care 24 .…”

Emergency Medicine Resident Education on Caring for Patients With Disabilities: A Call to Action

“…21 The negative attitudes of health care providers and use of outdated terms is discouraging and remains a significant barrier to effective care for patients with disabilities. 3,22,23 Additionally, adults with disabilities are substantially more likely to categorize their health as fair or poor (40.3%) when compared to those without disabilities (9.9%) and are more likely to delay seeking health care due to cost. 24,25 Physical accessibility also remains a significant challenge, as evidenced by a study in California demonstrating that out of a sample of 2,400 primary care clinics in California, more than half lacked full physical accessibility.…”

“…One study demonstrated that patients with disabilities were more likely than those without disabilities to feel that the doctor did not listen to them, did not involve them in the treatment plan, and did not adequately explain treatments 21 . The negative attitudes of health care providers and use of outdated terms is discouraging and remains a significant barrier to effective care for patients with disabilities 3,22,23 . Additionally, adults with disabilities are substantially more likely to categorize their health as fair or poor (40.3%) when compared to those without disabilities (9.9%) and are more likely to delay seeking health care due to cost 24,25 .…”

“…2 The causes of this are multifactorial, but one critical factor is a lack of structured, specific, and consistent training on caring for patients with disabilities in medical school and residency. 3…”

“…Yet according to a report by the Office of the Surgeon General in 2005, the U.S. health care system is insufficiently prepared to recognize and address the needs of people with disabilities 2 . The causes of this are multifactorial, but one critical factor is a lack of structured, specific, and consistent training on caring for patients with disabilities in medical school and residency 3 …”