How Do I Ask About Your Disability? An Examination of Interpersonal Communication Processes Between Medical Students and Patients with Disabilities

Abstract

Medical student behaviors were examined through digital recordings of interpersonal skills communication training framed around a brief curriculum on disability within a family medicine clerkship. This analysis focuses on interpersonal communication processes and ways medical students ask standardized patient educators about visually apparent disability (N = 142). Primary themes of asking about or avoiding disability were identified with regard to language and nonverbal communication in how medical students asked and whether they integrated chronic disability with new musculoskeletal pain complaints. Secondary themes related to timing and communication further contextualized the primary themes. Seventy-four percent of students asked about the disability. Analysis of feedback sessions immediately following the interactions revealed that more than half the students who did not ask about disability spontaneously recognized that they avoided disability language. Results suggest that some ways of asking about disability may inhibit patient disclosure and restrict relationship building. In particular, asking about disability, but then avoiding integrating disability disclosure into the treatment plan, or responding to disability-related disclosure with overly positive, infantilizing-type communication, may pose more difficult dilemmas than never asking about the disability. On the contrary, students who ignored disability altogether often also recognized they missed disability cues, thus providing a learning experience of considerable value. Underlying student attitudes and possibilities for integrating biomedical concerns with social-psychological impacts of disability are addressed.

When Rapport Building Extends Beyond Affiliation: Communication Overaccommodation Toward Patients with Disabilities

“…Divergence emphasizes differentiation between communication of the physician and patient 25 and is described as demonstrating differences from the "other." As observed in Duggan et al, 26 medical students who use different language than patients with disabilities, particularly by using "sickness" after the patient uses "disability," would be diverging. Maintenance occurs when individuals resist change in communication.…”

“I’d rather be dead than disabled”—the ableist conflation and the meanings of disability

“…Health communication scholarship has addressed multiple issues related to communication and narration about disability. This research includes studies on the manner in which medical students communicate with and about people with disabilities; 9 how such communication occurs within families; 10 how perceptions about disability affect medical decision-making; 11 and how assumptions about disability inform health communication and medical education as a whole. 12 From a broader philosophy of disability lens, it becomes clear that much of this research revolves around navigating-or failing to navigate-the multiple meanings of disability.…”

Standardized Patients

“…Medical students have reported that SPs increase their insight into the importance of connecting with patients in order to give them proper medical treatment (Wagner, Lentz, & Heslop, 2002), while residents and medical students who do express empathy toward an SP receive higher ratings on interpersonal aspects of care (Epstein et al, 2007). In addition, many studies including SPs use communication skills to assess clinical competence (Colliver, Marcy, Vu, Steward, & Robbs, 1994;Colliver, Swartz, Robbs, & Cohen, 1999;Duggan, Bradshaw, & Altman, 2010), and SP ratings of students have been associated with predicting failing performance in subsequent clerkships (Chang, Boscardin, Chou, Loeser, & Hauer, 2009). This research suggests that SPs offer an effective tool for teaching and a valid method of evaluation.…”