Barriers Fall for Disabled Medical Students

Barriers Fall for Disabled Medical Students

The Braille Monitor

January,

2004

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Barriers Fall for Disabled

Medical Students

by

Linda Villarosa

From the Editor: The

following article appeared in the November 25, 2003, edition of the New York

Times. It provides a useful summary of the situation facing disabled people

today who want to enter medicine. This is what it says:

As a fourth year medical

student, Jeffrey Lawler listens—really listens—as his patients run

through their lists of physical complaints. When he touches a scar or feels

for bumps, lumps, or growths, he directs all of his focus into his hands, moving

his fingertips slowly over skin, tissue, and bone, occasionally pressing and

prodding gently. A talking blood pressure cuff recites readings in an automated

voice, and a nurse or fellow medical student lets Mr. Lawler know that a patient's

temperature is hovering around 100.

Mr. Lawler's hearing and

sense of touch are extra

finely tuned, because he cannot look into a patient's eyes or see if a wound

has healed. He cannot read the numbers on a thermometer, blood pressure monitor,

or his pager.

His

eyesight began fading twenty years ago, as a result of the disease retinitis

pigmentosa. By 1993 Mr. Lawler, now forty-three, was legally blind. Still he

took the medical college application test with the help of a reader and a scribe

and was accepted to Western University Medical School in Pomona, California.

He will graduate in June near the top of his class and hopes to practice physical

medicine and rehabilitation.

"The

human body fascinates me, but my greatest strength as a doctor is patient contact,"

said Mr. Lawler, who is rarely without his guide dog Burke. "Yes, my knowledge

is good, but I also bring empathy to the bedside. I've been treated by doctors

who didn't really listen to me or said things like, `You're not planning on

having children, are you?' So I take my time with patients and try to really

listen and thoroughly explain things."

In

the past, students with physical disabilities were rarely accepted to medical

school, and they rarely completed it. But now Mr. Lawler joins a growing number

of students with disabilities who are thriving in medical school. Though no

statistics document how many of these students are attending medical school

or how many disabled doctors are practicing, experts in the field note that

laws like the Americans with Disabilities Act of 1990 allowed disabled students

access to every level of education and helped propel the current increase in

medical students.

"Over

the past several decades, the doors have opened for kids with disabilities to

go to school, get diplomas, and graduate, so we've seen huge increases in the

numbers of disabled students in undergrad," said Martha Smith, project

coordinator of the Center on Self Determination of Oregon

Health and Science University. A survey of the American Council on Education

notes that the number of full time freshmen with disabilities has increased

to 11 percent from 7 percent from 1988 to 1999.

"As

a result," Ms. Smith said, "these college students with disabilities

are part of the next wave of students who say, `I can go on to professional

schools.' Over the past several years, faculty members and administrators in

health sciences programs have noted that they are experiencing an increase in

the number of students with disabilities who are both applying and getting in

medical and dental schools and nursing programs."

Ms. Smith and colleagues

at the Center on Self Determination have trained faculty and staff members at

about twenty-five medical schools in the last three years, focusing on ways

to accommodate the students without sacrificing medical standards and patient

safety.

Brenda Premo, director

of the four-year-old Center for Disability Issues and the Health Professions

at Western

University, said: "When I first came here, the idea of a deaf or blind

person being in medical school was so foreign that no one knew what I was

talking

about. Now I'm getting several calls a month from students with disabilities

saying they want to go into health professions and many who want to become

doctors."

Dr.

Lisa I. Iezzoni says times have changed, perhaps drastically, from the early

80's when she attended Harvard Medical School. In her new book, When Walking

Fails: Mobility Problems of Adults With Chronic Conditions, she writes poignantly

of her battle with multiple sclerosis, which struck her just as she began medical

school.

After

graduating in 1984, Dr. Iezzoni, now a professor of medicine at Harvard, decided

against practicing and chose research, partly because of an internship adviser

who suggested that he could pass a "hat around to the chiefs of medicine

at the various Harvard hospitals to see what they would donate toward a salary

for my internship."

"A

top leader at a Harvard teaching hospital also told me that there were too many

doctors in the country right now for us to worry about training a handicapped

doctor," said Dr. Iezzoni, forty-nine, who uses a motorized scooter. "I

do regret not becoming a physician, but at some point I realized that I would

be fighting all the way, at the same time I was fighting my body."

Despite

increased acceptance of people with disabilities and changes in laws, attitudes

may still be hard to sway, particularly in medicine.

"Doctors

are the least comfortable and often the least knowledgeable about disability

issues," said Dr. Julie Madorsky, fifty-eight, who practiced from 1969

to 1995. She had childhood polio and was the prototype for the character Dr.

Kerry Weaver, the attending physician who walks with the aid of a crutch on

the television series "ER"

Dr. Madorsky said: "There's

a concept that it's `them' and `us.' The idea that someone can enter medicine

with a physical disability is counterintuitive. It goes against the notion that

doctors are healthy and perfect and able bodied

and patients are not."

Some

people in the field worry that the physically disabled cannot fulfill the clinical

requirements of medical school and that they need special treatment to graduate.

There is no national criterion for technical standards for admission and graduation,

and each of the nation's 126 medical schools is responsible for creating and

publishing its own graduation requirements.

"It's

very tricky," said Dr. Robert Sabalis, associate vice president of student

affairs and programs at the Association of American Medical Colleges in Washington.

The organization soon plans to produce an updated overview of legal requirements

for disabled medical students.

"Some

medical schools, for example, say that one cannot rely on the physical skills

of a third party for assistance, but other schools don't have that," Dr.

Sabalis said.

Advocates

for disabled students argue that some medical school standards that create hurdles

for the disabled are outmoded.

"Too

many schools are using the standard that a doctor has to see perfectly, walk

perfectly, and hear perfectly, but if they really followed that standard, no

one would graduate," said Ms. Premo of the Center for Disability Issues.

"I

support dropping students who don't achieve, and I don't believe in lowering

standards," she added, "but you have to allow for difference."

The

disabilities legislation may have had other influences as well. No studies have

looked at malpractice and whether disabled doctors and medical students are

at higher risk. But, according to the Physician Insurers Association of America,

a trade association of medical malpractice insurance companies, there is no

difference in underwriting medical liability policies for doctors who are disabled

and those who are not.

"Our application and

underwriting process is blind to disabilities," said Frank O'Neil, a senior

vice president at the ProAssurance Corporation, one of the nation's largest

medical liability insurance companies. "As long as a doctor is trained

and able to perform the procedures for which they are applying for coverage—with

or without an accommodation, like a physician extender—we

don't care."

Mr.

Lawler, the student, said he had a hard time getting a surgery rotation, a medical

school requirement, because of his blindness.

"Me

being in the operating room became a big issue," he said. "In the

third year you don't do anything except hold retractors during surgery, but

it was very challenging finding a site where I'd be accepted. Finally I was

able to scrub in on a procedure, and I was extremely focused. All I did was

hold the retractor like old medical students do to keep the cavity open, but

I really concentrated because I knew I was under a microscope and didn't want

to screw up."

Mr.

Lawler said he trained with a physician who was also blind, Dr. Stanley Yarnell,

who practiced rehabilitation medicine in the San Francisco area for twenty-seven

years before retiring in June. Dr. Yarnell, fifty-five, who began losing his

vision in 1969 because of recurrent optic neuritis, said he considered medicine

to be a cognitive process.

"When I couldn't see

something, I was able to get what I needed in terms of a description from a

resident, nurse, or even a patient," Dr. Yarnell said. "But there

are other low tech

ways to practice without vision. I can get a fair idea of what a patient's limp

is like by walking with someone with my hands on their back, shoulders, and

hips. That doesn't require vision."

As

for insurance coverage, Dr. Yarnell said, "The company knew I was blind,

but as long as I could perform a procedure safely with or without accommodation,

then the malpractice carrier had to insure me at the same rate as other physicians

performing the same procedures."

Dr.

Margaret Stineman, an associate professor of rehabilitation medicine at the

University of Pennsylvania, was born with a deformity of her skeletal system,

a reduced lung capacity, and missing muscles to move her eyes. She consults

on rehabilitation of patients with neurological injuries.

"I

look for settings where my mind and creativity are valued because these are

the two particular gifts I have," Dr. Stineman said.

She said that early in

her career some mentors were concerned that she might have difficulty getting

through medical school. To her knowledge, however, "there has never been

a patient who has been uncomfortable with my disabilities," she said. "I

work in a trauma service, and as a person who has lived with disabilities, I

can help my patients figure out how to develop ways to overcome their physical

problems and grow. The life experiences that I've had are part of what I bring

to patients, and they appreciate that."

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