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Despite the ADA, patients with disabilities do not receive the same medical care

Many medical facilities remain difficult to access, while doctors continue to harbor prejudices, study finds

The Americans with Disabilities Act of 1990 and the subsequent ADA Amendments Act of 2008 mandated equal access to health care for people with disabilities. But a new study reveals that many doctors are still unable or unwilling to provide the same level of care to patients with disabilities as to others.

The authors collected data for the study by conducting focus groups with primary care physicians in rural and non-rural practices and with specialists in various fields. Interviewers asked them about the challenges they faced in caring for patients with mobility, hearing, vision, mental health and developmental disabilities. Physicians were also asked about their knowledge and application of the ADA.

Participants identified five general barriers to providing care to patients with disabilities. They were:

  • physical barriers, such as inaccessible buildings and equipment, forcing doctors to find workarounds. For example, respondents in two of the three groups reported sending patients who were confined to a wheelchair and could not stand on scales in a supermarket, grain elevator, or livestock processing plant to to weigh.
  • Communicating. None of the participants provided patients with materials in Braille and only a few had materials printed in large print. Most said they relied on patients’ caregivers or written materials to overcome communication barriers.
  • Lack of knowledge, experience and skills between the physicians themselves and the support staff. Many participants were particularly concerned about the lack of skill in transferring patients, fearing injury to themselves or the patient.
  • structural barriers, especially time constraints. “Participants repeatedly raised the issue of limited time as a barrier to providing high-quality care to people with disabilities,” the authors state. Lack of time also hampers doctors’ ability to coordinate care with patients’ family members, especially if they are not on site or have not accompanied the patient to the visit.
  • Negative attitudes of physicians concerning people with disabilities. Many participants said that patients with disabilities made up small percentages of their patient panels, “suggesting limited recognition and deprioritization of people with disabilities,” the authors write. Other participants admitted to refusing care to people with disabilities or trying to remove them from their practice. They quote a participant saying, “We’ve had patients whose level of disability is too high…and we felt we couldn’t control the situation enough to do it right.
  • Lack of knowledge about ADA. “Nearly all physicians reported having little or no training in the law and its implications for their practices,” the authors write.

The authors say their findings highlight the difficulty of applying the ADA given the discretion physicians have to make clinical decisions. They note that the excuses given by doctors in the study for not providing care all seem plausible, making it nearly impossible to prove intent to discriminate against patients with disabilities.

Researchers say making health care settings more accessible and setting standards for disability education for doctors will help overcome the problem, but won’t solve doctors’ own biases. They call for the use of “every tool available,” including education, publicity, legal action, and policy levers to address the negative consequences of doctors’ stigmatizing attitudes toward patients with disabilities.

The study, “I Am Not The Doctor For You: Physicians’ Attitudes About Caring For People With Disabilities” appears in the October 2022 issue of Health Affairs.

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