The Executive Suite: Despite the ADA, patients with disabilities not getting equal medical care

Saturday, October 8, 2022

Despite the ADA, patients with disabilities not getting equal medical care

The 1990 Americans with Disabilities Act and subsequent ADA Amendments Act of 2008 mandated equal access to health care access to people with disabilities. But a new study finds many doctors still either unable or unwilling to provide the same level of care to patients with disabilities as those without.

The authors gathered data for the study by conducting focus groups with primary care doctors in both rural and non-rural practices and with specialists in a variety of areas. Interviewers asked them about the challenges they faced in caring for patients with mobility, hearing, vision, mental health, and intellectual disabilities. The physicians were also asked about their knowledge and application of the ADA.

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

Physical obstacles, such as inaccessible buildings and equipment, forcing doctors to devise workarounds. For example, respondents in two of the three groups reported sending patients who were confined to a wheelchair and couldn’t stand on a weight scale to a supermarket, grain elevator or cattle processing plant to get weighed.
Communicating. None of the participants provided patients with documents in Braille and only a few had print materials in large type. Most said they relied on patient caregivers or written materials to overcome communication barriers.
Lack of knowledge, experience and skills among physicians themselves and support staff. Many participants were especially concerned about lack of know-how in transferring patients, fearing they might hurt 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 say. Lack of time also impedes doctors’ ability to coordinate care with patients’ family members, especially if they are not local or didn’t accompany the patient to the visit.
Physicians’ own negative attitudes regarding people with disabilities. Many participants said patients with disabilities accounted for small percentages of their patient panels, “suggesting limited recognition and deprioritization of people with disabilities,” the authors write. Other participants admitted to denying care to people with disabilities or trying to discharge them form their practice. They quote one participant saying, “We have had patients where the level of disability is too high…and we felt we couldn’t control the situation enough to do it properly.”
Lack of knowledge regarding the ADA. “Nearly all of the physicians reported having little or no training on the law and its implications for their practices,” the authors write.

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

The researchers say that making health care settings more accessible and establishing disability education standards for doctors will help overcome the problem but won’t address physicians’ own biases. They call for the use of “all available tools”—including education, publicity, lawsuits and policy levers to address the negative consequences of doctors’ doctors’ stigmatizing attiudes towards 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.