Confusion over ADA obligations remains for clinicians

More than 30 years after the Americans with Disabilities Act (ADA) became law, a study found that many American doctors aren’t confident they can provide the same level of care to patients with disabilities as those without, and a large majority erroneously believe that disabled people have worse quality of life than non-disabled people.

In a February, 2021 paper in Health Affairs, researchers from Massachusetts General Hospital surveyed 714 physicians in outpatient practices nationwide regarding their perceptions of people with disabilities. They found that 82.4% believe that disabled people have a worse quality of life than the non-disabled, even though, in a 1999 study, more than half these people said their quality of life was excellent or good.

The current survey also revealed that only 40% said they felt “very confident” in their ability to provide the same level of care to disabled and non-disabled patients, and 57% strongly agree that they welcomed patients with disability into their practice. Just under one in five—18%—strongly agree that the health care system treats disabled people unfairly.

“Our findings suggest that large proportions of practicing US physicians might hold biased or stigmatized perceptions of people with disability,” the authors write, adding that the survey “did not assess whether participants appreciated that their perceptions are biased or instead believe that their views are justified and therefore do not negatively affect” the care they provide to disabled patients.

Passed in 1990, the ADA forbids discrimination against persons with disability. Among other provisions, it requires doctors and patients to collaborate in deciding what reasonable accommodations are needed to ensure that these patients get accessible and equitable care. However, the study found that 36% of respondents had little or no knowledge of their legal responsibilities under the ADA, 68% felt they were at risk for ADA-related lawsuits, and 71% could not correctly identify who determines reasonable accommodations.

“Despite the fact people with disabilities comprise 25 percent of the population, they often confront barriers to basic health care services such as physical examinations, weight measurement, and effective communication with their physicians,” lead author Lisa I. Iezzoni, MD, MSc, said in a news release, adding that “the lack of knowledge about who makes accommodation decisions raises troubling questions about healthcare quality and equity.”

The authors note that the COVID-19 pandemic has exposed aspects of the health care system that disadvantage people with disability. For example, some state standards of care developed to guide resource allocation, such as tests, ICU beds and ventilators specifically excluded people with disability. This caused the US Department of Health and Human Services Office for Civil Rights to warn in March 2020 that “persons with disabilities should not be denied medical care on the basis of stereotypes, assessments of quality of life, or judgments about a person’s relative ‘worth’ based on the presence or absence of disabilities.”

Addressing the problem, the researchers say, will require more training about disability, including disability cultural competence and etiquette. They also suggest finding ways for clinicians to gain greater empathy about the challenges disabled people face in their daily lives, such as through house calls, and adding a disability module to Implicit Association tests around race and ethnicity.

This article was originally published by sister publication Medical Economics.