Medical Schools Do a Poor Job Teaching About Disability

By Crystal Lindell

Medical schools don’t teach their students well about disability, which can have negative effects for both disabled patients and disabled medical students, according to a new study published in the Journal of General Internal Medicine.

Researchers found that medical school curriculum often treats disability as a problem, leading students to make negative assumptions about the health and quality of life of people with disabilities. That makes them ill-prepared for treating disabled patients.

The overall attitude also results in fewer disabled people becoming doctors.

“Doctors do not know how to care for people with disabilities because they never learned,” lead author Carol Haywood, PhD, assistant professor at Northwestern University’s Feinberg School of Medicine, said in a press release.

“Ultimately, our work reveals how medical education may be playing a critical role in creating and perpetuating ideas that people with disabilities are uncommon and unworthy in health care.”

Haywood and her colleagues hosted virtual focus groups for both medical school faculty and students. They found four recurring themes in the discussions:

1. Disability is often neglected in medical education 

Participants said disability was only mentioned in select lectures and elective coursework, largely relegating the training to students and faculty who are already familiar with or have a personal interest in disability. 

One faculty participant said: “The fact that [disability training] is not required, and it’s not seen as a core part of the medical school curriculum … reinforces the idea that these aren’t really your patients or they’re not important enough for you to learn about.”

2. Disability is often framed as a “problem” in medical school 

Most medical schools define disability as a condition where an individual is simply diagnosed and treated, rather than something rooted in physical barriers, social bias and stigmatization. 

One student said: “Just seeing how biases can be sort of continued on through generations of doctors … whether that means that thinking of disability as a tragedy or … a medical condition.”

3. Negative ideas about disability limit diversity in medicine 

Participants described a neglect of disability training as being part of a “hidden curriculum” in medical education that teaches students that disability does not belong in society. Students with disabilities are often viewed as weak or incapable of excelling in medical practice. 

One participant said: “We're just sending the message from the get-go that you’re not welcome, which is so damaging in every possible way.”

4. There’s an over-reliance on faculty and student-led efforts to cultivate change 

When their training fell short, faculty and students sought mentorship and communities to discuss and understand disability-related healthcare. 

One student said: “It’s hard to be mad at physicians …. Because they weren’t taught how to do it or taught to ask the questions, or it wasn’t emphasized.”

Insufficient support from institutional and licensing authorities has also stymied efforts to improve disability training. Disability is often not included in studies focused on mitigating healthcare disparity — despite well-known vulnerabilities of people with disabilities.

“While we have known about physician bias and discrimination against people with disabilities in health care for some years now, this new work emphasizes the need for medical schools and regulating bodies… to take on the responsibility of educating future physicians about the care of people with disabilities,” said co-author Tara Lagu, MD, adjunct professor of medicine and medical social sciences at Feinberg.

Improving disability-related medical education will require systemic reform, such as adding a “disability-competent” to medical education to make students more aware of abelism – a tendency to think that everyone has the same mental and physical abilities.

Other remedies include having disabled guest speakers share their experiences navigating the healthcare system; having physical therapists, occupational therapists and speech language pathologists discuss their treatment of people with disabilities; and having students participate in the care of disabled patients during patient rounds, physical exams, documentation, and clinical decision making.

A Pained Life: The Doctor Complex

By Carol Levy, PNN Columnist

The doctor walked into the exam room. He put out his hand and said, “I'm John Smith.”

For some reason, I did something I had never done before and asked, “Do you prefer John or Dr. Smith?”

“Uh, either is okay,” he said, looking a bit befuddled.  

So, I went with “John.” He didn't look happy with my choice, but he accepted it.

Flash forward to another exam room. Another doctor walks in and extends his hand to introduce himself. “I'm George Midas,” he says.

“Do you prefer George or Dr. Midas?” I ask.

He blew out his chest, like a gorilla in the mist. “I went to medical school and I deserve the title of doctor. You may call me Dr. Midas,” he said.

I returned to the first doctor. I never went back to the second one.

I read in medical blogs about how concerned many doctors are because they feel their elite status in the public eye is diminishing. “Doctor” or “physician” is what they are, so that is what they want to be called. Even the sobriquet “provider” is an affront to them. “Provider” makes them sound like nothing more than a businessperson, and that is an insult.

I remember being in the hospital years ago and my neurologist came into my room. He was wearing a sporty pinstriped summer suit. No white coat.

“I like your suit. You look really nice in that,” I said.

“You mean I don't look professional,” was his reply.

No, I didn't mean that. But apparently the white coat makes the man, and the man is more when he is seen as doctor and wears the uniform. Out of it, he becomes just another person doing business with a patient.

It is an odd thing. We don't call lawyers “Attorney Smith” or architects “Architect Michaels.”

You may recall when the Bidens first came into the White House. There was a hue and cry about First Lady Jill Biden calling herself “Dr. Biden” because, after all, she wasn't a medical doctor. She was “merely” a doctor of education.

Yes, it wasn't medical school, but does that mean that her graduate education was “less than” because it was not a medical school?

I hate to tell those who went through the rigors of medical school that doing so was a choice. No one forced them to become a doctor. And going through what may be the hardest of all graduate studies does not make them better than anyone else.

I will gladly call you “doctor” if that is the only option you give me. But don't confuse the use of your title with me being less elite than you are. Because that is one thing I am not.

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 30 years. She is the author of “A Pained Life, A Chronic Pain Journey.”  Carol is the moderator of the Facebook support group “Women in Pain Awareness.” Her blog “The Pained Life” can be found here.

A Pained Life: Teaching the Reality of Pain

By Carol Levy, Columnist

Excedrin, which makes an over-the-counter pill for migraine sufferers, has a wonderful TV ad.

A sufferer wanted to show her mother what she sees and experiences when she has a migraine. Excedrin developed a simulator that does exactly that (click here to see it).

The mother puts on the device and sees the visual disturbances her daughter sees when she has a migraine attack. As she removes the device the mother turns to her daughter, hugs her and says, “I'm so sorry. I didn’t know.”

How wonderful, I thought. If only...

If only there was a way to simulate the pain of constant, intractable chronic pain.

If only there was a way to get our message across, and in a visceral way.

Too often we are told, even by medical professionals:

“It can't be that bad.”

"I had a sprained ankle so I get your pain.”

“It's all in your head. You just don't want to (go out, work, be a part of the family, the community, the world, etc.)”

It is common for a pain sufferer to write in the comment section of articles on chronic pain the following:  

“I wish doctors would have chronic pain, even if only for a day or two so they would get it.”

When I had the worst of my trigeminal neuralgia, I could not tolerate any touch to my forehead on the affected side. This meant I could not wash that part of my face or my hair. As a result I would get a big buildup of soap and dirt in the area which, because of a facial paralysis and my eye not being able to close well, caused eye infections.

The only way to clean the area was to put me under general anesthesia. The nurses and doctors were wonderful about it, the doctor having shampoo in his locker in case I forgot mine.

When someone asks me about the pain and they say outright or make expressions indicating they don't believe me, I trot out my general anesthesia anecdote. Then they get it. After all, why would a doctor or a patient take the risk of anesthesia without a real need to do it?

I recall a TV show, maybe it was Doogie Howser, MD, where medical students went through a simulation of what it is like to be a patient. They were given cloudy glasses to feel the disorientation of being unable to see clearly. They also put pebbles in their shoes to feel the discomfort of severe pain when you are trying to get around.

I had hoped maybe they did actually do this at a medical school somewhere, but no matter what words I put into Google Search, I could not find anything. The closest are programs where actors are hired to portray various illnesses to help teach students better diagnostic skills, insight and empathy.  But no actors had the role of being in chronic pain.

How can we teach the students?

I didn’t realize when I started writing this I would feel so frustrated by the question.  I guess I expected I would find a pithy answer.

Unfortunately, part of the answer is that students come from the general population, which often cannot accept the level of pain we feel. So they bring that skepticism and disbelief with them.

It would be unethical to put them in actual pain.

But maybe if we could show them the impairment, if we could find a simulator to allow them to feel the frustration of being unable to tie a shoe, go out in the slight breeze without the triggering of exquisite pain, or even walk, we too might too hear a “I'm so sorry. I didn’t know.”

And wouldn’t that be wonderful.

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 30 years. She is the author of “A Pained Life, A Chronic Pain Journey.” 

Carol is the moderator of the Facebook support group “Women in Pain Awareness.” Her blog “The Pained Life” can be found here.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.