Clinical

What COVID-19 Can Teach Us About Treating Patients With Disabilities

Casey Gilman and Dr. Sarah Elizabeth Moreman
Published on Dec 3, 2020. Updated on Dec 1, 2020.

Today is International Day of Persons with Disabilities. This year the theme is “Building Back Better: Toward a disability-inclusive, accessible and sustainable post COVID-19 World”. To honor the theme this year, Osmosis Medical Education Fellow Casey Gilman partners with Dr. Sarah Elizabeth Moreman to discuss how COVID-19 has shed light on healthcare barriers for persons with disabilities and how we as future healthcare professionals can learn, educate, and be the change!

Disability in the midst of COVID-19

A constant weight on persons with disabilities is the “can do anything” attitude, an overbearing societal effort to try to normalize individuals with disabilities. COVID-19 has challenged this perspective, and this overwhelming burden has taken a significant toll on persons with disabilities. 

Similar to all individuals, those with disabilities are challenged to stay inside, but are additionally taxed to sit with their conditions and recognize the things that make them different from others. Among these include what might happen if they do indeed come down with COVID-19, as this is not impartial. 

Not only are many of these individuals immunocompromised from the medications that keep them alive or the conditions themselves restrict their ability to fight this infection, but our healthcare system bears inherent injustices amongst certain individuals, including persons with disabilities. 

Now the hard question comes: how can we use this pandemic to transform healthcare for persons with disabilities? In the current pandemic, we are seeing firsthand the extreme ends of inequity, for example, COVID-19 patients with concomitant neuromuscular disabilities not being given ventilators because they are less likely to survive the virus; however, this inequity does not begin at the pandemic, persons with various disabilities are often denied insurance, care, or adequate accommodations. 

This current state of affairs only brings to public awareness these disparities and the need to address them. 

Medical education is the starting point for change

The first place where we can implement change is at the foremost position of the health field: medical education. When higher education was first established, scholars were challenged to master Latin and other languages, philosophy, ethics, mathematics, and science.2

As the landscape of higher education evolved in the United States, these subjects inherently remained as the core curriculum in many universities and academic institutions. With increasing specialization into designated majors and programs, there was little room left for classes in advanced ethics and professionalism

Thus, courses guided at training physicians with reason and civic responsibility skills were not required in the majority of medical school programs. 

To further this problem, the intensity and rigidity of course requirements to complete medical programs may allow courses that focus on patient-physician interactions in persons with disabilities to be overlooked.  Additionally, many of the general courses about ethics and civic responsibility that medical schools do offer do not exactly extend a deep discussion on how to provide intentional attention and care for any person with a disability.


A large invisible minority in healthcare

The demographic of people with disabilities is by no means minor with an estimated ratio of one in every four persons having some kind of disabling conditions; people with disabilities are a large, invisible minority whose healthcare needs require more proactive communication strategies with acknowledgment of individual conditions.

There is a wide range of disabilities, which not only require a general understanding of conditions that accompany the disability, but recognition of the individual as a person first. As such, it is deeply important to identify upstream solutions beginning with interpersonal skills training. 

Courses designed to increase disability awareness and promote diversity, equity, and inclusivity should also pay special attention to interpersonal communication. This recommendation reflects the dynamics of the relationship between a medical professional and a person, especially one with a disability, in need of medical services. 

The current pandemic forces the issue of disparity between people with disabilities and others without disabilities in terms of receiving equal access to healthcare. A primary contributing factor is how a medical institution, whether it is a hospital or private practice, and its medical professionals proactively provide a welcoming environment, which means equal access to healthcare for people with disabilities. This is greatly reflected in the training that they have received. 

What makes any hospital or clinic a welcoming environment for any person with a disability? How can a medical professional, may it be a doctor, nurse, pathologist, or therapist, help ensure this welcoming environment? 

People first communication is important

People first language can be a starting place, where medical professionals take care in using words that reflect awareness and acknowledgement of any person with a disability as a person first. 

Adopting this approach will deepen the medical professional’s empathy and relational service. With consideration of healthcare needs for people with disabilities, using people first language effectively encourages client/patient cooperation to be open with the medical professional. Equally important is the active recognition by healthcare professionals and educators that there are inequities in health care for persons with disabilities. Providing equal access to healthcare asks medical professionals to readily adjust to the wide range of diverse communicative, emotional, physical, and mental capacities of people with disabilities depending on both conditions and constraints that come with their respective disabilities. 

Disability is a condition, not a handicap; whereas, constraints imposed upon the condition(s) of the disability such as a person who uses a wheelchair facing stairs, instead of a ramp, as the only access to the building. Erroneous planning and misguided communication can be met with awareness and recognition on the part of our healthcare system to satisfactorily meet the healthcare needs of persons with disabilities. 


COVID-19 shedding light on priorities

In hindsight influenced by the COVID-19, it is more imperative than ever to be proactive in communication strategies as to assist people with disabilities. Although laws such as Title III of Americans with Disabilities Act have been enacted to provide public access and civil rights protection for people with disabilities, public places including hospitals, clinics, and practices were gradual in meeting compliance.

Prior to the pandemic, there were still many issues that needed to be addressed such as putting in subtitles for videos, websites being accessible, and existing architectural infrastructures needing to be renovated to allow for ramps. The global pandemic of COVID-19 and its shift towards telemedicine has further highlighted these issues and the necessity for change. 

Along with this, abrupt modification of admittance protocol, people with disabilities face more communication barriers due to the cacophony of mixed information of what to do, whether to be tested for the coronavirus, or if they should maintain their regular doctor’s appointments. 

Awareness of these barriers to health care that those with disabilities face must be brought to the forefront in light of the current pandemic and may result in productive, profound changes in our healthcare system.

About Casey Gilman

Casey Gilman is a second year medical student at San Juan Bautista School of Medicine. She enjoys tennis, yoga, and helping others. She hopes to specialize in pediatric neurology and she has two twin dogs—Sadie & Boomer!

About Dr. Moreman 

As Creative Communications Consultant, Dr. Sarah Elizabeth Moreman, originally of Auburn, Alabama, shares her expertise on matters of creative communication strategies, disability awareness, compliance, DEI training, student-teacher interaction, and writing. Dr. Moreman serves as English Instructor at Jefferson State Community College of Birmingham, Alabama. When not teaching, public speaking, consulting, or doing marketing projects, she enjoys traveling to reconnect with friends and family, along with keeping healthy and fit taking Pure Barre and dancing classes. More information can be found via her website.

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