August 14, 2019
Worldwide there’s a growing movement advocating the need to
acknowledge and make place for doctors with disabilities. One of the leading
voices of that movement is Dr Lisa Meeks, currently Assistant Professor of
Family Medicine at the University of Michigan Medical School. She is also the
former President of the Coalition for Disability Access in Health Science and
Medical Education, Principal Investigator on the Association of American
Medical Colleges (AAMC) report on disability in medicine, former lead for the
disability inclusion movement at the University of California, San Francisco
and a leading expert in the US on disability in medicine.
Dr Meeks is also a vocal supporter of Doctors with Disabilities in
India which has challenged the admission guidelines regarding disabled
medical aspirants. In an email interview, she tells NewzHook about the
practices followed in the US and the rich perspective that doctors with
disabilities bring.
NewzHook (NH): One of the primary reasons the
Medical Council of India cites for the 80% disability cut
off is patient safety. Is there a basis to that and how is this
concern addressed in the US?
Dr Lisa Meeks (LM): In the US, patient safety is reviewed
under the Federal Code of Regulations (28 CFR 36.208), which
states,“In determining whether an individual poses a direct threat to the
health or safety of others, a public accommodation must make an
individualized assessment, based on reasonable judgment that relies on
current medical knowledge or on the best available objective evidence, to
ascertain the nature, duration, and severity of the risk; the probability
that the potential injury will actually occur; and whether reasonable
modifications of policies, practices, or procedures or the provision of
auxiliary aids or services will mitigate the risk.”
As you can see it is a very individualized assessment that MUST take into
account whether or not any accommodations could mitigate the risk and
whether or not there actually IS a risk, or if prejudice and stereotyping
“ideas about disability” are the cause of the fear. You could conceivably
be 80% in the domain of ambulating (walking) yet your hands, mind, thinking
are all intact. Ambulating can be done via other mechanisms, like a scooter
or wheelchair or other electric device, for example we have docs who use
Segway’s to ambulate long distances.
NH: What is the system followed when it comes to medical
aspirants? And are people with sickle cell disease or blood disorders banned?
LM: In the US best practice would be student-led
disclosure followed by a robust interactive process that is
individually based and takes into account required competencies and
progressive accommodations including assistive and adaptive technologies. We
focus on the required competency, not on the method utilized to achieve the
competency, which may be different-and equally effective and safe. Sickle
cell disease or other blood borne pathogens are not disqualified, indeed
there are specific guidances that protect this from happening including the
following:
https://www2.ed.gov/about/offices/list/ocr/letters/colleague-201306-504-title-vi.pdf
The same case by case approach under the CFR would drive the
evaluation for whether or not someone is safe. This varies by the
competencies (what a student must do) and can vary within specialty
(surgery/OB-GYN/family medicine). If viral loads are low students would be
able to continue using universal precautions. If viral counts are high it may
depend on the rotation.
NH: In your experience, what is the perspective that doctors
with disabilities and how does their exclusion end up depriving patients and
the field of medicine?
LM: True understanding of what it means to live with a
disability (the majority of our patients) and a complimentary understanding
of the rich life that is possible, does not occur in the absence of
interacting with people with disabilities, both in general and in equal
status relationships (other doctors, nurses, etc.) These relationships
challenge preconceived notions about the ability of those with
disabilities. As well, much progress and new technology is driven by need.
Individuals with disabilities drive innovation, and these innovations are
often good for everyone in society.
Finally, most individuals will experience a functional limitation in their
life-time that limits or disables them in some capacity. The knowledge,
innovation and respect for the individual with a disability that results from
having people with disabilities working in health care and technology will
inform better care and access that will help them function and continue to
engage in life with an acquired disability.
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