Opinion | When You Know Better, Do Better for People With Disabilities

This past week, Texas lawmakers presented Governor Greg Abbott (R.-Texas) with Senate Bill 17 mandating that publicly funded Texas universities — including medical schools — terminate their Diversity, Equity, and Inclusion (DEI) offices, programs, and mandatory training. While this bill, if signed into law, will undoubtedly impact people of marginalized races and genders, it will also have serious consequences for an often-overlooked group: persons with disabilities.

Clinicians and legislators need to recognize that disabilities are another aspect of diversity. Thus, being anti-ableist is just as important as being anti-racist when caring for marginalized populations. This vulnerable population already experiences inequitable health outcomes and worse patient care, and this legislation — and the ableism it would perpetuate among doctors in training — would only serve to worsen these disparities.

Ableism — behaviors and policies that diminish people with disabilities and presume that able-bodiedness is the norm — and ableist assumptions are surprisingly pervasive in medicine. For instance, I recently staffed a resident physician to support the care of a 32-year-old woman with abdominal pain.

“Well, did you ask her if she’s sexually active?” I asked.

“I didn’t ask,” he replied confidently.

“Why not?” I inquired further.

“Well, she’s in a wheelchair,” he responded.

After talking to the patient further, we found out that she was indeed sexually active, and then she requested testing for sexually transmitted infections (STIs). Assumptions about a patient’s sexual activity due to a physical disability is just one of many forms of ableism. Had we not reassessed the patient and asked about sexual activity, she may not have felt empowered to request a pelvic exam or STI testing. Untreated STIs can have devastating effects on the reproductive system and may even lead to infertility.

Fortunately, the medical field is beginning to address the social determinants of health, social factors such as racism that influence health outcomes, and the concept of anti-racism as a responsibility. Similarly, clinicians and educators must recognize disabilities as one of the many forms of diversity contributing to the intersectionality of oppression faced by patients and colleagues.

So, what does it mean to be anti-ableist? It means doing far more than avoiding offensive and outdated terminology such as “crippled.” Anti-ableism means not assuming that our patients have a poor or lower quality of life due to physical or intellectual disabilities. It’s about establishing patients’ communication preferences instead of making assumptions based on their physical appearance. In the words of Maya Angelou, “Then, when you know better, do better.”

Doing better by our patients with disabilities requires a systematic approach. A healthcare system with anti-ableism at its foundation requires individual level, organizational, and legislative interventions. To be sure, the Americans with Disabilities Act (ADA) offers some protections for people with disabilities from discrimination in public life, but it’s not enough to optimize healthcare interactions in clinical settings. Here are three types of things that we as healthcare providers need to be doing:

Check your biases

Recognize your own implicit biases when caring for patients with disabilities. Sadly, it is often offices of DEI — the very offices now under attack — that provide the training and resources for continued implicit bias training and analysis. If you’re employed by a university, make use of these resources while they still exist.

As you become more aware of your own biases, hold yourself accountable. If you make an offensive comment or oversight when caring for a patient with disabilities, apologize. Devise a plan for how you’ll do better in the future.

Hold your organization accountable

Identify what types of accommodation policies your hospital or institution has to make services accessible to all. Make sure that all training and curriculum recognize disabilities as a form of diversity with best practices in communication. Do you have reliable interpretive services for the deaf patients or resources for persons with low vision, or other disabilities? Even with ADA requirements, are the premises accommodating for people with walkers or other assistive devices?

Hold your legislators accountable

Do your local and state legislature seek to abolish the DEI agenda in public education and governmental organizations? Do they realize that this will severely affect the health and wellbeing of persons with disabilities? Advocate through your professional organizations to help lawmakers understand how DEI offices establish the culture and curriculum that makes healthcare settings accommodating to all of our patients — their constituents. And support legislators who already value DEI and work to increase their voters.

The COVID pandemic and the murder of George Floyd thrust racism as a public health crisis into the forefront of the American consciousness in 2020. Anti-DEI laws undermine this conversation, ignoring the complex forms of diversity that impact patients’ health outcomes. Governor Abbott, along with Governor Ron DeSantis (R.-Fla), may be among the first establishing harmful policies against DEI practices in public education, but they certainly won’t be the last. The dissolution of these offices in public universities has far-reaching effects for not only racial, ethnic, religious minorities, and the LGBQTI+ community, but for people with disabilities as well. This will result in increased barriers to seeking care and worsened health inequities.

The medical field and legislators must be aware of best communication practices, environmental accommodations, and implicit biases that impact health outcomes. We must be proactive in educating ourselves and advocating for our patients to be truly anti-ableist.

Katrina Gipson, MD, MPH, is an assistant professor of Emergency Medicine at Emory University School of Medicine, and a clinician at Grady Memorial Hospital. She is also president-elect of the Academy for Diversity and Inclusion in Emergency Medicine of the Society for Academic Emergency Medicine, and a public voices fellow with The Op Ed Project.