Lisa I. Iezzoni and colleagues have an article at Health Affairs titled Physicians’ Perceptions Of People With Disability And Their Health Care." The abstract:
More than sixty-one million Americans have disabilities, and increasing evidence documents that they experience health care disparities. Although many factors likely contribute to these disparities, one little-studied but potential cause involves physicians’ perceptions of people with disability. In our survey of 714 practicing US physicians nationwide, 82.4 percent reported that people with significant disability have worse quality of life than nondisabled people. Only 40.7 percent of physicians were very confident about their ability to provide the same quality of care to patients with disability, just 56.5 percent strongly agreed that they welcomed patients with disability into their practices, and 18.1 percent strongly agreed that the health care system often treats these patients unfairly. More than thirty years after the Americans with Disabilities Act of 1990 was enacted, these findings about physicians’ perceptions of this population raise questions about ensuring equitable care to people with disability. Potentially biased views among physicians could contribute to persistent health care disparities affecting people with disability.From the article:
Our multivariable findings suggest one potential explanation for the finding about not strongly welcoming disabled patients into their practices: Physicians expressing strong confidence in their ability to provide the same quality of care to people with disability had significantly higher odds of welcoming them into their practices. Medical schools generally do not include disability topics in their curricula.15,16,37,38 Nevertheless, even physicians with more than twenty years of practice, who presumably should have extensive experience with this population, did not appear more likely to strongly welcome patients with disability into their practices....
Some patients with disability express frustration about physicians’ lack of insight into the quality of their daily lives.39 Yet asking patients with disability to prove their quality of life to their physicians to avoid inequitable treatment is ethically unacceptable. Why should people with disability, unlike other patients, be compelled to justify to their physicians how they value their lives? More than twenty years ago, researchers investigated how perceptions of the quality of life of people with disability can diverge from societal assumptions. These inquiries identified a so-called disability paradox:40 that many people with significant disability equilibrate to living with functional limitations and enjoy good quality of life. Under the disability paradox, “the general public, physicians and other health care workers perceive that persons with disabilities have an unsatisfying quality of life despite the fact that over 50% of these people report an excellent or good quality of life.”40 More than three decades after the ADA, the disability paradox concept seems somewhat outdated, given its assumptions that people without disability have the authority to define what constitutes good-quality life and that all people’s lives must fit some preconceived notion of “normality.”