To achieve more equitable care and social justice for patients with disabilities, significant improvements are needed to educate physicians on how to make health care delivery systems more accessible and accommodating.

Lisa I. Iezzoni, MD, MSc,
Mongan Institute, Massachusetts General Hospital

BOSTON – More than 30 years after the passage of the Americans with Disabilities Act (ADA), most doctors still lack basic knowledge about the “reasonable accommodations” that the law requires them to provide to people with disabilities, according to a study conducted by researchers at Massachusetts General Hospital (MGH) found. In an article published in Health affairs, the team reported that more than a third of the doctors surveyed knew little or nothing about their legal obligations under the law, and more than 70 percent were unsure of who determines the “reasonable accommodations” necessary to provide care. fair to people with disabilities.

“Despite the fact that people with disabilities make up 25% of the population, they often face barriers to basic health services such as physical exams, weight measurement and effective communication with their doctors,” explains the senior author Lisa I. Iezzoni, MD, MSc, with the Mongan Institute Health Policy Research Center at MGH. “To achieve more equitable care and social justice for patients with disabilities, significant improvements are needed to educate physicians on how to make health care delivery systems more accessible and accommodating. “

Passed in 1990, the Americans with Disabilities Act prohibits discrimination against people with disabilities, including in health care. Specifically, it requires physicians and patients to work together to determine what reasonable accommodations are necessary to ensure that patients receive accessible and equitable care. To explore physicians’ understanding of their obligations under the ADA, researchers at the MGH conducted a nationwide survey of 714 U.S. outpatient physicians. They learned that 36 percent had little or no knowledge of their legal responsibilities under the ADA; 71 percent answered incorrectly about who determines reasonable accommodation; 21 percent did not know who is obligated to pay for these homes; and 68 percent believed they risked legal action against the ADA.

“The lack of knowledge about who makes housing decisions raises troubling questions about the quality and equity of health care,” notes Iezzoni. She cites previous studies by her team and others that have described people with reduced mobility examined in wheelchairs instead of being transferred to an examination table, resulting in substandard care and delayed diagnoses, including cancer. Additionally, patients who are deaf or hard of hearing have reported that their preference for effective communication arrangements, such as an in-person sign language interpreter, is often not followed by physicians.

“All patients with disabilities should ask their doctor’s office staff to accommodate their needs and preferences when making an appointment,” Iezzoni explains. “Doctors’ offices should keep this information in electronic health records and always ask at the time of planning if these needs and preferences have changed. “

Latest MGH study highlights need for more physician training on the civil rights of people with disabilities and their responsibilities under the ADA, starting with medical school, then as part of continuing medical education from a doctor. “Medical schools are currently training students in the fight against racism, and there should also be training in the fight against discrimination against people with disabilities, also known as ‘ableism'”, emphasizes Eric G. Campbell, PhD, researcher at the University of Colorado, and lead author of the study “Every practicing doctor can expect to see an increasing number of people with disabilities, and they must know how to accommodate them.”

Iezzoni is also a professor of medicine at Harvard Medical School. Campbell is Professor of Medicine and Director of Research at the Center for Bioethics and Humanities at the University of Colorado on the Anschutz Medical Campus. Other co-authors include Elizabeth Pendo, JD, professor of law at the University of Saint Louis, and Tara Lagu, MD, MPH, director of the Institute for Public Health and Medicine at Northwestern Medicine.

The study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

About Massachusetts General Hospital
Massachusetts General Hospital, founded in 1811, is Harvard Medical School’s first and largest teaching hospital. The Mass General Research Institute leads the nation’s largest hospital-based research program, with annual research operations of over $ 1 billion, and includes more than 9,500 researchers working in more than 30 institutes, centers and departments. In August 2021, Mass General was named # 5 in the American News and World Report list of “America’s best hospitals”.