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ThisAbility # 32: Accommodation vs. Unfair Advantage (Part Two in a Two-Part Series)

aaron broverman

Little Person M.D.: Dr. Jennifer Arnold is currently the most well-known doctor with a disability.

Little Person M.D.: Dr. Jennifer Arnold is currently the most well-known doctor with a disability.

Last week, I talked about preparing two pitches for the 2010 editorial calendar of New Mobility Magazine and I addressed one of them here. It was the one about Kyle Maynard, the limbless mixed martial arts fighter, and whether it was appropriate for him to fight at all. I argued he could do more for the disabled community by not fighting. It was ThisAbility #31: Why Inequality can be Good for the Cause. It’s part of a two-part series (this post being the second part) so if you haven’t clicked the link and read the first part, sections of this entry will not make sense to you. Why don’t you go read last week’s entry and save yourself the headache?

The second pitch, the one we’re discussing this week, concerns doctors with disabilities. There are more doctors with disabilities than one would think given how hard it still is to be accepted into medical school as a disabled person. I should point out that these doctors don’t exist thanks to the ADA forcing the hand of hospitals across the U.S. The proof is in Dr. Thomas Strax, a doctor with cerebral palsy who has been practicing physical medicine and rehabilitation for 42 years–way before the ADA. Along with Strax, there’s Dr. Michael Ain who may genuinely be the only orthopedic surgeon with dwarfism in the world and for all you fans of Little People: Just Married, you may have noticed that the wife, Jen Arnold, has an M.D. at the end of her name. She’s a successful doctor of pediatric medicine practicing in Texas.  Not that Canadians are so woefully behind the times, we have the Canadian Association of Physicians with Disabilities.
As far as I know, the doctors mentioned above completed all courses of study required to pass medical school with minimal accommodation: Dr. Ain performs surgery on a stool and Dr. Strax  was an early user of the now common vacutainer for drawing blood. This was necessary due to muscle weakness on Strax’s left-side, making it difficult to use both hands. There is one doctor whose accommodation caused quite the beef between my friend Kent and me and called into question his right to have an M.D. after his name.

His name is Dr. Jim Post, a doctor of nephrology and internal medicine who happens to be a quadriplegic. He graduated as a fully certified M.D. in 1997 with the help of a physician assistant selected and vetted by a polio survivor who taught in another department of  Post’s Alma Mater the Albert Einstein College of Medicine.

Physicians assistants have been used as support staff for licensed physicians of all kinds in the U.S. since the 1980s and in Winnipeg since 2002. They are currently being instituted across the rest of the country and also operate around the globe. Post’s physician assistant would be charged with placing the stethoscope around Post’s neck and situating it so he can listen to a heartbeat. As far as I know, Post’s assistant would also be directed to touch the patient where Dr. Post requested and relay what he felt back to the doctor so he could make the diagnosis. Post had excellent marks for written and oral examinations, using his wife to help assist in cadaver dissection; at the time they’d only been married two months.

I had no problem with this approach, especially since I believe that the assets disabled physicians bring to our hospitals far outweigh whatever accommodations they need to be in those hospitals.  We are frequently in and out of hospitals throughout our lives and it would be nice to have  doctors who can also be confidants; doctors who know what it’s like to have a disability from experience and not just from a diagnosis textbook. Having physicians with disabilities actively working also shifts how other doctors think about disability.  Instead of seeing just an unfortunate diagnosis and sad affliction, their minds could be opened to our real day-to-day capabilities.  As long as Post’s patients have no qualms about having a third party examine them for the purposes of relaying data to their doctor and as long as his medical school classmates had no problem with it, I call it progress. Remember, physicians have been asking their assistants to perform physical exams and do the heavy lifting for years  in the U.S. and around the world.

However, my friend saw the assistant as an unfair advantage that gave Post an M.D. designation that he didn’t actually earn.  Able-bodied physicians may use their assistants for exactly the same thing, but in medical school they were required to touch the patient for an accurate diagnosis and they can do it themselves if they feel their assistant is missing something.  Post has no choice but to rely on the data his assistant provides and since, based on what I know so far, he can’t feel the patient himself, a misdiagnosis could be right around the corner. Of course, that’s  unless he suspects something is wrong and calls in another doctor.  Since his specialty is nephrology, everything he deals with is internal and requires a minimum level of touch to be accurate.

No other med student is allowed to use a physician’s assistant; they must learn how to diagnose with touch. Kent’s main point was that with an assistant, Dr. Post doesn’t have  to meet the same standards required of his classmates, yet he still receives the same M.D. designation that they get in the end and that this is unfair, not only to his able-bodied classmates, but to the other disabled doctors, like Dr. Ain, Dr. Arnold and Dr. Strax, who made it through and performed well under the same high standards set for their classmates.

They each had accommodations, such as stools and the vacutainer, but accommodations are made so that you may have a chance to meet the existing standards set in your field. Accommodation should not mean lowering the bar set for everyone else, just for you.  You’re not owed anything simply because you’re disabled. You’re only owed the chance, as a human being, to meet and exceed the standards already set by the able-bodied world.  Kent countered my argument for a more diverse hospital, by saying med schools shouldn’t have to lower their standards in order to graduate more disabled doctors; disabled doctors should be able to rise to the occasion.

As guys with cerebral palsy, both Kent and I have had shortcuts built-in for us by virtue of our disabilities, but those circumstances never affected our professional responsibilities and we were never working in the realm of health and safety like Dr. Post.

Kent did posit a compromise during our conversation however, that could see Dr. Post still able to practice — just without the M.D. designation. He suggested that a specialist designation be created that indicates to patients and other doctors that while Post is a doctor, he wasn’t required to do all the typical medical training to get there.  I’m still skeptical, as a separate designation allows for prejudice.

Although, a  study at Physiatry.org suggests something similar, except they recommend that disabled doctors be permitted to pick a specialty, where they can comfortably meet all the existing criteria, earlier than is typical. They would then concentrate solely on that specialty through their entire med school and professional career. Dr. Post would also make an excellent teaching doctor, something he already does at the Mt. Sinai School of Medicine. We already know that he knows his stuff well enough to be tested on it and certainly to teach it.

But while I can fully endorse Kyle Maynard stepping back from MMA for the collective good of the rest of us, I can’t commit to one side or the other on this one without feeling a major pang in my chest. Both sides of this argument have valid points, so I’m turning it over to you (that is the semblance of a readership I hope isn’t just in my head)  and asking you to post a comment on who wins this argument. Your choices are me, the friendly neighbourhood writer monkey, or my “Loftsguardian”, who knows a little more about medicine than the average guy thanks to years of self-motivated research and experience working in medical media,  Kent Loftsgard.

So go ahead, Vote…

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