Physician bias, discriminatory attitudes may contribute to health disparities among people with disabilities

More than 30 years after the passage of the Americans with Disabilities Act (ADA), people with disabilities report having a difficult time accessing health care and often find that doctors' offices refuse to accommodate them. Now, a new Northwestern Medicine study of national practices reports that physicians may be choosing to deny care to people with disabilities, and some use discretionary excuses to strategically discharge them from their practice.

Scientists from Northwestern University Feinberg School of Medicine, in collaboration with colleagues from University of Massachusetts and Harvard Medical School, conducted focus groups with physicians drawn from a national database. Physicians who participated in these groups expressed bias toward people with disabilities, and a substantial number of participants reported that they make strategic choices to deny care to people with disabilities, the study found. This includes making statements such as "I am not taking new patients," "I do not take your insurance," or telling the patients they need specialized care and therefore, "I am not the doctor for you."

The study will be published Oct. 3 in the October issue of the journal Health Affairs.

"Our body of work suggests that physician bias and discriminatory attitudes may contribute to the health disparities that people with disabilities experience," said corresponding study author Tara Lagu, director of the Institute for Public Health and Medicine's Center for Health Services and Outcomes Research at Feinberg and a professor of hospital medicine and medical social sciences. "We need to address the attitudes and behavior that perpetuate the unequal access experienced by our most vulnerable patients."

Additionally, physicians in the study described a lack of knowledge about how to provide accommodations for people with disabilities, and some expressed adversarial attitudes toward the ADA, saying the legislation "works against physicians."

The ADA is a key facilitator of autonomy and independence for people with disabilities. The physicians' attitudes toward the ADA were upsetting and disappointing."

Tara Lagu, Corresponding Study Author

The ADA requires all medical practitioners to provide "full and equal access to their health care services and facilities" for people with disabilities. This includes building accessibility, such as creating spaces that are designed to be user-friendly for everyone, including people who use wheelchairs, canes and mobility scooters; assisting with transferring patients from chair to examining table; and providing sign language interpreters and other accommodations. Prior studies have reported that people with disabilities have difficulty obtaining appointments with physicians and are known to receive less preventive care than their non-disabled counterparts.

"Meaningful improvements in access to high-quality care for people with disabilities will require a multipronged approach and should include changes to medical education, efforts to increase the presence of accessible equipment and changes in our approach to physician reimbursement," said co-author Carol Haywood, research assistant professor of medical social sciences at Feinberg. "At Northwestern, we are working to lead change through research and also through advocacy and improvement efforts such as the Disability Advocacy Coalition in Medicine, patient safety and quality efforts at Northwestern Memorial Healthcare, and the NM Champion Network Disability Chapter."

This study follows work conducted by Lagu in 2012, in which she attempted to make an appointment for a (fictional) patient who used a wheelchair. Of 256 surveyed practices in the 2012 study, 56 (22%) reported they could not accommodate the patient. Of the rest, more than half planned to transfer the patient using methods considered to be unsafe. More recently, Lagu and Dr. Lisa Iezzoni, professor of medicine at Harvard Medical School, published results of a national survey of physicians: only 56% reported that they welcome patients with disabilities to their practice; 36% said that they know "little or nothing" about the ADA; and only 41% were confident that they could provide similar quality of care to patients with disabilities as they could to those without disability.

Funding for the new study, "I am not the doctor for you: Physician bias contributes to disparities in health care for PWD," was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant number 5R01HD091211) of the National Institutes of Health.