Who accommodates a doctor with a disability?

In my practice, as in most medical practices, we accommodate patients’ particular needs in all kinds of ways: wheelchair accessible rooms and hallways, interpreters of virtually all languages including American Sign Language, gowns and instruments in a wide range of sizes, information sheets and videos suitable for patients with a variety of educational backgrounds.

No one questions the appropriateness of these accommodations.

But what about when the doctor or nurse requires an accommodation?

current lawsuit involving a deaf medical student at Creighton University in Nebraska invites a reconsideration of this question.

The student, Michael Argenyi, is suing Creighton because they have refused to provide an interpreter for him during his interactions with patients. One of the school’s arguments is that introducing a third person into the doctor/patient interaction would be intrusive. (Though this is not an argument often used against providing an interpreter for a patient).

Argenyi’s suit, it seems to me, taps into broader questions about doctors’ roles. Some would argue that physicians are like other workers, whose working conditions should be protected by all sorts of laws and regulations including the Americans With Disabilities Act.

Some would argue that doctors are not like other workers, that our duty to our patients supersedes all other concerns, including our own needs. This was certainly the ethos in which I was trained, long before the current restrictions on resident work hours. I remember, back then, telling a non-medical friend about the long hours I worked and her asking, “But don’t you get paid lots of overtime for that?” I laughed. There was, of course, no “overtime.”

I actually don’t think these two views are at odds when it comes to physicians with disabilities. Couldn’t the argument be made that having a deaf physician — or one with cerebral palsy, blindness, dwarfism, or any of several differences and disabilities–has the potential to enhance patient care? I know that my own experiences with such clinicians, as a teacher, colleague and (in one case) as a patient myself, have enlarged my own sense of the ways in which disabilities can be overcome and the varied forms in which excellent and compassionate care can appear.

Is is possible that having a deaf doctor has, for some patients, therapeutic benefits that equal or even outweigh any problems that disability poses?

Suzanne Koven is an internal medicine physician and a Boston Globe columnist.  She blogs at In Practice at Boston.com, where this article originally appeared. She is the author of Say Hello To A Better Body: Weight Loss and Fitness For Women Over 50

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  • http://barefootmeds.wordpress.com/ Barefootmeds

    The only disabled doctors/medical students I’ve ever met were paraplegics, and they struggle a bit in our hospital because it is big and old and the the elevators are regularly broken, and our hospital is overcrowded and so it is often difficult for them to get to the patient’s bedside, and our beds are from the stone age and often aren’t able to be lowered.

    My school has quite a few visually impaired students (e.g. Stargardt’s, RP) studying physiotherapy and although there are good attempts at accommodating them, they do have struggles too.

    Our OT department does very well with disabled students, and once had a deaf student graduate suma cum laude because they were so good at accommodating her – not surprisingly for an OT department.

    The only real “experience” I have to contribute it that of my dad, who has Stargardt’s disease and wanted to become a clinical psychologist. He was not accepted to the program because the panel believed that a psychologist needs to be able to “see the expressions and body language of his clients”. My dad was heartbroken, but these days he believes that the path his life took brought him to better things.

    I would love to see a survey or study of how healthcare workers with disabilities are accommodated for. I think we will be ashamed.

  • Frank Lehman

    It all depends on the disability.

    Is use of a stethoscope an essential capability for a physician? If so (and it would seem to me that it probably is essential), then being deaf would disqualify someone.

    Koven never discusses whether the disability impacts on the essential functions of a physician. She really misses the point.

  • Reese

    I’m a nurse with 28y experience. I am no longer able to work due to the effects of chemotherapy; I am totally disabled. I wish there was a job I could do per diem, but that sort of thing just does not exist. I’m afraid the longer I’m away from the profession, my skills will just die off, and a lifetime of learning will be lost.

    • Guest

      My dad was a very skilled carpenter, and made a good living at it too. He had to stop work after he had a stroke which paralyzed his left side. Stuff happens.

    • Suzi Q 38

      I am sorry for your medical condition, which has affected your life and work. Are you able to work at all? If so, how many hours?
      Can you be a part-time nurse navigator?
      If you want a job, don’t give up.

  • pbat

    The University of Rochester/Strong Memorial in NY has from what I understand a good track record of having deaf residents, in OB and peds I know for sure but likely others also. It is also the location of a very large deaf community with a deaf college, so much so that there is an in-house ASL interpreter there 24/7. I know it is a unique scenario but definitely works and deaf physicians have provided great care to hearing and non-hearing patients there!

    • Guest

      I live near a large school for the blind but I wouldn’t be too keen on being saddled with a blind neurosurgeon.

      • kjindal

        that is a completely irrelevant statement. This deaf student isn’t going to audiology school! And having a relatively minor disability (compared to CP, paraplegia, blindness) shouldn’t relegate him to working at walmart or the post office!

        • guest

          Just because someone might not be suited to being a hands-on doctor doesn’t mean that walmart or the post office are their only other options. What an incredibly strange thing for you to presume!

          • kjindal

            The point is that we mandate (via legislation) that accommodations for
            all types of disabilities be made in cases like Walmart or USPS employees. Yet our collective entitlement mentality prevents us from looking at this issue from the young medical students perspective, rather than our own selfish needs as prospective future patients.

            The neurosurgeon point is just silly. Nobody would argue that a blind person be so accommodated to be, e.g., a pilot, cab driver, surgeon etc.

          • Guest

            “our own selfish needs as prospective future patients”

            I’m sorry, but when it comes to the lives of myself and my children, I WILL be selfish about who treats us. I won’t accept sub-par treatment just to make you feel warm and fuzzy, not when I’ll be the one to ultimately pay the price. Pander to political correctness all you like, but don’t expect poor hapless patients to suffer or even die for it. There are plenty of high-skilled high-paying jobs in medicine which don’t require hearing. Directly treating patients is not one of them.

  • Ron Smith

    I wonder what discussions there were between the medical school and Argenyi were prior to his acceptance? Surely this present problem had to be addressed several years prior to this conflict? I somehow think that any conclusions drawn with the information presented would be unintentional flawed.

    Ron Smith, MD
    www (dot) ronsmithmd (dot) com

  • Guest

    I would not see a doctor I could not communicate with. I’m sorry, but I just don’t want a third party (or a rotating set of third parties) in the exam room, and also I don’t think I’d like to trust an unqualified layman to be the “go-between” between my medical practitioner and me. What if they mis-translated something, either from me to the doctor or from the doctor to me? And what if I didn’t WANT to tell some strange third party whom I’ve never seen before and who has no medical expertise about certain medical symptoms?

    I wouldn’t want to fly in a plane piloted by a blind captain either, or hire a deaf lifeguard to man our public beach, or hire a Down syndrome sufferer to tutor my son in calculus. Fair or not, some skilled positions are not suitable for all.

    • Guest

      But what if you were deaf? Do you think you would benefit from a deaf physician who could really understand your issues?

      I’m just playing devil’s advocate. Personally though I do think the deaf medical student deserved an interpreter because ultimately he/she will become a physician who can serve a unique need.

      • Guest

        Fine, if some patients want to see them. Just don’t force patients who don’t want to deal with a deaf doctor to do so, under the name of “equality” (which would benefit the doctor but provide the patient with UNEQUAL treatment).

        A handicapped doctor’s right to practice does not trump my right to have a doctor who can hear what my cough sounds like, or what my baby’s cry sounds like, and with whom I can communicate one on one without having to go through a third party translator who may or may not be someone I feel comfortable sharing my problems with and who may or may not always get things right.

        In a life or death situation, which healthcare can be, where a patient can literally pay for communication deficits with his or her LIFE, this is not the time or place to be pandering to political correctness. Patients should not be expected to martyr themselves on the altar of “equality”.

  • EE Smith

    Is a digital stethoscope superior to a traditional one, or is the patient being asked to accept a lower standard of care in order to accommodate their doctor’s disability?

    • Frank Lehman

      Good question, EE Smith. Jennifer Isaacs apparently believes the medical student in question was successfully using a digital stethoscope (how does she know that). The important question (even though Jennifer Isaacs and Dr. Koven do not seem to want to address it) is whether ability to hear is essential for a physician.

      • kjindal

        Auscultation is overrated, and underused anyway (how many times has your doctor rejected the results of X-ray or echocardiogram over his own ears?).
        And this student could easily be an excellent pathologist, radiologist, or with the same accommodations we so quickly demand of anyone working at walmart, or the us gov’t, he could practice in any other field of medicine. Maybe DEAF PATIENTS would prefer seeing him, realizing he may have greater empathy with their experience.

        Ridiculous that we aren’t all rallying around this bright and motivated young man.

        • Guest

          “Ridiculous that we aren’t all rallying around this bright and motivated young man.”

          He’s not a pet, and this is not the special olympics. Being able to hear, and being able to communicate directly with your patients, is an intrinsic part of healthcare. Because it’s THEIR lives on the line, patients have the right to be picky about who their doctor is.

  • MJR

    I am a deaf physician trained in the late 1990′s before ADA. As a pathologist,I don’t often have direct patient contact, but when I do, patients are very often considerate and happy to accommodate my deafness. Many ask questions about my cochlear impant. Those who are less willing to accomadte me are my colleagues, especially surgeons who find it frustrating to use the relay service for telephone calls because it wastes”My precious time”.I am surprised it has taken this long for an ADA lawsuit against a medical school to appear, because there have been deaf medical students and resident trained in schools across the country. These physicians are integrating into the workforce with little fanfare because enlightened medical schools and residency programs have clearly outlined methods of complying with ADA regulations. There are also medical schools that have “technical standards” that they use to skirt ADA and prevent any disabled candidates from being accepted. I hope this student wins this lawsuit so medical schools across the country will begin to understand that we truly need Doctors of all types and capabilities.

    • Frank Lehman

      You said: “I am a deaf physician trained in the late 1990′s before ADA.” The ADA was signed into law in July 1990.

  • guest

    I wanted to join the Air Force, but I’m color blind. It didn’t actually occur to me that I should sue.

  • pbat

    I have to agree with Ron Smith as my final input on this one. All med schools that I know of require an interview prior to acceptance, so it is pretty much not possible that they did not know of his disability prior to acceptance….why would they choose him to go to this medical school knowing full well he is deaf, then refuse to make the needed accomodations? There are literally hundreds of applicants per spot in medical schools. Maybe there is part of the story we are missing, but it doesn’t make sense no matter what your opinion on the subject is…..???

  • Kathy Zain

    No patient would see a doctor who is unable to communicate in any way: who cannot see, speak, feel or hear. But if these disabilities occur later in a doctor’s life, who cares for the carer???????????

    • Guest

      Hopefully, like anyone else, they would have bought disability insurance. It’s not just doctors this happens to, it’s teachers, firefighters, trial lawyers, veterinarians, star basketball coaches…

  • maggiebea

    Prejudice against people with disabilities is rampant, and nowhere worse than in colleges, universities, and grad schools (medical schools included). Meanwhile actual people who graduated first and then became disabled are continuing to do wonderful work in a huge range of jobs. This argument isn’t about whether the student in question can become an excellent physician; this argument is about whether the temporarily-abled (most of us who occupy positions of power) can become sufficiently accepting of ‘otherness’ to allow this student and others like him to make their own successes without our active interference, or whether we are so insecure ourselves that we must pretend that all our own abilities are ‘essential’ and all their ‘extra’ abilities are ‘irrelevant.’

    MB
    former Dean of Students at a small seminary
    all too familiar with the arguments in favor of able-ism

  • Eric Thompson

    Do whatever; as long as patients who do not want him as a provider are not forced to see him.

  • katerinahurd

    Do you think that discrimination against professionals such as doctors with disabilities starts at the medical schools? Are you aware of any medical school that teaches students that the best interest of the patient is not only served when the physician exercises his knowledge and skills to restore health, but also can sympathize with the imperfections of human nature. Disability is one of the contextuals of human nature.

  • SBornfeld

    My quick perusal of the comments did not reveal any I saw from experts in disability law.
    My (also inexpert) understanding of ADA enforcement is that all REASONABLE accommodations should be made for persons otherwise capable of performing their jobs. The comments about “blind neurosurgeons” and “doctors who can’t communicate” are straw man arguments.
    However, whether it is considered economically “reasonable” to provide a full-time interpreter for a doctor or student–I find it hard to believe that issues very much like this have not been addressed in case law.
    I’m aware that this is not black and white; and I know that some rather large and difficult accommodations HAVE in fact been made for the disabled in some work contexts.

  • Kaya5255

    Good Lord! It’s hard enough trying to communicate with physicians who have all of their facilities (ego’s aside)!! Being unable to hear or see diminishes the essential functions of being a practicing physician. Consumers deserve better.

  • wiseword

    I was once in a dental chair, screaming in pain (a clinic, not a private practice), while the dentist happily flirted with a pretty hygienist. Turned out the dentist was deaf. I’d like my dentist to be in good shape from the waist up.

  • Omaha

    First, I wish we knew the whole story. It’s a lot easier to blame/sue
    someone than take accountability for our own actions. How many times
    have we all heard an excuse that someone blames the teacher when someone
    fails a test? We need smart, competent doctors. I only say this
    because I went to Creighton School of Medicine with Michael and have
    conversed with him multiple times. He communicates by someone speaking
    loud and reading their lips. He does not know sign language which I
    think is helpful to know before passing judgement on Creighton.
    Wouldn’t someone in that position take the time to learn sign language?
    Creighton provided him with someone to help him speak slow and read
    lips during M1 and M2. His argument is that he had trouble during the
    clinical rotations. Thus, if the patient choose to speak slow and
    enunciate fully, he would have been able to communicate with them. It
    was their decision. We all talked to him all the time without an
    interpreter. As a medical student, patients have refused me being in
    the room based on my gender. It was a female patient’s choice to not
    let a med student do a pelvic exam. The patient’s choice. Just like it
    is the patient’s choice to speak slowly to Michael or find a different
    doctor. Again, Michael can communicate with anyone as long as they
    speak slowly and clearly. Med school is hard. I failed quizzes and
    tests a lot at Creighton. I also wanted to sue Creighton, rather than
    take accountability for my own actions. Instead, I studied more and
    worked harder. People do fail out of every medical school, not just
    Creighton. It saves medical malpractice lawsuits later. I guess Michael
    could sue Creighton now or he could be sued later for missing something
    important, potentially killing someone. I’m not trying to be harsh and
    I am a FIRM believer in the Americans with Disabilities Act. But I do
    not think that someone blind should be flying an airplane, even with
    someone sitting next to them saying “there is a building straight ahead
    on your left, you might want to fly a little higher”. Pilots “lose
    their wings” when their vision gets bad to protect others. They don’t
    sue and call out the ADA demanding “it’s their right” to fly because as
    US citizens “it’s our right” to be safe. If I go into an ER with a
    gunshot wound, I want to know I’m in good hands.

    Something to
    think about: In the United States, one must pass an exam called “Step 2
    CS”. 1/3 of the exam is “English proficiency”. One is graded on how
    well they understand, comprehend, and communicate in English. It was
    originally designed for foreign medical students to take to make sure
    their English was sufficient to communicate with patients. Now, every
    single medical student/physician has to pay about a thousand dollars to
    take it. If the standardized patient feels the medical student taking
    the test has too thick of accident or problems communicating in English,
    they fail and cannot get their medical license. If you fail Step 2 CS
    three times, you can never get your medical license in the United
    States. So, should someone sue the USMLE for being “prejudice” against
    their ethnicity and thick accent? If I am short and slow should I sue
    Creighton basketball team for not offering me a basketball scholarship
    when I was in high school? If I’m 6’8 240lbs should I sue if I cannot
    become a jockey? We each have gifts and need to learn to use them to
    our own abilities rather than sue others for our own shortcomings.

  • AnonRD

    As a hearing-impaired dietitian I am shocked at the lack of understanding and compassion voiced by some people here. It confirms my decision recently not to inform my employer of my “disability”. It was something I agonized over, but I’ve come to realize that most people don’t understand that only the disabled person him or herself is able to determine what they are, or are not, capable of doing. I did not want a complete stranger to decide if I was able to do my job. I have enough common sense to not apply for a job where I had to work in an environment where I could not hear well enough to be an effecitive clinician. I’m sure this young man knows his limitations, as well, but believes that reasonable accomodations would allow him to fulfill his dream.

    It’s a very valid point that interpreters are used all the time to communicate with patients and I believe some patients, especially those with their own disability, might not have a problem with this if the table was turned. It is also the case that many people choose their physician based on ethnicity, where they were trained, and what languages they speak, so why not other factors such as a disabilty?

    As a person with a disability myself, I would jump at the chance to have a physician who had an inkling of an idea of what being hearing-impaired is like. After being told by my specialist that a hearing aid would never help me, I am utterly grateful that I didn’t listen to him. A hearing aid significantly improved my quality of life in ways beyond speech recognition (that only improved slightly). Of course, he would not understand. How could he?

    I think it’s fair to say that anyone smart enough to get into medical school probably has a pretty good idea what he is capable of and determining what his limitations are. And, as a few people pointed out, there are options other than direct patient care for physicians who chose to go that route, i.e. radiology or research, in addition to pathology. Many “deaf” people are not without hearing and, in modified environments, can communicate very effectively. Places with a lot of background noise or where the person they are communicating with are turned away from them are the worst. But a quiet exam room or office setting may be fine.

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