Study shows troubling lack of knowledge by physicians about the Americans with Disabilities Act
To achieve more equitable care and social justice for patients with disability, considerable improvements are needed to educate physicians about making healthcare delivery systems more accessible and accommodating. – Lisa I. Iezzoni MD MSc, Mongan Institute, Massachusetts General Hospital
Vicky Hladynets photo, Unsplash
Key Takeaways
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BOSTON – More than 30 years after the passage of the Americans with Disabilities Act (ADA), most physicians still lack basic knowledge about “reasonable accommodations” the law requires them to provide to people with disabilities, a study by researchers at Massachusetts General Hospital (MGH) has found. In a paper published in Health Affairs, the team reported that more than a third of physicians surveyed knew little or nothing about their legal requirements under the law, and more than 70 percent did not know who determines the “reasonable accommodations” required to provide equitable care to people with disabilities.
“Despite the fact people with disabilities comprise 25 percent of the population, they often confront barriers to basic health care services such as physical examinations, weight measurement, and effective communication with their physicians,” says lead author Lisa I. Iezzoni MD MSc, with the Mongan Institute’s Health Policy Research Center at MGH. “To achieve more equitable care and social justice for patients with disability, considerable improvements are needed to educate physicians about making healthcare delivery systems more accessible and accommodating.”
Passed in 1990, the Americans with Disabilities Act prohibits discrimination against people with disability, including in healthcare. Specifically, it requires physicians and patients to collaborate on determining what reasonable accommodations are needed to ensure that patients receive accessible and equitable care. To explore the understanding by physicians of their obligations under ADA, MGH researchers conducted a nationwide survey of 714 U.S. physicians in outpatient practices. They learned that 36 percent had little or no knowledge about their legal responsibilities under ADA; 71 percent answered incorrectly about who determines reasonable accommodations; 21 percent did not know who is obligated to pay for these accommodations; and 68 percent felt they were at risk for ADA lawsuits.
“The lack of knowledge about who makes accommodation decisions raises troubling questions about healthcare quality and equity,” notes Iezzoni. She cites previous studies by her team and others that have described individuals with mobility disability being examined in wheelchairs instead of transferred to an examination table, resulting in substandard care and delayed diagnoses, including of cancer. In addition, patients who are deaf or hard of hearing have reported that their preference for effective communication accommodations, such as an in-person sign language interpreter, are often not followed by physicians.
“All patients with disabilities should ask their physician’s office staff about accommodating their needs and preferences when they schedule an appointment,” explains Iezzoni. “Physician practices should retain that information in electronic health records and always ask at the time of scheduling if these needs and preferences have changed.”
The latest MGH study stresses the need for more training of physicians about disability civil rights and their responsibilities under ADA, beginning in medical school and then as part of a physician’s continuing medical education. “Medical schools are currently training students about combatting racism, and there should also be training in combatting discrimination against people with disability, also known as ableism,” emphasizes Eric G. Campbell PhD, a survey scientist at the University of Colorado, and senior author of the study. “Every practicing physician can expect to see increasing numbers of people with disability, and they need to 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 University of Colorado Center for Bioethics and Humanities on the Anschutz Medical Campus. Other co-authors include Elizabeth Pendo JD, professor of Law at Saint Louis University, 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 the Massachusetts General Hospital |
| Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In August 2021, Mass General was named #5 in the U.S. News & World Report list of “America’s Best Hospitals.” |
| References |
US Physicians’ Knowledge About The Americans With Disabilities Act And Accommodation Of Patients With Disability, Iezzoni LI, Rao SR, Ressalam J, Bolcic-Jankovic D, Agaronnik ND, Lagu T, Pendo E, Campbell EG. Health Aff (Millwood). 2022 Jan;41(1):96-104. doi: 10.1377/hlthaff.2021.01136.
| Further reading |
Physicians’ Perceptions Of People With Disability And Their Health Care, Iezzoni LI, Rao SR, Ressalam J, Bolcic-Jankovic D, Agaronnik ND, Donelan K, Lagu T, Campbell EG. Health Aff (Millwood). 2021 Feb;40(2):297-306. doi: 10.1377/hlthaff.2020.01452.
Comments in Eliminating Disability Bias: The Authors Reply, Iezzoni LI, Campbell EG. Health Aff (Millwood). 2021 May;40(5):852. doi: 10.1377/hlthaff.2021.00520. No abstract available.
Comments in Addressing Disability Bias, Isaacson A, Rushin C, Coleman J, Tolchin DW. Health Aff (Millwood). 2021 May;40(5):851. doi: 10.1377/hlthaff.2021.00344. No abstract available.
Comments in Eliminating Disability Bias, American Association on Intellectual and Developmental Disabilities; American Autoimmune Related Diseases Association; American Foundation for the Blind; American Therapeutic Recreation Association; Autism Advocacy; Autistic Self Advocacy Network; Brain Injury Association of America; Epilepsy Foundation; Justice in Aging; National Association of Councils on Developmental Disabilities; Partnership to Fight Chronic Disease; TASH. Health Aff (Millwood). 2021 May;40(5):851. doi: 10.1377/hlthaff.2021.00409.
Demonstrating the vital role of physiatry throughout the health care continuum: Lessons learned from impacts of the COVID-19 pandemic on the disability community, Chandan P, Kirschner KL, Prokup J, Blauwet CA. PM R. 2021 Jun;13(6):589-598. doi: 10.1002/pmrj.12611. Full text
Communicating with Patients with Disability: Perspectives of Practicing Physicians, Agaronnik N, Campbell EG, Ressalam J, Iezzoni LI. J Gen Intern Med. 2019 Jul;34(7):1139-1145. doi: 10.1007/s11606-019-04911-0. Epub 2019 Mar 18. Full text
Exploring issues relating to disability cultural competence among practicing physicians, Agaronnik N, Campbell EG, Ressalam J, Iezzoni LI. Disabil Health J. 2019 Jul;12(3):403-410. doi: 10.1016/j.dhjo.2019.01.010. Epub 2019 Feb 1. Full text
Also see
What Docs Don’t Know About the Disabilities Act Can Hurt Them and Patients Medscape Medical News
Misperceptions Of People With Disabilities Lead To Low-Quality Care: How Policy Makers Can Counter The Harm And Injustice Health Affairs
Large majority of doctors hold misconceptions about people with disabilities, survey finds STAT
