Persistence and Perseverance
By Julie G. Madorsky, MD, and Barry Corbet
For doctors with disabilities, overcoming obstacles is part of the job.
In 1973, a class of medical students slipped on their white coats, grabbed
their clipboards and readied themselves for what they thought would be just
another routine lecture. Instead, they got a different eye-opening lesson.
They watched as a patient was wheeled into an examining room. He had
cerebral palsy, dysarthria and ataxia. After taking a history and doing a
physical examination, the class was asked to appraise his capacity for
learning and employment.
The collective opinion was that, at most, he might end up selling pencils on
the street.
Minutes later, the “patient” returned to the classroom. This time he was
introduced as Dr. Thomas Strax, then the assistant medical director at
Philadelphia’s Moss Rehabilitation Hospital.
That was twenty six years ago, and some people in the medical community
have come a long way since those days of gross misperceptions and wild
assumptions. But many qualified applicants with a disability still have an
uphill fight to gain access to medical schools. While 13.7 percent of the U.S.
population has a significant disability, a 1988 survey found that nationwide,
people with disabilities constitute only 2.6 percent of physicians and .25
percent of medical students.1 And in 1993, an AMA report confirmed that
applicants who have disabilities still face stiff barriers gaining entrance to
medical schools.2
It’s not an easy road for people with disabilities who want to become
doctors. Take the case of Jim Post, MD, who has quadriplegia. He had to
overcome four years of rejection by 10 medical schools before Albert
Einstein College of Medicine in New York gave him a chance. He earned
his MD with honors in 1997.
Perfect Healers
Medicine has long harbored an unwritten code of perfection, and physicians
are often seen in unrealistically heroic terms. “This idea of the perfect
healer, the godlike person, just simply is unrealistic,” says Selma Calmes,
MD, who has post-polio syndrome and is chief of anesthesiology at Olive
View/UCLA Medical Center in Los Angeles. “The attitude of many
physicians toward colleagues with a disability is blatantly discriminatory.
The whole culture of medicine would improve if it was possible to consider
the whole person, to capitalize on strengths, not weaknesses.”
In the 1988 survey, physicians were subdivided into two groups according to
different life circumstances: those who had a disability before medical
school, and those who acquired their disabilities later in life.1 Of the two
categories, the former confronted more attitudinal and financial barriers, but
their disabilities required less adjustment during adulthood. The latter had
better economic and professional resources, but had greater accommodations
to make to the radical changes that accompany the late onset of disability.
Although there is a tendency to type-cast doctors with disabilities for certain
fields such as psychiatry, clinicians with disabilities are functioning
successfully in various specialties, including physical medicine and
rehabilitation, neurology, pathology, anesthesiology, general surgery,
urology, orthopedics, obstetrics and gynecology, plastic and reconstructive
surgery, internal medicine, family medicine, radiology and pediatrics.3
People with late onset disabilities tend to stay in their original specialties,
and adjust the workload and the workplace to accommodate new needs.
Adaptations to compensate for a disability add to the culture of change.
Talking thermometers, vibrating beepers, optical-tactile converters, Braille
sphygmomanometers and Braille transcription services are just a few
technology options to help physicians to do their jobs.
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But not all adaptations require high technology, just ingenuity. For instance,
Serena Young, MD, an orthopedic surgeon who had polio as a child,
developed her own protocol for scrubbing and gowning with crutches and
braces.
Frank Jirka, MD, a urologist and past president of the American Medical
Association, has a double below-the-knee amputation; he modified the cut
and burn pedals of a cutting and coagulating machine. David Rogers, MD,
who has high-level quadriplegia and is clinical geneticist with Genzyme
Genetics in Orange, Calif., uses a voice-activated computer to access
information. An assistant helps answer telephone calls, transport records, file
papers, stamp signatures and turn pages of documents.
Overcoming Discrimination
While physicians can change and adapt work environments, attitudes aren’t
so easily altered. Discrimination is a fact of life for all people with
disabilities, and physicians are no different. For many clinicians, past
experiences have hardened their resolve and form the bedrock of their
perseverance.
During childhood, Sharon Kawai, MD, who has spina bifida, was first
treated as someone expected to die soon, then later as a mentally
handicapped child. She was initially turned down at every educational level
from kindergarten to college to medical school. Yet she persevered and is
now a physiatrist and medical director of rehabilitation at Saint Jude Medical
Center in Fullerton, Calif. But she still encounters prejudice. “Even today,
people think that because you’re in a wheelchair, you don’t think as well as
others,” she says.
Dr. Strax, professor and chair of the department of physical medicine and
rehabilitation at the University of Medicine and Dentistry in New Jersey and
medical director of the JFK/Johnson Rehabilitation Institute, lived through a
time when children with disabilities were considered shameful. Dr. Strax
was mainstreamed because of his parents’ persistence in court, but not
before he was exposed to bus drivers who didn’t want him on the bus and
teachers who felt he couldn’t be educated. He had to continually prove
himself, a quality that carried over to his drive to join the medical
profession.
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While society still struggles to come to grips with disability rights, it’s not
the only source of discrimination facing physicians with disabilities.
Ironically, the strongest resistance to bringing people with disabilities into
the profession comes from within medical circles. Just getting into medical
school is a huge hurdle.
Applicants run into by-the-book “technical standards,” which effectively bar
all people with disabilities. For example, of 127 medical schools in the
United States, 28 rely on technical standards, demanding that candidates for
an MD degree must have “somatic sensation and functional use of the senses
of vision and hearing, coordination of gross and fine muscular movement,
equilibrium and functional use of touch and vision.” Only two report a
policy of disregarding disability in the admissions process.1
Judith Pachciarz, PhD, MD, spent 17 years trying to get into medical school
and found that schools didn’t bother to hide that she was being rejected
because she was deaf. It’s easy to wonder how physicians with disabilities
can do specific tasks, and it’s even easier to assume they cannot. “I would
explain technical advances.
I would bring pictures of my instruments, and I would explain how to do it,”
says Dr. Pachciarz. “Even after I answered their questions, they felt
uncomfortable. They didn’t want to say ‘Yes,’ but they had a hard time
saying ‘Why not?’” Today, Dr. Pachciarz is transfusion service director at
Martin Luther King Jr. and Drew Medical Center in Los Angeles.
Margaret Stineman, MD, who has multiple congenital malformations of the
musculoskeletal system, remembers her struggles. “Some schools
interviewed me because they were curious, because I was different. And
some schools flatly rejected me. Either they had filled their ‘quota’ of
disabled people, or they just thought I couldn’t do it,” says Dr. Stineman,
associate professor of physical medicine and rehabilitation at the University
of Pennsylvania in Philadelphia.
David Hartman, MD, a psychiatrist practicing in Salem, Va., who has been
blind since age 8, encountered similar resistance. “At first, there was some
ambivalence in the field of medicine as to whether I could do a full
evaluation or not. I didn’t feel the people saw me as someone who would
take responsibility,” he says.
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Stanley Wainapel, MD, who has a progressive visual impairment and is
clinical director of rehabilitation medicine at Montefiore Medical Center in
the Bronx, N.Y., believes these problems stem less from prejudice and more
from ignorance. “There’s a great deal of unawareness from physicians, in
admissions committees and in many levels of the medical community, about
what a person with a disability can accomplish.
I don’t think it’s occurred to many of them that the white coat is a symbol
that does not have to be worn standing up, or that a physician does not have
to be taller than the patient.”
These barriers can even extend to the workplace. Stanley Yarnell, MD,
medical director of rehabilitation medicine services at Saint Mary’s Hospital
in San Francisco, has recurrent optic neuritis and is legally blind. He had
been medical director at another facility for three years, but things changed
abruptly when his blindness advanced and forced him to use a cane. The
hospital viewed his visual impairment as a medical-legal liability and asked
him to step down as medical director, says Dr. Yarnell.
“I was numb. I couldn’t believe that somebody wouldn’t want to make an
accommodation for me.” Dr. Yarnell shifted his primary focus to an already
established private practice.
Adjusting was simple. He handed off procedures, such as EMGs and nerve
blocks, to his partners and kept a sighted resident at his side when he saw
patients. Although the hospital was eventually supportive, scars remained. “I
have a lot of self-confidence, but I was rocked to the core by institutional
prejudice even more than adjusting to personal changes,” he says. “I thought
that was the beginning of the end.”
Despite these difficulties, one area, surprisingly, doesn’t create much of a
problem: patient acceptance. It’s a concern that weighs heavily, but only
briefly, on most fledgling doctors with disabilities. “If anything, I am much
more effective dealing with disabled people,” says Dr. Yarnell. “People look
at me and know I know what I’m talking about. And I think I’m a little more
empathetic too, as all disabled people are with other disabled people.”
Dr. Wainapel uses his disability to his advantage. “I’m capable of taking the
metaphor of vision loss and applying it to other disabilities. I can’t tell
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someone who [has] paraplegia that I know what it’s like to [have]
paraplegia, but I can say that I know what it’s like to be stigmatized.”
As a physiatrist who was disabled by polio while he was in medical school,
Glenn Reynolds, MD, agrees that “disabled people’s empathy in dealing
with other people who are disabled is a great asset, especially in an
environment where everything has been reduced to a procedure. There are so
few people who get a chance to have someone sit down and listen to them
and help them work out a problem. Any disabled person who’s in medicine
can do that. It’s worth more than any kind of dexterity of arms or legs.”
In addition, says Dr. Strax, doctors with disabilities are perceived as being
warm, humanistic, understanding, caring and confident. Today, physicians
with disabilities are still pioneers. But they are more than just educated
survivors.
They’re making it possible for others to accept the challenge of practicing
medicine with a disability.
References
1. Ring, J.J. (1988). Handicapped Medical Students. Report to the AMA
Board of Trustees (I-88).
2. McCormick, B. (1993, January). Disabled still face stiff barriers to
medicine. American Medical News, 1.
3. Wainapel, S. F. (1987). Physical disability among physicians: An
analysis of 259 cases. International Disability Studies, 9, 138-140.
Julie Madorsky, MD, is clinical professor of physical medicine and
rehabilitation at the University of California, Irvine, and the Western
University of Health Sciences in Pomona, Calif. She is a polio survivor.
Barry Corbet is a writer, filmmaker and the editor of New Mobility
magazine. He sustained paraplegia after a helicopter crash.
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