Moving From Disability to Possibility

When I was in the first grade, an astute teacher noticed that I had trouble seeing the blackboard. This finding was quickly confirmed by a vision test. Formal evaluation by an ophthalmologist revealed that I had a rare degenerative retinal disease. Worse than that diagnosis was the ophthalmologist’s devastating prognosis for my life: attending college would be very challenging, sports and certain activities would be difficult or impossible, and it was unlikely that I would ever have a professional career. With the support of my family, I strove to not live out the dystopia of my ophthalmologist’s predictions. This formative patient experience also shaped my future. Years later, as a college premedical student shadowing physicians in the hospital, I became convinced that patients deserve to be defined by their strengths and not by a physician’s discouraging perspective of disability, such as the one that my family and I received. When applying to medical school (and disclosing that I had a disability), I once again encountered a myopic view, sometimes receiving unsolicited advice that medicine was unrealistic given my visual disability and to consider other careers. This appears to be the norm, as recent research suggests that only one-third of US medical schools would explicitly provide accommodations to a qualified student with a disability.1 Accommodations such as extended time on examinations or the use of assistive technology provide equal access to medical school curricula and the ability to demonstrate competencies despite having a disability. Society as a whole and, I feel, education and health care professionals have, for too long, viewed students with disabilities as a problem to be managed. As a firstyear medical student, I repeatedly heard William Osler’s maxim that the good physician treats the disease, but the great physician treats the patient. Osler’s caution, I believe, was to not rely exclusively on a biomedical model. I fear that sometimes when medical schools encounter applicants or students with disabilities, they do not see the whole individuals; they do not see possibilities. Instead, looking through the lens of that same biomedical model, they focus narrowly on the disabilities and, as a result, see only impairments. In 2015, the United States celebrated the 25th anniversary of the Americans with Disabilities Act (ADA). As a nation, we have made important progress toward improving the education and employment opportunities for Americans with disabilities. Nevertheless, disparities in education and employment remain— particularly in the health professions.2 In recent years, several notable lawsuits have been filed against medical schools related to the schools’ failure to provide accommodations to students with disabilities. In some instances, these cases involved overt discrimination. But, more broadly, these lawsuits are emblematic of the need for a new lens with which to look at the inclusion of individuals with disabilities in medical education. That new lens should emphasize possibility. Defining technical standards—those capabilities required of students for admission, promotion, and graduation from medical school—is important, but accommodations and currently available assistive technology offer many opportunities for students with disabilities to fulfill technical standards.3 In the preclinical years, I used large-print versions of lecture slides and handouts for didactic coursework. In anatomy laboratory, I wore custom-made optical surgical loupes—the same kind of magnifying lenses worn by surgeons when operating—to magnify dissections. On the clinical wards, I carry and use various pocket-sized magnifying devices in order to read small print on medicine vials, to more clearly see patients’ pupillary responses, or to magnify rashes. Prospectively, one of the greatest barriers identified by my ophthalmologists, low-vision specialists, and advisors was the accessibility of clinical workstation computers. As my transition to the clinical wards neared, I approached my institution’s chief medical information officer—with the support of my advisors—to determine how to make the more than 5000 clinical workstation computers visually accessible, regardless of the location of my assigned clerkships. Working with institutional technology leaders, we devised a solution that provided customized computer screen magnification across our health system—a solution that can be scaled to assist other low-vision employees and patients. This partnership focused not on disability but on possibility, and the solution was imaginative in how it pushed the limits of currently available virtualization technology. Moreover, this approach embodied the concept of “universal design,” which seeks to create environments that are intrinsically accessible to all individuals regardless of disability status. The collaborative experience that I have described— which involved my personal physicians, academic advisors, disability services experts, and technology engineers—is what the ADA mandates, but in practice may be the exception and not the rule. In addition, my experience likely does not generalize to students with other types of disabilities or at other institutions, and this is why the ADA requires that accommodation decisions be made on a case-by-case basis. In my case, technical solutions exist that make medical school possible. Technical solutions also exist to extend the opportunity to go to medical school to students with other disabilities. For example, hard-of-hearing individuals can auscultate with electronic stethoscopes that dramatically amplify sounds. Individuals with spinal cord injuries can use standing wheelchairs to work at the operating table. Universities across the United States are required to have institutionally designated disability A PIECE OF MY MIND