Many Physicians May Harbor Negative Perceptions Of People With Disabilities

The vast majority of physicians believe that significant disabilities are associated with a worse quality of life, results from a U.S. survey suggest.

The national survey, which included the opinions of 714 doctors from a wide variety of specialties, found that nearly 80% believed that a patient with a significant disability would have a worse quality of life ("a little worse" was chosen by 42% and "a lot worse" was chosen by 37%) compared to those who are not disabled, researchers report in Health Affairs.

"This raises questions as to whether a physician's judgement of a person's quality of life might affect the care they give to someone," said the study's lead author, Dr. Lisa Iezzoni, a professor of medicine at the Harvard Medical School and the Massachusetts General Hospital in Boston.

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"That's especially an issue during pandemic surge periods when ICU beds and ventilators are scarce," Dr. Iezzoni said. "A disabled person might be denied these scarce resources because of physician bias."

The study also found that only 40.7% of doctors were very confident of their ability to provide the same quality of care to patients with a disability as they did to others. Just 56.4% strongly agreed that they would welcome patients with disabilities into their practices.

"The fact that only 40.7% of physicians felt confident in their ability to provide an equal quality of care to patients with disabilities is troubling given that about 25% of the population has a disability," Dr. Iezzoni said.

The survey shows that many doctors are assuming they know what disabled people's lives are like, Dr. Iezzoni noted.

"Doctors don't do house calls anymore so they don't see how people with disabilities have figured out how to organize their lives," Dr. Iezzoni said. "The point is, doctors should not be imposing their value structure on someone else's life, especially when they could be the ones who get to decide things that could have a really big impact on your life."

To get a sense of how doctors viewed quality of life among those with disabilities, the researchers asked "In general, compared to persons without disability, do you believe the overall quality of life of persons with significant disability is…?." Possible responses were: "a lot better," "a little better," "the same," "a little worse," and "a lot worse."

To evaluate doctors' other attitudes toward patients with disabilities, the researchers listed a series of statements asking for responses on a scale from "strongly agree" to "strongly disagree." This section of the survey included statements such as: "Understanding my patients with disability is valuable to me as a physician;" "People with disability are often treated unfairly in the health care system;" and "I welcome patients with disability into my practice."

The new findings are "disturbing" said Dr. Albert Wu, an internist and professor of health policy and management at the Johns Hopkins School of Public Health in Baltimore. "I'm not sure which of the findings was most disturbing," he added. "It is shocking the lack of understanding that the majority of physicians had about the lives of people with disabilities and the incorrect assumptions they held suggesting people with disabilities may have a worse quality of life than so-called normal people, or as a friend calls them 'the temporarily abled.'"

It's been known for over 20 years that most people, even those with significant disabilities, "level-set and equilibrate to living with their limitations and enjoy a good quality of life," Dr. Wu said. "Despite this, the general public and physicians in particular perceive that people with disabilities are unsatisfied with their quality of life even though more than 50% of them report a good to excellent quality of life."

There is a real risk, Dr. Wu said, that because of this people with disabilities might be deprived of beneficial treatments. "In the most extreme case, many of the guidelines for allocating scarce lifesaving resources during COVID exclude people with disabilities," he added. "In a less egregious example, many women with disabilities are not offered Pap smears or contraception because of assumptions about their sexual activity. And many with early breast cancer are referred for mastectomy rather than breast conserving surgery because doctors assume they don't care about their breasts."

"It appears that a majority of physicians practicing in the U.S. cling to biased and stigmatizing perceptions of people with disabilities," Dr. Wu said. "And worse, some don't appreciate those biases in themselves. It's high time for those attitudes to be corrected and changed."

—Linda Carroll

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