Eliana Cardozo, DO, Assistant Professor of Rehabilitation and Human Performance, with a patient. Photo taken before the pandemic.
While it is important for physicians to skillfully and compassionately care for patients, specific competencies may improve the experience for patients with disabilities, said Jenny Lieberman, PhD, Senior Occupational Therapy Rehabilitation Specialist at the Department of Rehabilitation, Medicine, and Human Performance, who was the featured speaker for a virtual talk hosted by the Office for Diversity and Inclusion (ODI) at Mount Sinai. The session, “Building Physician Skills and Competencies in the Care of People with Disabilities,” may be viewed here.
The talk was part of the third annual Raising Disability Awareness Virtual Talk Series, launched by ODI for Disability Awareness Month. The series featured speakers from the Mount Sinai Health System and the community to raise awareness and promote an inclusive and equitable workplace and health care environment for people with disabilities.
Patients with disabilities may face a wide range of neurological, orthopedic, or medical challenges, said Dr. Lieberman, who is an occupational therapist, researcher, and educator. “There are a varying range of diagnoses,” she said. “But many times the presentation will be similar when it comes to their disability. The worst thing that we could possibly do to any patient that comes through our doors is to make them feel invisible. This is their life. This is what they’re living on the day to day. So it’s really important to recognize them so they feel they are heard, and not invisible.”
Jenny Lieberman, PhD, Senior Occupational Therapy Rehabilitation Specialist.
The first key is knowledge, Dr. Lieberman said. Having awareness of specific secondary diagnoses that develop is key to providing good care—for example, knowing that a person with a spinal injury also could develop urinary tract infections, skin irritation, or autonomic dysreflexia, a sudden increase in heart rate blood pressure. Assessments and evaluations often differ for people with disabilities during medical appointments. For example, only 5 percent of people who use wheelchairs are weighed during their visits, which affects proper dosage of medication and management of their health, Dr. Lieberman said. The solution may be using a lift or an assessment table with a scale. Even if you cannot weigh them during the visit, you can validate their concerns by acknowledging your awareness that this is a problem that needs a solution.
Tasks like weighing patients, conducting secondary diagnoses, and administering medication might require different equipment and accommodations. Dr. Lieberman recommends to “be aware if someone is coming to you with a disability,” she said “The support services, access, and requirements should be in place beforehand to ensure that they get the treatment they need.”
People with disabilities often feel invisible or viewed as incompetent during their health care experiences. They also do not receive adequate information about treatments and interventions, often have access limitations, have to advocate for themselves, and may have trouble getting the financial or insurance support they need. Dr. Lieberman said clinicians can address these important issues if they are culturally competent and understand this population’s experiences.
Dr. Lieberman also discussed ways clinicians can ensure that patients with disabilities are heard: “Do a thorough chart review before you see the patient. Introduce yourself. Acknowledge their history, ask them if they’re still experienced the symptoms they were previously experiencing, and validate their concerns and symptoms,” she said. “While all of this seems very obvious to do, it doesn’t translate to our patients. They often don’t realize that we have looked into their chart and we actually have some backstory on them.”
In the end, Dr. Lieberman suggested that physicians and other providers always be empathetic and patient. They should create an environment that makes everyone feel safe and comfortable and speak to a person with a disability in language they are able understand so they can actively participate in their care plan.