Ableism is a common yet misunderstood “–ism”. Yet the common thread that ties ableism and other –isms/ forms of discrimination like racism, sexism, and homophobia, is the belief that one group or identity is “less than” others. Specifically, ableism is discrimination of and prejudice against people with disabilities and is rooted in the belief that people with typical abilities are superior to those with disabilities. Ableism circumscribes an individual’s identity to their disability thus limiting our impressions of the person. In medicine, we have a unique opportunity to enhance our understanding of ableism, increase our own awareness, and share this knowledge with our community.
We spoke with first-year medical student, Blake Hardin, author of “Go the Extra Mile,” about his experience with chronic illness and the healthcare system, at our February 2023 #JHMChat. Joining him was Dr. Ashley Jenkins, Med-Peds hospitalist and researcher, whose focus is on equitable healthcare delivery for people living with chronic illness.
The conversation began with the challenges faced by people with chronic illness as they navigated the healthcare system. As the #JHMChat proceeded, the flaws revealed themselves to be multifactorial, yet interwoven.
Here’s Question 1 for tonight’s #JHMChat:
Q1: What flaws or obstacles within the healthcare system negatively impact people with chronic illness?
Remember to respond with A1 and #JHMChat pic.twitter.com/SWkPX8o6VA
— Journal of Hospital Medicine (@JHospMedicine) February 28, 2023
A1. Lack of integration of care. Our system is so siloed that patients with complex, chronic illness are so frequently forced to be the middle men in their care between providers. I get frustrated just talking about it, can’t imagine what it’s like on patient side #JHMChat
— Charlie M. Wray, DO, MS (@WrayCharles) February 28, 2023
A1. Lack of integration of care. Our system is so siloed that patients with complex, chronic illness are so frequently forced to be the middle men in their care between providers. I get frustrated just talking about it, can’t imagine what it’s like on patient side #JHMChat
— Charlie M. Wray, DO, MS (@WrayCharles) February 28, 2023
A1. So many but I’ll start with sequencing of appts/testing which doesn’t take into account that many people need MULTIPLE things done and they should be allowed batch. Making multiple trips for testing/appts is a huge barrier to care! #JHMChat
— Gopi Astik (@gopiastik) February 28, 2023
Navigating the healthcare system can be a daunting task but is made more challenging when patients feel that they are not heard.
A1 in the inpatient setting- not having a clear understanding of goals that are important to patients as they live with a chronic illness. #JHMchat
— Areeba Kara (@areeba_kara) February 28, 2023
The flaws of the healthcare system arise from, as Hardin remarked, from “systemic ableism that disproportionately impacts people with disabilities and chronic illness.”
A1 I am by no means an expert, but many of the flaws and obstacles stem from systemic ableism that disproportionally impacts people with disabilities and chronic illnesses. Systemic ableism intersects with systemic racism and other identities which harms all patients #JHMChat
— Blake Hardin (@Blake347) February 28, 2023
Clinicians’ knowledge of the human body may promote a false assurance that “doctors know best.” This is how ableism’s insidious influence begins to take root. Though we may know the pathophysiology of a person’s medical condition, we sorely lack knowledge of their life experiences.
? Whew that was fast! Question 2 coming your way! Share your experiences and insights!
Q2: How does ableism and our understanding of disability influence the care we deliver to patients with chronic illness?#JHMChat pic.twitter.com/m2kSeojfcr
— Journal of Hospital Medicine (@JHospMedicine) February 28, 2023
Very true. More education from patient perspectives in medical education is critical. Even as someone who lives with short bowel syndrome, a rare illness, I will never completely understand others’ healthcare journeys. This is where cultural humility comes into play. #JHMChat
— Blake Hardin (@Blake347) February 28, 2023
We see the difficulties patients face from a medical perspective, less than considering the environments not built for them or the systems that bring about these challenges. #JHMChat
— Jennifer Tich, MD (She/Her) (@JenniferTichMD) February 28, 2023
A2. I don’t think providers understand what constitutes accommodations for every patient. Just like providers don’t always understand the SDoHs patients face. I think asking about accommodations would allow for greater understanding #JHMChat
— Anika Kumar, MD (she/her) (@freckledpedidoc) February 28, 2023
Cultural humility, as Hardin alluded, is a process whereby we learn about others’ cultures and identities by reflecting on our own beliefs and how these beliefs shape our interactions with others. The remedy for ableism starts internally and begins with an honest critique that may involve reformulating previously held beliefs.
A3 This is tough! I think we have to unlearn some things and value what our patients value for themselves.#JHMChat
— Areeba Kara (@areeba_kara) February 28, 2023
A1: there are so many assumptions I know I have made and often continue to make about what ‘suffering’ is and what is or is not ‘worth’ living through. Without checking this ableist bias I cannot meet a patient where they are. #jhmchat
— Ashley Jenkins (@AJenkins_MD) February 28, 2023
As Epictetus in Discourses articulates “It is impossible for a man to learn what he thinks he already knows.” Approaching our patient interactions with a learner’s mind primes us to receive invaluable knowledge that can enhance both our care and the patient’s healthcare experience.
A3: Partnering with patients/families and hearing their stories. Understanding their struggles and triumphs makes us better doctors.
It needs to be taught from early on in medical education and the rest of us need to catch up.#JHMChat
— Jen Readlynn, MD, FHM (she/her) (@jenreadlynn) February 28, 2023
A3: Systemic disparities require systemic solutions. Change at the level of policy, research, education, and the culture of healthcare is required to make a dent in ableism. However, a good start is for providers to LISTEN and BELIEVE their patients with chronic illness #JHMChat
— Blake Hardin (@Blake347) February 28, 2023
I would add that the systemic solutions will only truly be found through patient and caregiver partnership and collaboration. #jhmchat
— Ashley Jenkins (@AJenkins_MD) February 28, 2023
Collaboration. The patient-physician relationship is rebuilt from one in which the physician, historically, stood on higher ground to one where all patients are empowered to stand shoulder to shoulder with their care team, bringing a different yet equally significant piece to the healthcare puzzle. Only then can we truly move the dial towards a more equitable and sustainable healthcare system.
Join us for the next #JHMChat on Monday, March 20, when we discuss burnout, collective suffering, and organizational compassion, with guest expert Dr. Rachel Thienprayoon, author of “Beyond Burnout” in the Journal of Hospital Medicine.
Leave A Comment