Ableism in Society
Of course, the issue extends well beyond medicine. Ableism is deeply ingrained in society, but seems more invisible because people may acquire disabilities later in life. In many ways, most of us will encounter and experience one or more forms of disability throughout our lives, even if it is temporary. Perhaps that is part of our angst: We imagine ourselves as healthy until we are not, and because of that, we may unconsciously distance ourselves from people who remind us of that fundamental vulnerability.
This reluctance to admit the prevalence of disabilities shows up in architecture, in public discourse, in media and in our assumptions about productivity and value. Disability has often evoked pity rather than pride, based on assumptions about limitations rather than adaptation. The lack of physical access, the digital inaccessibility of healthcare platforms, the societal discomfort with seeing assistive devices, all lead to marginalization of those who navigate the world differently.
This is a tragedy because health outcomes are inextricably linked to social structures, and ableism has measurable effects. In large part because of the world we have constructed, individuals with disabilities have lower life expectancy, higher rates of chronic disease and more barriers to accessing timely care.3 They are more likely to face housing insecurity, unemployment and mental health struggles. And yes, they are less likely to be included in research studies, even studies on the very diseases they experience.
The broader challenge, then, is not only how we treat people with disabilities in our clinics, but how we design health systems that treat disability as part and parcel of normal variation, rather than an exception to be managed.
Ableism in Training
While societal ableism sets the stage, our professional training environments often reinforce these dynamics in subtle ways. For generations, aspiring physicians with disabilities were counseled, either explicitly or implicitly, that they couldn’t or shouldn’t pursue medicine. Despite the Americans with Disabilities Act (ADA), many institutions maintained internal standards about what a qualified trainee looked like. Even when not fully articulated, those with disabilities were treated separately from, and sometimes as unwelcome members of, our community. This has resulted in a loss of talent, limited perspectives and a lack of empathy.4
Thankfully, that’s starting to change. Such organizations as the Coalition for Disability Access in Health Science and Medical Education have begun advocating for flexible technical standards, reasonable accommodations and a broader recognition that excellence in medicine is not confined to one physical or cognitive form. Advocates have made considerable headway in bringing to the fore that disability is a form of diversity, not deficiency.
