The pathologizing of disability: Why academic medicine must prioritize accessibility

Panelists, left to right, Oluwaferanmi O. Okanlami, MD, Kristin Limpose, MD, PhD, and Amy Rule, MD, MPH, spoke on a panel about accessibility in medicine at Learn Serve Lead 2024: The AAMC Annual Meeting in Atlanta on Nov. 11.

Credit: Kaveh Sardari

"Most people know me as Dr. O. I'm a middle-aged Black man with brown skin, short black hair. I'm wearing dark-rimmed glasses, a black blazer, and I'm sitting in a manual frame wheelchair. Now, I start with that because what people don't often recognize is that individuals that are blind or low vision, that don't have the ability to see who you are or see your slides, don't have the opportunity to fully participate in presentations."

This is how Oluwaferanmi O. Okanlami, MD, MS, director of Student Disability Services and assistant professor of family medicine at the University of Michigan in Ann Arbor, introduced himself before speaking on a panel session titled "Accessibility in Action: Navigating Academic Medicine and Health Care With a Disability" at Learn Serve Lead 2024: The AAMC Annual Meeting in Atlanta on Nov. 11.

Okanlami was joined by co-panelists, Kristin Limpose, MD, PhD, a neonatal and perinatal medicine fellow at Emory University School of Medicine, and Amy Rule, MD, MPH, FAAP, an assistant professor of pediatrics at Emory and a pediatric and neonatal hospitalist at Children's Healthcare of Atlanta.

Each of the panelists spoke from their professional expertise as well as their lived experience as people with disabilities. Okanlami was paralyzed from the chest down after diving into a pool during his third year of orthopedic surgery residency. Limpose was born without a left hand. And Rule has a rare skeletal dysplasia and is the parent of an 8-year-old son who also has a disability.

"There's great diversity within disability," Rule said. "I think it's one of the things that can sometimes be both one of our greatest strengths and one of our greatest challenges when it comes to thinking about this on an institutional level. How do we accommodate both physicians and trainees that have such diverse needs?"

The panelists addressed several barriers that people with disabilities often face when pursuing medical education and a career in medicine. These include admissions and recruitment processes that are not welcoming and inclusive to people with disabilities, the fact that the onus of identifying and obtaining accommodations often lands on the person with the disability as opposed to the institution, and the prevalence of ablism in the academic medical community.

Limpose recalled that, to qualify for accommodations in medical school, she had to go to the health clinic for a doctor's note certifying her disability.

"It makes me laugh in retrospect … I'm like, you can just see that," Limpose said. "I don't need a physician to tell you and certify that I have a limb discrepancy. And so, I think that was another added barrier, and another thing that I had to do in my very busy medical school schedule that other people did not have to do."

Okanlami added that he has often had to address both subtle and blatant devaluation of people with disabilities among academic medicine colleagues, for example, when asked to justify the expense of implementing an accessibility accommodation. These questions are rooted in ablest bias that has survived in much of medical education and culture, which pathologizes disability and is quick to assume people with disabilities - as patients, trainees, and physicians - are less than, Okanlami said.

"Study after study shows that physicians view the quality of life of disabled patients as lower than patients themselves [do]," he said. "When physicians look at our bodies, they think, 'That quality of life is so bad, they're not going to want this [treatment].'"

Okanlami emphasized that better inclusion and accessibility for disabled people in academic medicine will ultimately benefit everyone, particularly by improving the understanding of how to meet the needs of disabled patients.

He added that accessibility is something that people from all positions and life experiences have a stake in, not only to support their community members, but also because it's the one marginalized group in which everyone could one day be included.

It's a message that needs to start early, added Rule.

"We need to make sure that we are reaching our students with disabilities earlier, but then we also need to make sure that we're addressing inclusion for all children, including those that don't have disabilities," she said.

One way that Okanlami is helping change the cultural narrative around disabilities is through an initiative he's leading that teaches children of all abilities and disabilities to play adaptive sports. That way, they'll grow up with a more normalized view of people with disabilities, he hopes.

"My son thinks all wheelchair users are professional athletes," he said. "They will grow up to have a different mindset than [I did]."