番茄社区

Doctors with disabilities are far more likely to experience mistreatment from coworkers and patients -- such as threats of physical harm, actual physical harm, and unwanted sexual advances -- compared with their peers without disabilities, researchers found.

Overall, 64% of physicians with disabilities reported at least one type of mistreatment from their coworkers, including threats of physical harm (27.6% vs 4.8% of those without disabilities), actual harm (24.6% vs 1.8%), and unwanted sexual advances in the previous 12 months (31.3% vs 7.5%), noted Lisa Meeks, PhD, of the University of Michigan in Ann Arbor, and colleagues .

Physicians with disabilities also reported experiencing more mistreatment at the hands of patients than their non-disabled peers. About 40% reported threats of physical harm by patients compared with 22.6% of physicians without disabilities, 26.3% reported actual physical harm versus 5.3% of non-disabled peers, and 39.9% versus 16.4%, respectively, reported unwanted sexual advances.

"This study offers the first comprehensive national assessment of physician mistreatment among physicians with disabilities," Meeks and team wrote. "Our findings highlight the need for immediate system-level intervention and training focused on the value of disabled physicians and the need to create safe, equitable, and supportive workplaces."

These study results are not surprising, especially those concerning mistreatment by coworkers without disabilities, said Lex Frieden, MA (no relation to this writer), professor of biomedical informatics and physical medicine and rehabilitation at the University of Texas Health Sciences Center at Houston.

"As a matter of fact, it makes perfect sense to me," he told 番茄社区 in a phone interview.

"Medicine for decades, even centuries, has focused on cures -- making people well again, making them back to their normal, making them perfect. That fundamental focus of medicine has promoted the notion that people who are not perfect -- people with disabilities -- are somehow substandard, and [represent] failures in their industry. That's deeply ingrained in the whole practice and philosophy of medicine," he noted.

"We've been working over the last few decades to change that," said Frieden, who directs the Memorial Hermann Health System's Independent Living Research Utilization program at the Institute for Rehabilitation and Research. (Frieden's institution is part of the , which provides education and assistance to organizations wanting to implement the ADA and be more inclusive of persons with disabilities.)

"I think most younger physicians and kids in school understand and appreciate" that people with disabilities deserve inclusivity and equal treatment, "and I think over time that the industry and culture of medicine will change. We've seen good examples of that," he added.

Frieden applauded the recent movement at many companies and organizations -- including healthcare facilities -- to focus on diversity, equity, and inclusion (DEI). "We have seen outstanding examples here in Houston where organizations have established DEI programs and made a special effort to include people with disabilities," he noted, adding that on the other hand, "a number of companies have great programs but forgot to include [people with disabilities] as one of the groups they want to reach out to and include."

The growth of employee resource groups (ERGs) in this area is especially important, he said. "Those groups have done more to empower people with disabilities and have enabled them to be open about frustrations, experiences, and barriers they have in the workplace than anything in recent memory."

Being part of an ERG "makes it easier for any individual in the group to have their issues addressed appropriately, without fear of reprisal," he added.

Mistreatment of physicians is a growing concern, given its link to physician well-being, Meeks and colleagues noted in their introduction. Previous studies have found that among physician trainees, mistreatment is associated with higher levels of burnout and suicidal thoughts, and one smaller survey of medical residents at a California teaching hospital found that 25% who had personally experienced mistreatment were almost eight times more likely to report burnout.

To explore the issue further, Meeks and colleagues analyzed data from the Association of American Medical Colleges National Sample Survey of Physicians, a nationally representative sample of 6,000 practicing physicians, collected from February to March 2019. The data were weighted based on the American Medical Association Physician Masterfile to represent all practicing physicians in the U.S. on specialty group, gender, age group, and international medical graduate status.

Respondents were provided with the definition of disability from the Americans with Disabilities Act (ADA), and were then asked whether they had a disability as defined under that law. Among the 5,851 respondents, 178 reported having a disability (169 in the unweighted analysis).

They were also asked the frequency with which they had experienced various forms of mistreatment by patients and coworkers in the last 12 months. Types of mistreatment included physical harm and threats of physical harm, unwanted sexual advances, and offensive comments regarding the respondent's gender, sexual orientation, race and ethnicity, disability, or personal beliefs.

The researchers ran a multivariate logistic regression to assess whether physicians with disabilities were more likely than nondisabled physicians to experience mistreatment in their workplaces. "To ensure that external factors did not influence the measured effects, we controlled for demographic variables (age, sexual orientation, marital status, and race and ethnicity), workplace characteristics (practicing primary care and employment type), and international medical graduate status," they noted.

Limitations to the study included the use of self-reported data, and the fact that the ADA definition of disability might not fully capture the breadth of disability in this population. Furthermore, mistreatment variables were not defined, potentially leading to disparate interpretations of mistreatment by respondents. "Given society's prevailing construct of disability, physicians with disabilities in practice might not identify as disabled, even if they would qualify as disabled under the ADA," Meeks and team noted.

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