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Physicians’ attitudes about caring for people with disabilities

healthaffairs.org

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Re: Physicians’ attitudes about caring for people with disabilities

#11

Post by octokatt »

N=1, but I can confirm the experience of being disabled and getting medical care is mutually frustrating. Taylorism and one-size-fits-all fails hard.

Appointment times are standardized, despite patients not being standard. I know I'm going to take extra time. I have multiple chronic conditions, getting treatment is a mess. But I can't arbitrarily ask for more time during booking; it's all automated now. Worse, I need to confirm the doctor kept in mind _all_ of this in my treatment plan, because I've had awful reactions when they haven't.

This is terrible for the doctor. I'm making them go over time, be late to the rest of their appointments for the day, and asking them for extra energy and brain cycles for treatment, for no extra money.

And that's not even including accommodations I might need.

I don't blame doctors for not wanting me in their practice. Controls put in place by administrators and insurance companies make me a pain in the ass to treat instead of a fun puzzle. Incentives make me more expensive, with lower payoff and higher risk.

Which... is fucked.

Re: Physicians’ attitudes about caring for people with disabilities

#12

Post by Test0129 »

logicalmonster wrote: post #2

Could the ADA itself be the cause of at least some of this hesitation by some doctors to want to deal with disabled patients? With a disabled patient, there's a larger chance that something about your medical practice (the parking lot, the hallway, the stairs and ramps, the chairs in the waiting room, the equipment in your office, etc) aren't going to satisfy somebody and you're faced with a dumb legal headache even…

The ADA is a definitely a case of great idea, terrible execution. Unfortunately, doctors (and really businesses in general) are forced into a no-win situation where as you stated you either comply in the fullest legally, or face a potential customer looking for a reason to sink your business. Where I live, the ADA is also responsible for some of the large increase in home prices over the last 20 years.

I wish it differentiated between necessary things like ramps, spots in a waiting area, etc, vs unnecessary things. There are just simply too many disabilities for even an honest, well intentioned business owner to keep up with. Of course, without retaining an insanely expensive lawyer.

Re: Physicians’ attitudes about caring for people with disabilities

#13

Post by candiddevmike »

ad404b8a372f2b9 wrote: post #9

A lot of modern medicine is factory work, there is no time or interest for the patient. It's the same reason people with symptoms that aren't immediately obvious get diagnosed with anxiety. It can be life-destroying when it's systemic, a lot of disabled people find that when they age out of pediatric care no one will touch them, not doctors, not physiotherapists, nobody.

Does this apply globally or just in the US? Do folks in other countries with disabilities have better experiences?

Re: Physicians’ attitudes about caring for people with disabilities

#14

Post by [deleted] »

jt2190 wrote: post #8

From the synopsis: > Physicians reported feeling overwhelmed by the demands of practicing medicine in general and the requirements of the Americans with Disabilities Act of 1990 specifically; in particular, they felt that they were inadequately reimbursed for accommodations. In the U.S., primary care is becoming more and more industrialized, with patients limited to very short visits. Patients hate this because they…

[deleted]

Re: Physicians’ attitudes about caring for people with disabilities

#15

Post by ad404b8a372f2b9 »

jrm4 wrote: post #7

Quoted post unavailable.

Every day I thank god that I was born disabled and not black, since I've started talking to Americans I've learned it's the absolute worse thing you can be, regardless of the issue being discussed or personal circumstances.

Re: Physicians’ attitudes about caring for people with disabilities

#16

Post by kayodelycaon »

Test0129 wrote: post #12
logicalmonster wrote: post #2

Could the ADA itself be the cause of at least some of this hesitation by some doctors to want to deal with disabled patients? With a disabled patient, there's a larger chance that something about your medical practice (the parking lot, the hallway, the stairs and ramps, the chairs in the waiting room, the equipment in your office, etc) aren't going to satisfy somebody and you're faced with a dumb legal headache even…

The ADA is a definitely a case of great idea, terrible execution. Unfortunately, doctors (and really businesses in general) are forced into a no-win situation where as you stated you either comply in the fullest legally, or face a potential customer looking for a reason to sink your business. Where I live, the ADA is also responsible for some of the large increase in home prices over the last 20 years. I wish it diff…

What’s an example of an unnecessary thing?

Re: Physicians’ attitudes about caring for people with disabilities

#17

Post by Test0129 »

octokatt wrote: post #11

N=1, but I can confirm the experience of being disabled and getting medical care is mutually frustrating. Taylorism and one-size-fits-all fails hard. Appointment times are standardized, despite patients not being standard. I know I'm going to take extra time. I have multiple chronic conditions, getting treatment is a mess. But I can't arbitrarily ask for more time during booking; it's all automated now. Worse, I need…

> Worse, I need to confirm the doctor kept in mind _all_ of this in my treatment plan, because I've had awful reactions when they haven't.

I'm not disabled but do have some chronic stuff. A couple decades ago I started carrying my medical record (well...the synopsis) to the doctors office for this reason. Especially when you end up in a clinic rather than a real private practice you're often not guaranteed to even see the same doctor twice.

> This is terrible for the doctor. I'm making them go over time, be late to the rest of their appointments for the day, and asking them for extra energy and brain cycles for treatment, for no extra money.

Though I'd not worry about this. My insurance EOB stated for a simple visit and bloodwork the doctor charged well over $1300. I saw the doctor for exactly 10 minutes. Make them work a little for their money.

Re: Physicians’ attitudes about caring for people with disabilities

#18

Post by parkerhiggins »

octokatt wrote: post #11

N=1, but I can confirm the experience of being disabled and getting medical care is mutually frustrating. Taylorism and one-size-fits-all fails hard. Appointment times are standardized, despite patients not being standard. I know I'm going to take extra time. I have multiple chronic conditions, getting treatment is a mess. But I can't arbitrarily ask for more time during booking; it's all automated now. Worse, I need…

Spot on. It becomes more clear when you ask who pays medical professionals salaries?

Insurance companies do.

Insurance companies are medical professionals’ bosses.

The customer receiving treatment has no influence on the standard of care.

Re: Physicians’ attitudes about caring for people with disabilities

#19

Post by photochemsyn »

This is yet another argument for the transition of American health care from a primarily private for-profit operation to a socialized medicine model. Compare to the British NHS, which takes this issue into consideration and devotes resources to it:

https://www.england.nhs.uk/2017/09/nhs-england-launches-prac...

Yes, you can still get privatized health care if you want to pay for it in Britain, you can hire a nurse and doctor to follow you around 24-7 if you can find any willing to do so at the rate you're willing to pay.

Re: Physicians’ attitudes about caring for people with disabilities

#20

Post by Test0129 »

kayodelycaon wrote: post #16
Test0129 wrote: post #12

Earlier quoted context omitted.

The ADA is a definitely a case of great idea, terrible execution. Unfortunately, doctors (and really businesses in general) are forced into a no-win situation where as you stated you either comply in the fullest legally, or face a potential customer looking for a reason to sink your business. Where I live, the ADA is also responsible for some of the large increase in home prices over the last 20 years. I wish it diff…

What’s an example of an unnecessary thing?

I dunno, that's the point. Since it only technically requires "reasonable accommodation" it's up to interpretation. "Reasonable accommodation" has been used by ambulance chasers to sink businesses. I'm sure a set of absolutes could be codified.

I'm getting downvoted to death for having an opinion again so I'm just gonna leave the topic.

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