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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

#61

Earlier quoted context omitted.

You can just keep the pills. If you're really that strong about avoiding addiction why do you feel the need to throw them away?

Most medicine has expiration dates. If he needs it only every 3-5 years, it's unlikely the pills will still be usable.

> it's unlikely the pills will still be usable

Pills (and chemicals) are not SSL certificates: they don't cease to work at the expiration date + 1 second.

Re: Physicians’ attitudes about caring for people with disabilities

#62

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…

Yes, since ADA mandates that accommodations must be provided at no cost to the patient (an unfunded mandate). Here is a tidbit from the article:

Participants described both financial and time-related challenges of accommodating communication needs. One non-rural-practicing primary care physician stated: “I took it upon myself to actually hire an outside service to do [sign language interpretation]. They billed the office. …Their bill was higher than what we were making, so it was a losing venture. …It cost me $30 per visit for that patient, out of pocket.”

Re: Physicians’ attitudes about caring for people with disabilities

#63
post #31

Earlier quoted context omitted.

Most customers could not afford the treatment at the standard of care they want anyway, hence the reason they purchase via insurance.

Interestingly this wasn’t the case in living memory in the USA. The insurance cartels have effectively greatly increased prices while commensurately lowering the standard of care.

My dad told me in the 90s to avoid injury because the family could not afford healthcare. I distinctly recall hospital bills being in the tens of thousands even back then.

I doubt newer cancer care, medicines, imaging, or other care would be cheap in any world, with or without insurance.

Re: Physicians’ attitudes about caring for people with disabilities

#64

Earlier quoted context omitted.

You can just keep the pills. If you're really that strong about avoiding addiction why do you feel the need to throw them away?

I'm not sure where they said they got rid of them to avoid addiction: It is more that they have to convince medical staff that they aren't simply looking to get high but want health instead. But outside of that, getting rid of unused pills is good practice. These pills are going to expire. Once they do, you can no longer rely on them doing what you expect. Plus, a lot of folks don't like to keep stuff they aren't usi…

>But outside of that, getting rid of unused pills is good practice. These pills are going to expire. Once they do, you can no longer rely on them doing what you expect.

Disagree completely.

Source: retired neurosurgical anesthesiologist (38 years practice)

Reasons:

1) When you need those pills you won't have them

2) Properly stored pills (dark shelf/cabinet) lose potency/efficacy VERY slowly: perhaps 10%/year. So 5-year-old pills will still work fine. Take one, see if does what it did originally; if not, take another.

3) If you're traveling and need that medication, good luck. You'll wish you'd saved them.

Re: Physicians’ attitudes about caring for people with disabilities

#65

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…

As a sibling commenter notes, it's great that you recognize the real root of this is often not a lack of empathy by physicians, but instead constraints of the system and especially the payors, who are not patients but insurers (or the federal government). Frankly, I'm surprised a small community-based primary care physician practice is even financially tractable in 2022. This bit from the article was also very intere…

> who are not patients but insurers (or the federal government).

Or state government, in the case of Medicaid.

Re: Physicians’ attitudes about caring for people with disabilities

#66
post #22

Earlier quoted context omitted.

> 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 se…

That’s not what the doc gets paid. That’s the pretend amount that the insurer and doc have agreed upon, before their agreed upon discount. Source: doctor.

My EOBs have always stated what the healthcare provider is owed per the insurance price. It shows what was billed (the fantasy number), then the insurance price (or the discount), and patient responsibility (dependent upon an individual’s deductible/copay/oop max).

Is that not true?

Re: Physicians’ attitudes about caring for people with disabilities

#67

Earlier quoted context omitted.

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.

Reasonable accommodation isn’t significantly onerous in the vast majority of cases. You don’t have to provide the accommodation a person wants. For example… - Ordering via phone could be an acceptable accommodation for an inaccessible website. (Just don’t place the person on hold for half an hour.) - Pen and paper can be used for communication when verbal communication isn’t possible. - If someone is blind, you may b…

You are correct that "reasonable accommodations" are, in fact, reasonable and don't have to be exactly what a disabled person asks for (though listening to people when they tell you what they need is important).

> Ordering via phone could be an acceptable accommodation for an inaccessible website

A particular person may find ordering by phone to be acceptable but in court cases, it has been found to not be equal to using an accessible website. One example is in the Domoino's case [0] (it references experiencing long hold times but there are other reasons it is unequal).

[0] https://www.lflegal.com/2021/06/dominos-june-2021/#A-phone-i...

Re: Physicians’ attitudes about caring for people with disabilities

#68

Earlier quoted context omitted.

Reasonable accommodation isn’t significantly onerous in the vast majority of cases. You don’t have to provide the accommodation a person wants. For example… - Ordering via phone could be an acceptable accommodation for an inaccessible website. (Just don’t place the person on hold for half an hour.) - Pen and paper can be used for communication when verbal communication isn’t possible. - If someone is blind, you may b…

> Reasonable accommodation isn’t significantly onerous in the vast majority of cases. You are correct that a reasonable accommodation isn't particularly hard in many cases. The disconnect in communication here is that you're thinking in terms of a reasonable person. Unreasonable people exist. There are unfortunately some disabled people that would refuse to be satisfied by almost anything you provide them. The ADA la…

One unreasonable person can ruin a lot of things. You’re never getting around that. I wish ADA wasn’t handled by lawsuits, but everything is the US is a fucking lawsuit…

The problem I have is many businesses don’t even try in the first place. They don’t know anything about ADA and point to the one unreasonable person as justification to do nothing.

There are far more businesses being “unreasonable” than there are people filing ADA lawsuits.

Re: Physicians’ attitudes about caring for people with disabilities

#69

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 an…

This was the thing that was so baffling to me about this study. I read the interview quotes, but then was baffled by the study's conclusion where they focused on things like "attitudes" and "structural barriers" (I kinda hate that term because it's easily interpreted in different ways). Meanwhile I'm screaming "Duh, it's money!". Meaning that: 1. The study, for some reason seems reluctant to come out and say "treatin…

>2. Thus, in a private care system where reimbursements aren't changed for treating people with disabilities, there are tons of embedded incentives to not want to deal with those with disabilities.

>The only was to get rid of these unwanted incentives is to fundamentally change the for-profit nature of American health care. Good luck with that.

As I understand, in the US, it is often the government itself that is not sufficiently reimbursing.

Re: Physicians’ attitudes about caring for people with disabilities

#70
post #67

Earlier quoted context omitted.

Reasonable accommodation isn’t significantly onerous in the vast majority of cases. You don’t have to provide the accommodation a person wants. For example… - Ordering via phone could be an acceptable accommodation for an inaccessible website. (Just don’t place the person on hold for half an hour.) - Pen and paper can be used for communication when verbal communication isn’t possible. - If someone is blind, you may b…

You are correct that "reasonable accommodations" are, in fact, reasonable and don't have to be exactly what a disabled person asks for (though listening to people when they tell you what they need is important). > Ordering via phone could be an acceptable accommodation for an inaccessible website A particular person may find ordering by phone to be acceptable but in court cases, it has been found to not be equal to u…

Domoino’s had 45+ minute wait times. That’s what got them in trouble.

Phones are an acceptable alternative if you can provide equivalent service.

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