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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

#71

Post by [deleted] »

kayodelycaon wrote: post #68
logicalmonster wrote: post #48

Earlier quoted context omitted.

> 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 peo…

[deleted]

Re: Physicians’ attitudes about caring for people with disabilities

#72

Post by dontbenebby »

https://en.wikipedia.org/wiki/Panspermia -- I have literally never had a doctor who was supportive of my disability, and when I finally sought out someone "queer friendly" they were more condescending and rude than most of the straight ones I'd interacted with. Purposefully unhelpful to the point I started reminding folks, why would you only kill yourself? These doctors might not harm you, but they'll purposefully avoid helping you, and that's the same.

(Maybe I should walk around Scott Township handing out fifty cent pieces so my opinion matters in 30 years like the local party officials used to in the park down the road from St Clair hospital -- I like how it's the same thing as if you hit a 21 in blackjack. I notice little things like that.)

Some of that is due to bouncing between insurances, so I clarified I'm eligible for an Italian passport to reduce the "Hi, I'm a shitty specialist but feel free to peruse a review website and pray to christ you don't have any meltdowns while I siphon up a few copays to pay for the degree I felt entitled because I refused to raise the minimum wage".

I hope it's coming through that while sometimes I can be intense in the comments section, if someone is so distrustful of the medical system they're considering emmigration it should be taken as an extreme signal.

But that's the problem -- no one ever has interacted with me like a victim or a peer in a medical context. I remember saying I wanted to be a horror writer and cautioned it might be better to stick to nonfiction when I was a teenager.

That's why I did things like point out when I turned 18 in February, I'd be legally able to buy an AR-15 during the 30 days it would take to try to evict me prior to graduation, because my parents were that kind of petty -- to this day they treat 911 like a customer service line... I had a cop bang on my door the other day because I hadn't called my mom.

(I tried telling them hey, I actually looked into being a domestic violence counselor, you need to stop coming here without a warrant, my mom is abusive and this is false concern but they just kind of ignored me -- the police, much like politicians, never actually seem to care what I say unless they agree, which is fine, but people tend to regret not listening to me.)

I hope for his safety he doesn't do that to someone with more severe anger issues, I've given up on trying to find a solution to that issue though -- I haven't had two weeks of quiet enjoyment of my home since Trump took office, and folks keep having increasingly terrible meltdowns when they fuck around and find out that I don't need to break the law to get them in line.

At this point, I'm debating if I should renew my medical marijuana card, since it seems like I'm just... rewarding a bunch of extortionists.

Re: Physicians’ attitudes about caring for people with disabilities

#73

Post by arkades »

User23 wrote: post #33
arkades wrote: post #22

Earlier quoted context omitted.

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.

You as the doctor actually explicitly signed off on the real price? Not some administrator somewhere? Did you have any real input, or is your relationship to the insurer more like a driver’s relationship to Uber?

When working for a hospital, it’s an admin somewhere. When in private practice, the insurer generally has geographic monopoly, so I sign off on whatever they shove in my face if I intend to accept their patients. The only time I have a real say in price is in private practice for uninsured patients, which is where I set aside a piece of my time for charity care.

Re: Physicians’ attitudes about caring for people with disabilities

#74

Post by lotsofpulp »

uoaei wrote: post #28
lotsofpulp wrote: post #27

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.

A large portion of patients ( customers seems like a dirty word in this context...) can't even afford insurance!

Of course, because the root problem in the US is most people cannot afford the healthcare that they expect to receive. Hence all the political maneuvering to redistribute wealth, and the corresponding efforts to avoid having one’s (present or future) wealth redistributed.

Re: Physicians’ attitudes about caring for people with disabilities

#75

Post by klyrs »

Test0129 wrote: post #10
jrm4 wrote: post #7

Quoted post unavailable.

I have a lot of experience with doctors. I've found regardless of what you look like unless you're going to a concierge clinic you wont even get the time of day from most of them. It seems to be a volume business, and thus they just go through the motions. Much like tech with engineers, the good doctors seem to leave as soon as you find them.

Well, that's an anecdote, but numerous studies indicate that black people, indigenous people, women, people in poverty, transgender people, are systematically mistreated by health care systems in north america. I know HN loves to pretend that racism only affects white people, but it just ain't so.

Re: Physicians’ attitudes about caring for people with disabilities

#76

Post by extra88 »

kayodelycaon wrote: post #70
extra88 wrote: post #67

Earlier quoted context omitted.

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.

A screen reader user can read all the information in a decent online menu way faster than having a Domino's employee read it to them. A customer who is deafblind or is blind and has a speech disability would need to use a TTY relay service, which makes it even slower.

It is not unreasonable to make an ordering website accessible; Domino's even admitted it would only cost $58,000. $58K would be a lot if every individual restaurant in the country had to spend that much. Thankfully, that's not the case, most don't have an don't need their own bespoke ordering site, they license a platform.

Re: Physicians’ attitudes about caring for people with disabilities

#77

Post by johannbok »

parkerhiggins wrote: post #18
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.

This is partly true. In no small part because they tend to control the bulk (or all) of our patient supply. In part because people have gotten the idea that insurance equals care, and vice versa - so people tend not to think about high-impact moments where it pays to go cash.

For instance, I specialize in neuromodulation for highly-treatment-resistance psychiatry. I'm very good at what I do; my mentor is (IMO) better, and one of the absolute best in the country. A single consultation session with him is around $200 if he happens not to take your insurance. If you have a highly-treatment resistant condition, and are about to embark on a course of neuromodulation, it absolutely behooves you to go to him for a single session consultation to plan out your intervention before going to some local mediocre whatever to actually slap the equipment on your head and carry out the intervention.

For instance, people have incredibly debilitating autoimmune conditions. Rheumatic conditions are notable for their polymorphic presentations. It absolutely behooves you to go to an absolute top rheumatologist for one to three visits to confirm your diagnosis before going on a lifelong adventure of immune modulating drugs.

But folks hear "this guy doesn't take my insurance" and treat it as equivalent to "I can't get care there," even when they can afford it. I have a chronic condition, it's terrible, and my absolute world-famous specialist costs me about $250/yr - a small fraction of my monthly insurance premium. Less than my monthly prescription costs. Yet people will go to whatever specialist happens to be near them, while bearing all those other costs, and not investing in the linchpin.

Re: Physicians’ attitudes about caring for people with disabilities

#78

Post by gamblor956 »

VancouverMan wrote: post #47
lotsofpulp wrote: post #27

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.

And those pricing distortions are due to significant government-imposed regulations and restrictions that tightly limit the supply of doctors and medical services, even in the face of increasing demand.

That's false, but why let the truth get in the way?

The limitation on doctors in the U.S. is based on the available funding for residents. The government supplies the money because private institutions largely are unwilling to do so.

Re: Physicians’ attitudes about caring for people with disabilities

#79

Post by johannbok »

VancouverMan wrote: post #47
lotsofpulp wrote: post #27

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.

And those pricing distortions are due to significant government-imposed regulations and restrictions that tightly limit the supply of doctors and medical services, even in the face of increasing demand.

Government regulations have been dragging back price of care for ages. Multi-month waiting lines to see a doctor are largely about price ceilings. If docs could price up, their waiting lists would go down commensurately.

Constrained physician supply doesn't do much when physicians can't raise prices in the face of greater demand.

People in these discussions always make things about physician costs. The majority of expenditures in the healthcare system are on drugs and equipment, followed by procedures - physician visits make up a tiny fraction of that.

Re: Physicians’ attitudes about caring for people with disabilities

#80

Post by rdtwo »

Siddarth1977 wrote: post #24
CoastalCoder wrote: post #3

Earlier quoted context omitted.

I just assumed that ADA requirements made their way into commercial building codes a while ago. And because of that, physicians would rarely bump into that issue, whether leasing office space or building new space. Am I mistaken?

Unfortunately, it's not that simple. ADA requirements are incredibly complex, at times very specific and at times very unclear and open to interpretation. The truth is that almost every building could be found to be in violation, no matter how hard the builders tried to make it ADA compliant. In practice, this rarely matters. 99% of people with disabilities are just trying to get around, not looking for an opportunit…

Usually it’s the building inspector that gets you because they have a different view of Ada code then you do.
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