For many disabled patients, the doctor is often not in

Some doctors avoid patients with disabilities, and barriers to routine care abound.


See full article...

 

[Deleted member 553147]

So I'm only allowed to have an opinion about the human suffering that's happening on my own soil? Am I not allowed to feel outrage that people with disabilities like me are being treated this way because they have an eagle on their passport instead of a lion and a unicorn?

Sure? Of course you can feel outraged. But in the US, a doctor works for profit. You can be outraged at the system - but being outraged at the doctor is simply you saying that he must take on a patient even if it costs him money. The system needs to be changed, not the doctor. It’s not hard to do - either reimburse the doctor better for such patients, or make it part of the deal the doctor gets his license from that he must take on disabled patients, and then have some kind of oversight on that.
But if the system if simply for-profit? Would you demand that your local supermarket sells milk at half the price to poor people?

Of course, this is a clear example of why health care should never ever be for-profit.

 

[ColdWetDog]

Why?

Honestly, everything you said in your post speaks of a mindset where medicine is a for-profit endeavour. It absolutely should not be. The American health care system is fundementally broken at its core philosophy. Maybe the NHS isn't perfect (and it certainly is not), but the entire premise for its existence is that health care is a fundemental human right, and people should not have to worry about the financial burden of calling an ambulance or getting necessary treatment.

While I don't disagree that heath care is a human right and that for profit systems suck donkey balls, just making it a right doesn't necessarily fix things. See Civil Rights for copious examples. I would also point out that other countries with more socialized and civilized systems are having severe coping issues.

One of the problems is medicine's success. Yes, we can treat a wide variety of things more successfully in the past. Offer patients enormously successful treatments for (some) diseases. But that comes at some significant expense. And politicians, who generally fund these things, have been leery of actually funding all manner of systems for various reasonable and unreasonable reasons.

No easy answers here and yes, the US system has lots of low hanging fruit that will help at the margins. But, for example, to ensure that every person on a wheelchair had rapid and easy access to a lift that can weigh a patient and help transfer the patient to a bed would cost something on the order of $50-$100K per patient room*. You don't need to arrange that for every patient but even mandating say, one room like this per every 5 patient rooms (WAG) would be a funding issue that even Bernie Saunders would balk at.

And that's the easy part.

* - just so you don't think I'm going too crazy - A Hoyer lift (picks up patients, weighs them, transfer them) runs from about $15K and up. An ER level patient bed is close to $10K. Then you need room, lots of room in order to be able to transfer them. That room has to come from some where and rennovation in a medical setting tends toward the expensive side. And then you have to train staff to use them. And then you have to have enough staff so they can take the time to move the patient. And then you have to remember I'm talking about a generic outpatient setting where appointments are in 15 minute blocks. They are that way because of the pressures to push patients out the door and you can't push these people that fast. Remember, this is the easy part.

 

[Meathim]

The part about obese patients cuts close to home. Fat discrimination is real, even among physicians who should know better.

Nobody chooses to be obese, just as nobody chooses to have a disability. And, to be clear, I'm talking about obesity, not merely overweight. It is not, as many voice aloud and probably even more think, a mere matter of overeating and laziness - if it was as simple as eat less and move more... again, nobody chooses to be obese.

Everone' different, but for me the realization that it actually was that simple, the mechanics of it, helped immensly when I lost weight. As always it is the mental stuff that makes things hard, but I take solace that the actual thing in itself is not hard to do.

 

[fancysunrise]

Keep your oath, or get the fuck out of medicine. It's as simple as that.

Unfortunately, form my experience, we'd lose a great many clinicians. Not sure if that's a bad thing overall, but that's what would happen. It's worse in some domains than others, though. Psychiatric and related is especially bad, partly due to the models of disease and treatment and legal frameworks arching over everything and partly just due to the history and culture that had become endemic. But I imagine e.g. a surgeon isn't really going to be as prone to these sorts of issues, if for no other reason than the nature of the interaction providing less opportunity regardless of what else may be going on.

 

[balthazarr]

Everone' different, but for me the realization that it actually was that simple, the mechanics of it, helped immensly when I lost weight. As always it is the mental stuff that makes things hard, but I take solace that the actual thing in itself is not hard to do.

I've been over 100kg over my healthy weight, lost over 95 of those kilos, regained 75 of them , lost another 50 - up and down and up and down. I've struggled with weight my entire life, including childhood.

It took me a bit over two years of militant diet and exercise to lose those 95kg, and I mean militant. I exercised 2-3 hours per day, 5-6 days per week - 30 mins of cardio before breakfast, walk/run at lunch and gym after work. I weighed, measured and tracked everything I ate or drank for those 2+ years. And even after all of that, I still couldn't reach my goal weight, which was the top of the healthy weight range.

Meanwhile, my housemates would eat junk at practically every meal, drink like fish, do zero exercise, and still have mesomorph bodies with visible abs.

In short, I absolutely and utterly disagree with you that it's not hard to do. For me, it has been impossible. The mental struggle is the icing on the crappy cake.

 

[hasib]

So I'm only allowed to have an opinion about the human suffering that's happening on my own soil? Am I not allowed to feel outrage that people with disabilities like me are being treated this way because they have an eagle on their passport instead of a lion and a unicorn?

I think this poster wants you to be elated at the chance to rub American’s noses in their poor healthcare system. Especially disabled Americans.

Edit: typo

 

[amphibiouscat]

Keep your oath, or get the fuck out of medicine. It's as simple as that.

You know there isn’t a requirement to take the Hippocratic oath to become a doctor right?

 

[The Lurker Beneath]

While I don't disagree that heath care is a human right and that for profit systems suck donkey balls, just making it a right doesn't necessarily fix things. See Civil Rights for copious examples. I would also point out that other countries with more socialized and civilized systems are having severe coping issues.

One of the problems is medicine's success. Yes, we can treat a wide variety of things more successfully in the past. Offer patients enormously successful treatments for (some) diseases. But that comes at some significant expense. And politicians, who generally fund these things, have been leery of actually funding all manner of systems for various reasonable and unreasonable reasons.

No easy answers here and yes, the US system has lots of low hanging fruit that will help at the margins. But, for example, to ensure that every person on a wheelchair had rapid and easy access to a lift that can weigh a patient and help transfer the patient to a bed would cost something on the order of $50-$100K per patient room*. You don't need to arrange that for every patient but even mandating say, one room like this per every 5 patient rooms (WAG) would be a funding issue that even Bernie Saunders would balk at.

And that's the easy part.

* - just so you don't think I'm going too crazy - A Hoyer lift (picks up patients, weighs them, transfer them) runs from about $15K and up. An ER level patient bed is close to $10K. Then you need room, lots of room in order to be able to transfer them. That room has to come from some where and rennovation in a medical setting tends toward the expensive side. And then you have to train staff to use them. And then you have to have enough staff so they can take the time to move the patient. And then you have to remember I'm talking about a generic outpatient setting where appointments are in 15 minute blocks. They are that way because of the pressures to push patients out the door and you can't push these people that fast. Remember, this is the easy part.

One issue with modern medicine is that the demand curve goes to infinity. It doesn't matter whether the supply curve is set by the market, government fiat, insurance, or a combination - in the real world a lot of people are going to end up getting less care than they want. [Unless we had a society actually centred around medication, as in Bruce Sterling's Holy Fire. Even in that, social credit separated what today we'd call great care from the best.]

 

[aurelius rex]

If someone doesn't have a well documented condition it shouldn't be surprising that they would be referred to someone else who may be more knowledgeable on it. I don't expect a family medicine doctor to handle a complex neurological condition for example. Especially one that isn't straight forward.

The problem is that no one will take time to identify that it’s a neuro condition, or whatever.

I’ve been fighting for two years to get mental health care. I’ve been fighting for three years to get treatment for my chronic pain. I’ve been fighting for ten years for post-TBI care. But because the conditions aren’t clear, because they can’t turn into billable codes, they get punted from doctor to doctor. No one is spending the time to figure out what specialists I actually need. Because it’s not profitable.

 

[aurelius rex]

Ignoring profit motive, it’s a workers rights issue. People who work should have the option of getting rid of patrons they don’t like for whatever reason, including in a doctors cast certain patients that are much more difficult to handle.

Any good doctor typically has way more patients they can handle, no reason to kill themselves trying to accommodate everyone.

There’s a difference between a profession and a job. A baker can turn down a cake when they’re busy and the customer doesn’t get the seven tier wedding cake of their dreams. Sucks but not lethal. A doctor turns down a patient and that could spell death.

 

[autostop]

You know there isn’t a requirement to take the Hippocratic oath to become a doctor right?

Right. The oath is tenth-century twaddle. Among other things, it says

I will not use the knife, not even, verily, on sufferers from [kidney] stone, but I will give place to such as are craftsmen therein.

Meaning, originally, that doctors must defer to barbers in matters of surgery, since those hacks are the people who practice the crude, bloody craft of cutting things off of people.

It also forbids doctors from prescribing abortion drugs. Which, to be fair, is still a prohibition some people want to apply to doctors.

On the other hand, it has fairly strong patient privacy provisions, even by current-day standards, which is a plus.

 

[passivesmoking]

Sure? Of course you can feel outraged. But in the US, a doctor works for profit.

Which is exactly what I'm outraged over.

You can be outraged at the system - but being outraged at the doctor is simply you saying that he must take on a patient even if it costs him money.

I wasn't focusing my ire at any individual doctor but at the system as a whole. However, what's wrong with thinking there's something very very wrong that money is being used to determine who gets treated like a human being and who gets treated like some kind of useless eater?

The system needs to be changed, not the doctor.

As the article itself states, several doctors interviewed are openly contemptuous of disabled people. Those doctors most definitely DO need to be changed. Or removed from medical practice.

Medicine is a basic human right. A doctor who acts as a gatekeeper regarding who gets it or not based on their own prejudices has no business being in medicine

But if the system if simply for-profit? Would you demand that your local supermarket sells milk at half the price to poor people?

I'd demand that anyone who can pay for the milk gets to have the milk. Assuming that a poor person shows up who just so happens to have enough money to buy milk, should they be denied milk? Your analogy is stupid.

Of course, this is a clear example of why health care should never ever be for-profit.

On that, we can at least agree.

 

[passivesmoking]

I think this poster wants you to be elated at the chance to rub American’s noses in their poor healthcare system. Especially disabled Americans.

Well I'm not. I'm appalled at the suffering of fellow human beings who may share similar problems to my own, regardless of where they come from.

And that's the thing. I doubt any of us with the good fortune to have a proper social health care system take any pleasure on holding that over the heads of people who don't. What I want is for you guys to do better, so that people living in the richest nation on Earth don't have to worry that calling an ambulance might lead to them forcolsing on their home. I want the human condition to get better everywhere, not just for me.

 

[Meathim]

I've been over 100kg over my healthy weight, lost over 95 of those kilos, regained 75 of them , lost another 50 - up and down and up and down. I've struggled with weight my entire life, including childhood.

It took me a bit over two years of militant diet and exercise to lose those 95kg, and I mean militant. I exercised 2-3 hours per day, 5-6 days per week - 30 mins of cardio before breakfast, walk/run at lunch and gym after work. I weighed, measured and tracked everything I ate or drank for those 2+ years. And even after all of that, I still couldn't reach my goal weight, which was the top of the healthy weight range.

Meanwhile, my housemates would eat junk at practically every meal, drink like fish, do zero exercise, and still have mesomorph bodies with visible abs.

In short, I absolutely and utterly disagree with you that it's not hard to do. For me, it has been impossible. The mental struggle is the icing on the crappy cake.

Yeah. Everone's different.

And I don't mean to sound like an ass (and this is a bit off topic) but "healthy" is a very individual thing and has nothing to do with visible abs, and society's obsession with bodies and how they look is devestating, and I assume you know these things. When I was at my thinnest I was still overweight according to the normal calculations, but I didn't really look it or felt it (I'm a big dude no matter how much I weigh). I could maybe have pushed it further and gotten the shitty visible big muscles, but at that point ... why? Being happy with myself is impacted by what I do and not what I look like ... well it should be like that anyway. I still share your struggle (having put back some of the 40kg I lost), but I actually put on weight when I obsess about my looks (blergh i suck where's the beer) and loose weight when I distance myself from body ideals and just don't think about it (I don't mean totally letting go, just being content with myself as is), and that is the real struggle for me. But we're all different.

In any case doing all of that I assume you're healthier than your housemates despite their visible abs.

 

[Happy Medium]

Yeah, as an emergency physician I see a lot of the people who fall through the cracks of America's hugely-strained primary care network and ... I get it. Our beds weigh patients and we always have lots of hands for moving help. We can spend as much time as we need to address the presenting emergency medical complaint and don't have to worry about falling behind a triple-booked schedule. We are (in my opinion) well-compensated for our time and effort and PCPs (in my opinion) are not.

You want to fix equity in access, you restructure the terrible compensation structure, in particular the failure to account for the fact that patients with complex needs don't neatly fit into the "twelve minutes to see and chart" grind that PCPs are forced to endure.

Yup, as another practicing physician it's not generally about physicians "disliking" disabled people (though I'm sure, unfortunately, some actually do). But the PCPs I work with are insanely overtasked even seeing people without disabilities. They're constantly being asked to do more and more, with less and less support provided. At some point many of them are just like "fine, I'm just going to take care of the easiest patients then if they're only paying or giving me enough support to take care of the easiest patients". Is it fair? No absolutely not, but when every time you take "too much time" to take care of a more complex patients (and disabled patients ARE absolutely more complex and take more time than most non-disabled patients) your told your RVUs are low and you get threatened with salary decreases well what do you expect to happen?

Ultimately there's a reason why capitated payment systems like the VA have much better disabled care than fee for service or episode based payments (what most US insurance systems pay as). It's the only reimbursement system that really incentivizes (for all those participating) providing good enough care to the patient that they remain healthier for longer. Of course, it also perversely incentivizes excluding medically complex patients from the insurance system overall, so you have to have guards against discriminating against pre-existing condition for those types of payment systems.

 

[passivesmoking]

You know there isn’t a requirement to take the Hippocratic oath to become a doctor right?

Yes. The original oath as written has some stuff in it that's very cringy from a modern perspective, but times change, which can only be a good thing. I'm also aware that most practicing doctors are expected to take an oath of some description. And I'm pretty sure that regardless of the specific oath, most of them put the care and well-being of the patient pretty high on the list of things an ethical doctor is required to do.

The specifics of the Hippocratic Oath aren't what make it important, what makes it important is that it's the first evidence of a professional code of ethics and conduct for practitioners of medicine, and serves on the foundation on which all medical ethics is built.

Besides, some aspects of the Oath are actually enshrined in law even to this day, foremost amongst them being that doctors that don't practice medicine to acceptable ethical standards should be held accountable.

 

[passivesmoking]

People who work should have the option of getting rid of patrons they don’t like for whatever reason,

NO!

Absolutely not! Then you're one step away from right-wing doctors refusing LGBTQ+ patients, or christian doctors refusing to treat muslims.

When you become a doctor, you take on certain responsibilities, some of which trump your personal opinions

This isn't a manager kicking some Karen out of his Walmart, it's a potential death sentence.

 

[Maxer]

Something not addressed but that is a persistent issue in how our healthcare system is structured in America:
1. Doctors are not in charge of their own time anymore. They work for hospital systems that own their clinic. They are allocated 15 minute timeslots for patient visits and they are penalized if their production drops too low. Complex patients require more time and the clinic owners do NOT allocate that additional time for those patients. This setup PUNISHES doctors who get more complex patient populations.
2. Malpractice/complaints: A doctor that gets malpractice complaints has to report those to their medical boards, future employers, and insurance. Even if this are NOT founded (just random complaints) it drives their insurance costs up. They see that medicaid patients and complex case patients on average file more complaints so it makes doctors work hard to avoid those patient populations.

The issue with malpractice is that the system does NOT do a good job separating between VALID complaints where the doctors really did do something wrong and random complaints from patients who were drug seeking, saw too many billboards, etc...

This applies to medical board complaints as well. You get a patient who is drug seeking and calls the state medical board, that board opens a formal investigation and the doctor must defend themselves against it. Even when the complaint is totally BS on its face, proper procedures must be followed. This takes weeks and months to resolve and the doctor has to hire a lawyer to handle their affairs or take time off work to gather documentation and respond to complaints.

The problem here is that these systems exist for GOOD REASON. There ARE BAD DOCTORS out there and these complaint and investigatory systems DO need to exist. The issue.... the bad doctors are a small minority and these complaint systems are used to threaten doctors if they don't do what patients want. You get the "Karen" patients out there in the last 20 or so years sending more and more complaints as a threat.

Doctors have then become conditioned to avoid all "problematic" patient populations. Medicaid, complex cases, patients with multiple factors such as disabilities, chronic illness, etc...


To put this into perspective, those of us who work in IT imagine if every help desk ticket complaint created a formal investigation that could strip us of our ability to practice in IT ever again. You would screen your customers with a fine toothed comb

 

[Geebs]

Keep your oath, or get the fuck out of medicine. It's as simple as that.

No medical professional outside of the USA swears the Hippocratic Oath, it’s an American affectation.

I don’t know why you quoted the bit that deals with doctors not having sex with their patient’s slaves while in their house, though?

 

[xoe]

Why?

Honestly, everything you said in your post speaks of a mindset where medicine is a for-profit endeavour. It absolutely should not be. The American health care system is fundementally broken at its core philosophy. Maybe the NHS isn't perfect (and it certainly is not), but the entire premise for its existence is that health care is a fundemental human right, and people should not have to worry about the financial burden of calling an ambulance or getting necessary treatment.

It is like the people who complain about the USPS losing money. It doesn't lose money, it costs money!

 

[balthazarr]

Yeah. Everone's different.

And I don't mean to sound like an ass (and this is a bit off topic) but "healthy" is a very individual thing and has nothing to do with visible abs, and society's obsession with bodies and how they look is devestating, and I assume you know these things. When I was at my thinnest I was still overweight according to the normal calculations, but I didn't really look it or felt it (I'm a big dude no matter how much I weigh). I could maybe have pushed it further and gotten the shitty visible big muscles, but at that point ... why? Being happy with myself is impacted by what I do and not what I look like ... well it should be like that anyway. I still share your struggle (having put back some of the 40kg I lost), but I actually put on weight when I obsess about my looks (blergh i suck where's the beer) and loose weight when I distance myself from body ideals and just don't think about it (I don't mean totally letting go, just being content with myself as is), and that is the real struggle for me. But we're all different.

In any case doing all of that I assume you're healthier than your housemates despite their visible abs.

I totally agree, I wasn't aiming for any particular look, but wanted to be healthier. And I am. And fitter. But I am also miserable when I try to lose or maintain weight. I'm always hungry. But then obesity isn't fun either. The struggle is real.

And it's all the more galling when others judge or discriminate - and it's especially galling when it comes from trained physicians that should know better.

 

[Bippy]

There are a lot of problems with the NHS (UK healthcare system) over here. But compared to the absolute train wreck that is the US system, were doing OK.

How has it got this bad and how can anyone but anything but outraged by it?

We are outraged. But we're also absolutely exhausted. The people it effects most are the people least able to rise up and do anything about it.

It's at the point, and if you work in tech you'll be familiar with this, that the people who rely on it have given up complaining because it gets them nowhere, so they put their energy into living another day, rerouting around the system. But the people in charge think they're doing a good job because complaints are down.

 

[arsisloam]

I think all medical staff practice triage, whether they notice, or not. As I've gotten fatter and older, doctors, nurses and technicians are less and less enthusiastic about helping me. When you're thin and good looking, cost is no object. But the more gross you become, the less inclined medical staff are to do anything other than basic care.

 

[ColdWetDog]

Right. The oath is tenth-century twaddle. Among other things, it says


Meaning, originally, that doctors must defer to barbers in matters of surgery, since those hacks are the people who practice the crude, bloody craft of cutting things off of people.

It also forbids doctors from prescribing abortion drugs. Which, to be fair, is still a prohibition some people want to apply to doctors.

On the other hand, it has fairly strong patient privacy provisions, even by current-day standards, which is a plus.

It's been modified throughout the years to be a bit more appropriate to the current world. Most of us don't profess fealty to Apollo (the god, not the space program). While surgeons aren't barbers, we often do describe the workplaces as 'Physicians and Surgeons'....

And the abortion proscription is a bit rigid. But the basic philosophy behind the oath is still valid today. The Wikipedia article actually has a good overview of this.

 

[Skelator123]

Why?

Honestly, everything you said in your post speaks of a mindset where medicine is a for-profit endeavour. It absolutely should not be. The American health care system is fundementally broken at its core philosophy. Maybe the NHS isn't perfect (and it certainly is not), but the entire premise for its existence is that health care is a fundemental human right, and people should not have to worry about the financial burden of calling an ambulance or getting necessary treatment.

Why? Because profit motive or not, you're talking about a huge waste of resources. There's no good reason for every facility to be capable of treating every condition, what matters is that treatment is reasonably available.
And expecting every Dr. to be an expert on every condition is just plain silly.
Most countries, regardless of finance structure, have general purpose facilities and then more advanced ones for more specialized care.

 

[mjeffer]

It's not even just major disabilities. It can just be conditions they're not used to or comfortable treating. I have hypogonadism (low testosterone) and have since I was in my early 20s. Aside from the fact it took almost 10 years and me demanding that my testosterone be tested and finding a doctor who would do it to even get diagnosed, then to get proper treatment was just as bad. I had someone tell me that because I had no known underlying condition causing it I didn't even need treatment, despite the fact that I had every single one of the symptoms (and taking the shots completely alleviated every problem I was having). I ended up just having to call a bunch of random clinics until I found one that said they were comfortable treating it.

Moving just reinforced this. The first doctor I tried (I should have asked when I set the appointment but forgot since I had been on it for a long time by that point and forgot about the hassle...) was downright hostile to it. Then I finally figured out that the easiest way was to find trans friendly doctors since they were used to prescribing hormone replacement. This actually landed me on a community clinic in my area, which turned out to be absolutely wonderful and some of the best care and most attentive doctors I've ever had.

 

[ColdWetDog]

I think all medical staff practice triage, whether they notice, or not. As I've gotten fatter and older, doctors, nurses and technicians are less and less enthusiastic about helping me. When you're thin and good looking, cost is no object. But the more gross you become, the less inclined medical staff are to do anything other than basic care.

Are you sure you are reading everyone correctly? As you get older and larger, things do become harder for the medical profession. Even drawing blood in an obese, older person can be a real challenge. Sure, things would be better if everyone was 25 with a BMI of 22 but we all understand that reality is a bit different from that. And, as you might have come across, medical staff in general isn't in a happy space these days. Burnout and behavioral changes are rife across many levels.

And of course, there is likely to be some perjorative connotations of your condition. Health care workers are human and tend to have human biases. But it's pretty complicated. It may not be just you.

 

[balthazarr]

It's not even just major disabilities. It can just be conditions they're not used to or comfortable treating. I have hypogonadism (low testosterone) and have since I was in my early 20s. Aside from the fact it took almost 10 years and me demanding that my testosterone be tested and finding a doctor who would do it to even get diagnosed, then to get proper treatment was just as bad. I had someone tell me that because I had no known underlying condition causing it I didn't even need treatment, despite the fact that I had every single one of the symptoms (and taking the shots completely alleviated every problem I was having). I ended up just having to call a bunch of random clinics until I found one that said they were comfortable treating it.

Moving just reinforced this. The first doctor I tried (I should have asked when I set the appointment but forgot since I had been on it for a long time by that point and forgot about the hassle...) was downright hostile to it. Then I finally figured out that the easiest way was to find trans friendly doctors since they were used to prescribing hormone replacement. This actually landed me on a community clinic in my area, which turned out to be absolutely wonderful and some of the best care and most attentive doctors I've ever had.

A friend of mine had a similar experience. A lot of doctors are wary of HRT - especially testosterone for younger men, even if it is clinically indicated - because the law in many places is pretty draconian with respect to anabolics. It's easier to turn patients away than have to deal with possible audits/investigations/whatever.

 

[wrylachlan]

Why? Because profit motive or not, you're talking about a huge waste of resources. There's no good reason for every facility to be capable of treating every condition, what matters is that treatment is reasonably available.
And expecting every Dr. to be an expert on every condition is just plain silly.
Most countries, regardless of finance structure, have general purpose facilities and then more advanced ones for more specialized care.

Just because you have a disability doesn’t mean all your care is specialist care. People in wheelchairs still get strep throat and the flu and a million other things that people without disabilities get. Primary care facilities don’t need to suddenly morph into specialist hospitals, they just need to have the basic equipment necessary for providing primary care to patients with disabilities.

 

[Maxer]

Keep your oath, or get the fuck out of medicine. It's as simple as that.

It absolutely is not.

Doctors work for private for profit health systems, they aren't in charge anymore.

 

[hasib]

Why? Because profit motive or not, you're talking about a huge waste of resources. There's no good reason for every facility to be capable of treating every condition, what matters is that treatment is reasonably available.
And expecting every Dr. to be an expert on every condition is just plain silly.
Most countries, regardless of finance structure, have general purpose facilities and then more advanced ones for more specialized care.

In other contexts, the ADA states otherwise. People who are costly or just inconvenient to accommodate due to disability must have equal access made available, no matter if someone thinks it is a “huge waste of resources”.

Providing standard care to people with disabilities is not “specialized” care. It’s standard care. Providers who can not meet standards are sub-standard providers. Even if it is a genuine financial hardship, there are appropriate ways to rectify that which do not include illegal discrimination.

IMO, the lede here is the widespread failure to comply with the ADA, rationalized by the same pernicious attitudes that make the ADA necessary. We’ll see if the health care industry can continue operate outside the ADA, but it wouldn’t be the first to discover otherwise.

 

[KBGB]

I can relate to the doctors, you probably do need a specialist.

But in my time of need when a doctor decided they "couldn't offer compassionate care" I ended up with none for almost 2 years instead.

Doctors are people at the end of the day. Some are well intentioned who come up short & some aren't.

 

[LexiMentor]

Useful, important story. Thank you Ars. May we all (not just health care professionals) treat the handicapped, sick, disenfranchized, and impoverished better realizing that except for a lot of luck go I. (Success and Luck: Good Fortune and the Myth of Meritocracy by Robert H. Frank)

 

[Longmile149]

Fun addendum to the bit about there being no ADA police:

Here in Michigan, we have a state agency that’s responsible for handling complaints of discrimination: the Michigan Department of Civil Rights. We filed a complaint with them a year ago related to mistreatment at a local hospital. Nothing has happened. I called and spoke to the investigator they assigned and we were told there’s a big backlog and they have no way to tell us when our case will be investigated. I asked how big the backlog was and the investigator couldn’t tell me. Neither could her supervisor.

So I filed a FOIA request dating back to 2018.

Just since 2018, the MDCR has added around 10,000 cases to their backlog. They’ve resolved around 7000 cases in that same timeframe. The MDCR currently has a staff of around 30 investigators, a number that’s fluctuated by +/- 3 each year covered by my FOIA. They issue annual reports, but they very pointedly do not track the size of their backlog of unresolved cases. They tap dance past that unreported number in their reports and, clearly, they’re right to do so since no one in charge actually cares enough to notice.

Further, since 2018 not one single civil rights complaint filed with the MDCR has resulted in a hearing. Zero. Zip. Nada. None.

We filed a complaint with the Joint Commission last year, too. They responded by telling us that they will never tell us whether they even investigated the claim, much less whether they found any evidence of wrongdoing. The JC’s complaint process exists essentially as a fig leaf to play act at compliance.

The Michigan agency that licenses hospitals, LARA, investigated the complaint we filed with them after I started sending letters to their director asking for clarification on why they didn’t want to investigate…and they substantiated our claims! Hallelujah! At last, sweet justi…an, no, wait. They told us they have no authority to actually do anything about it except to ask the hospital to pretty please not do that any more.

I don’t believe for a second that Michigan is an outlier here. Not only is the US healthcare system rife with discrimination, there are no actual mechanisms for accountability or redress.

It’s fucking *broken.*

 

[hasib]

Nobody generally chooses directly to be obese, but being obese is a result of one's choices.

It absolutely is a result of eating more than you expend. No one can defy the laws of thermodynamics.

I have hypothyroidism, and it does affect my energy levels and my appetite. But I know that if I don't move as much I will gain weight.

It is simply Calories in:Calories out.

And if mobility issues impose profound constraints on the “calories out” side of the equation?

Or one has a metabolic disorder or is dependent on medication that renders the equation effectively meaningless?

 

[Pablo_DC]

I think it is pretty obvious that people with disabilities deserve the same quality of healthcare that non-disabled people do.

But it is also true that many disabilities require specific knowledge to assess risks and properly care for. That is not knowledge that you can expect from every doctor. And given the huge amount of disabilities you can also not just add it to the doctors training.

I don’t think this article is fair in describing the complexities of caring for, and administrating that care, in the current healthcare system. It’s just presented as a civil rights violation of the medical professionals.

That does not tell the whole story, and does a disservice to disabled people by not suggesting changes that realistically could be made.

And it’s even worse than that if one doesn’t have the health insurance to cover the costs. I happen to have both Medicare and a Medigap insurance. My neurosurgeon remarked to me once that one of his patients only had Medicare, which would not cover all his costs for the surgery she needed so she could not get the surgery she needed. Great surgeon but a big jerk.