Soon after Lisa Iezzoni MD was diagnosed with multiple sclerosis during her first year at Harvard Medical School, from which she graduated in 1984, faculty and administrators discouraged her from practicing medicine.

And in her final year they made it impossible for her when the dean’s office refused to write a recommendation letter (now called a Medical Student Performance Evaluation).

This week marks the 35th anniversary of the American Disabilities Act which was signed into law on July 26th, 1990. Much has changed since but -- as Dr. Iezzoni, who went on to become an eminent scholar and national policy leader on disability, has documented -- not nearly enough.

She and others have documented wide disparities in the quality of care patients with disabilities still receive, and in 2021 she published the findings of a national study of physician attitudes towards disability that document’s persistent stigma and misinformation. Disabled patients were described as a “disruption to clinic flow” and a majority of physicians believed that patients with significant disability inherently have a worse quality of life.

Practices are also ill-equipped to care for them, Dr. Iezzoni, who chaired the U.S. Access Board’s advisory committee on accessibility standards for medical equipment observed that “healthcare has been among the most backward environments, in terms of making itself accessible. Movie theaters are accessible, sports stadiums are accessible, transit is accessible. But healthcare facilities—no.”

In our conversation with her, we explore why. How is it that physicians have such difficulty appreciating that disability is simply a part of the human experience? We explore the link between the culture within medical education and training, and the kind of people physicians become.

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References:

Physicians' Perceptions of People with Disability and Their Health Care

US Access Board

It is difficult to overstate the achievements of Richard Clarke Cabot (1868-1939) a relatively little-known, old-moneyed physician of the early 20th century who was far ahead of his time in how much he contributed, and how willing he was to question his own limitations.

Cabot's achievements include: creation and self-funding of the first medical social work service and establishment of the fields of clinical pastoral care and medical ethics. His work offered seminal contributions to the fields of hematology, cardiology, infectious disease, and medical education – including the clinical pathologic conference, case-based learning and the differential diagnosis; the first large-scale randomized experiment in the history of criminology; the science of medical error; and introducing the concept of a group insurance plan. He authored countless books, articles and textbooks.

Most remarkable, considering Cabot's extraordinary intellect, was his openness to reflecting on his own deficits as a physician, including getting diagnoses wrong, and describing his own failures in seeing the humanity of his patients.

Joy, curiosity, and generosity were among his distinctive personal characteristics.

So, why is he not more widely remembered? Perhaps because of one of his greatest attributes: he pointed out things about his profession that the medical establishment didn’t want to hear.

In an April 23rd executive order (EO), the president of the United States alleges that the Liaison Committee for Medical Education (LCME) and the Accreditation Council for Graduate Medical Education (ACGME) are requiring medical schools and residency programs to pursue unlawful discrimination through DEI policies. The EO calls for the US Department of Education to “assess whether to suspend or terminate” them, and to “streamline the process” for recognizing new accreditors to replace them.

In addition, medical journals, including the New England Journal of Medicine, are getting letters from a US Attorney, calling them “partisans in various scientific debates,” and requesting information.

As a follow up to our last episode on authoritarianism and its implications for the medical profession, we consider these new developments from two perspectives: On the one hand we look for evidence to support the government’s claims; and, on the other, we consider how they fit into the authoritarian’s playbook of capitalizing on polarization to breakdown civil society and consolidate power.

There are things physicians and other health professionals can and should be doing now – and we propose a few -- to protect our profession from an authoritarian incursion that threatens our commitment so scientific integrity, and to a medical education system that, however imperfect, is informed by expert knowledge and professional values.