Second Class Patients

Rodney Warner
Rodney Warner

There is a large group of people with cancer who may be having a very difficult time getting diagnosed and treated. It’s not because they’re poor or don’t speak English (though those issues may be contributing factors), it’s because they’re disabled, according to a recent NPR story. It states,

Though nearly 20 percent of Americans have physical or mental disabilities, studies show that less than 20% of medical schools teach their students how to talk with disabled patients about their needs…More than half of medical school deans report that their students aren’t competent to treat people with disabilities, and a similar percentage of graduates agree…Numerous studies have found people with disabilities receive inferior health care, including less information about prevention and fewer screening tests.

Last year, according to the article, researchers contacted doctors’ offices in four U.S. cities to make an appointment for a fictional patient who was obese and in a wheelchair. One in five offices refused to see the person, claiming reasons that included a lack of trained staff and a lack of equipment to help patients onto an examining table.

The article’s author, Leana Wen, is a physician. She described a scene in an ER where she worked while a senior resident,

(T)here was that one patient everyone seemed to avoid, a man in his 20s with back pain. I watched as the medical student picked up his chart, then placed it back on the rack. Nurses, too, weren’t going to his room. Finally, I assigned a team to care for him.

“We drew the short straw here,” I overheard the nurse say.

The resident sighed. “I already ordered labs and an X-ray. It’s going to take too long to examine him, so let’s just get this started.”

What was different about this patient? Was it a dangerous, contagious disease? A mental health problem marked by a violent streak? A history of weekly drunken visits to the ER?

No. All he had was a wheelchair.

He had been in a car accident five years before and was paralyzed from the waist down. He told me that he was used to waiting, to being the patient that providers avoided. His back pain was from a kidney infection, and it turned out that all he needed was an antibiotic.

Given most people diagnosed with cancer are older, it’s my guess than more than 20 percent of those with cancer have a disability of one kind or another. The National Cancer Institute estimates 1,665,540 Americans will be diagnosed with cancer this year. So that’s at least 333,000 people a year that the health care system has a difficult time dealing with, possibly resulting in later diagnoses and a higher mortality rate.

How many delays, how much inferior the care, how much grief and crap in general, do disabled Americans with cancer have to put up with? Those of us without disabilities can only imagine. Having cancer is bad enough. We don’t need more prejudice by health care providers heaped on top of our problems.

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