The VCH Medical Staff Equity, Diversity and Inclusion Committee kicked off the new year with a thought-provoking presentation from two disability experts on ableism in health care: what it is and how it impacts patients, health-care providers, and learners in our health-care system. The session’s goal was to improve inclusion and access for patients, faculty, staff, students, and peers with disabilities.

Dr. Bonita Sawatzky, the director of READI (Respect, Equity, Accessibility, Diversity and Inclusion) for the Department of Orthopaedics at UBC and a dedicated teacher in UBC’s Faculty of Medicine, was joined by Dr. Julia Hanes, a fourth year Physical Medicine and Rehabilitation resident at UBC and active member of the Canadian Association of Physicians with Disabilities. Both are wheelchair users.

We can think of ableism as a belief system that sees people with disabilities as being less worthy of respect and consideration, less able to contribute and participate, or of less inherent value than others. It is used to rationalize the exclusion, neglect, abuse, and exploitation of people with disabilities in various different contexts.

Disability can be conceptualized as a mismatch between the task being asked of someone, the environment in which they are being asked to do it, and their body’s or mind’s ability to complete it in that setting.

Nearly one-quarter of Canadian women have at least one disability; in men, it is one in five. (4.6 per cent of medical students experience a disability.) The four most common disability types are pain related (15 per cent), flexibility (10 per cent), mobility (10 per cent), and mental-health related (seven per cent). (In 2022, StatsCan indicated that mental health disability is now as high as 20 per cent.)

Disabilities are often seen as “bad” and requiring “fixing.” The word disability is frequently seen as synonymous with impairment and handicap. Instead, we could see variation among people as normal and value such human diversity.

The repercussions of ableism in health care

Stats Canada reported in 2017 that 1.6 million Canadians with disabilities were unable to afford required aids, devices, or prescription medications due to costs. People with disabilities are four times more likely to report an inability to access necessary medical care.

A 2021 study revealed that:

• 4 per cent of physicians believed people with disabilities have a worse quality of life compared to non-disabled people.
• Only 40.7 per cent of doctors were confident in providing the same service and care for people with disabilities.
• Only 56.5 per cent strongly agreed to welcome patients with disabilities in their practice.

The words we choose to describe people with disabilities have power. Rather than saying someone is “unfortunate” or “suffers from” a disability, simply state that they have or are with a specific disability. Avoid making value judgements (e.g., “That quadriplegic patient’s wife is a saint for being with him.”). Rather than describing someone as “wheelchair bound,” use the term “wheelchair user.”

All people, including physicians, have both explicit bias (attitudes and beliefs on a conscious level) and implicit bias (unconscious attitudes that may influence our behaviour). While close to 68 per cent of health-care professionals who believed they have no preference between disabled and nondisabled people, over 44 per cent who have taken the Disability Attitudes Implicit Association Test were ranked as implicitly strongly preferring nondisabled people. Only 10.8 per cent actually displayed no preference.

Nondisabled people (especially physicians) tend to underestimate the quality of life of people with disabilities. This is called the disability paradox. Ableism contributes to unequal social outcomes including increased suicide rates, decreased access to education, employment, and health care.

Discussion scenarios

Drs. Sawatzky and Hanes provided personal examples where ableism has affected their and their families’ lives. Attendees also had the opportunity to discuss four scenarios in breakout rooms and then bring their thoughts back to the larger group. There were thoughtful suggestions as members brainstormed how to address each situation.

Recommendations

Drs. Sawatzky and Hanes ended the session by encouraging attendees to advocate for accessibility planning and engagement with patients and learners needing accommodation. This can include education, procuring equipment, and accommodating needs regarding EMR recordings.

Resources

Session participants watched all or part of the following videos that emphasize the need to change the way we look at disabilities.

• The Social Model of Disability (Raise the Roof)
• Inspiration Porn

Harvard University’s Implicit Association Test (select Disability)

B.C.’s Accessibility Plan

This Toronto Star article from January 5, 2025 was referred to during the session: A mystery illness stole her son. Doctors in Canada couldn’t find the answer, but she wouldn’t give up

Session feedback

Twenty-three of the 45 medical staff who attended the presentation completed a post-event evaluation. Several reported difficulties with the breakout rooms; comments regarding what resonated the most from the session included:

• The reality of how much stigma and barriers there are in health care.
• Removing environmental barriers; the short video Raise the Roof was very illustrative.
• The reminder that feeling sorry for people with disabilities is a result of systemic bias.
• The idea that we should not assume that all disabilities need treatment to be resolved. Bias that causes us to believe that all disabled people have low quality lives.
• The implicit bias stats were fascinating.
• Excellent overview of many key topics with challenges to each of us as physicians.
• The examples of terminology that should be used.
• The discussion regarding taking time and making space to accommodate people with disabilities.