To the Editor:
We applaud Dr. Meeks and colleagues1,2 for identifying key structural barriers to inclusion of physicians with physical and mental disorders and agree that poor understanding of the Americans with Disabilities Act (ADA), perceptions of dangerousness, and an overemphasis on services rather than rights remain especially problematic.
At all levels of the profession, understanding of the ADA remains poor.1–4 Important ADA rules are not included in institutional policies, and many are inconsistent with the ADA’s provisions.2,4 As a solution, Dr. Meeks and colleagues recommend education and training on ADA rules pertaining to academic accommodations. But we believe that the ADA’s protections against prohibited medical inquiries are just as important.3,4 Unwarranted referrals for psychiatric evaluations can harm or even end the careers of employees regarded as impaired by these conditions, and they can affect many physicians other than those with self-disclosed disabilities, who were the focus of the authors’ recent report.
It is important to bear in mind that those who self-disclose disabilities and request accommodations (the respondents in Dr. Meeks and colleagues’ survey and report accompanying the article) represent a small fraction of the overall group of physicians with physical or mental disorders. And it should come as no surprise that the former place value on accommodations and other support services.
But while providing accommodations to those who want them is helpful, overemphasizing needs and dependence on services or treatment can exacerbate stigma and also become coercive.
Though the authors’ report speaks in glowing terms of workplace wellness programs and their potential for benefit of physicians with disabilities,3 readers should become more aware of the reasons why many disability rights groups and advocates have vehemently opposed workplace wellness programs.5 Their article and report are very important but are only first steps in reducing discrimination against physicians with these conditions within the profession at all levels.
Nicholas D. Lawson, MD
Law student and former psychiatry resident, Georgetown University Law Center, Washington, DC; [email protected]
Adina L. Kalet, MD, MPH
Arnold P. Gold Professor of Humanism and Professionalism and codirector, Program on Medical Education, Innovations, and Research (PrMEIR), Division of General Internal Medicine and Clinical Innovation, New York University School of Medicine, New York, New York.
J. Wesley Boyd, MD, PhD
Associate professor of psychiatry, Harvard Medical School, Cambridge, Massachusetts.
1. Meeks LM, Herzer K, Jain NR. Removing barriers and facilitating access: Increasing the number of physicians with disabilities. Acad Med. 2018;93:540543.
2. Meeks LM, Jain NR. Accessibility, Inclusion, and Action in Medical Education: Lived Experiences of Learners and Physicians With Disabilities. 2018.Washington, DC: Association of American Medical Colleges.
3. Lawson ND, Kalet AL. The administrative psychiatric evaluation. J Grad Med Educ. 2016;8:1417.
4. Lawson ND, Boyd JW. Do state physician health programs encourage referrals that violate the Americans with Disabilities Act? Int J Law Psychiatry. 2018;56:6570.
5. Kirkland A. Critical perspectives on wellness. J Health Polit Policy Law. 2014;39:971988.