"Do you consider yourself a patient or a doctor?"
I participated in a "Physicians with Disabilities and/or Chronic Illnesses" interview at the Stanford University School of Medicine to provide insight into what it is like to be a doctor, who also happens to be a patient. I had never thought about that question and frankly, I questioned even being able to be a doctor when I was first diagnosed with focal segmental glomerular sclerosis (FSGS) in my final year of undergraduate studies. It is well known that there are significant barriers and bias to students in all fields of education with disabilities and chronic medical illnesses. Recognizing these issues, the ACGME created the Common Program Requirements which specifically states that residents and fellows "must be given the opportunity to attend medical, mental health, and dental care appointments, including those scheduled during working hours."
However, this is hard to do in practice and the system often fails to support trainees with disabilities and/or chronic medical illnesses.
In many ways, I have been fortunate and privileged – my chronic illness is not visible and my co-residents, co-fellows, and now co-attendings would not be aware, unless I chose to bring it to their attention. My renal function did not decline until residency and fellowship, and I did not exhibit physical signs until my final year of training. This has manifested in many ways – during my first year of fellowship (which coincided with the peak of the COVID-19 pandemic), I was placed on immunosuppression to reduce the decline in my glomerular filtration rate. When that did not work, I enrolled on a clinical trial with an experimental drug and received infusions every other week over a 6-month period. And when that did not work, my medical team obtained FDA approval for compassionate use of another experimental drug indicated for a different glomerulopathy. And now we wait for the inevitable.
While the requirements for allowing house staff to attend medical visits is very clear (as outlined above), I consistently encountered resistance when requesting time off for my own doctor visits. I was told, "If we change your schedule, we'll have to change everyone else's" and even worse, "Just change your appointment to your day off." There is inherent guilt and fear of stigma or bias when disclosing disability and asking for time off during training, as most programs require that time be covered by a co-resident or co-fellow. A "hard-working" ethos is lauded during graduate medical training, while taking time to improve physical or mental well-being is often labeled as "lazy."
It is ironic that we, as health care workers, expect our patients to prioritize their health and be on time for their appointments. We express frustration if they are delayed or have conflicting work obligations, yet we rarely extend the same consideration to our own colleagues in medicine. This double standard suggests that being a physician somehow excludes them from also being patients – a notion reinforced by the boundaries and expectations set by our medical training. While we encourage our patients to advocate for their health needs, we often fail to do the same for ourselves when it comes time for our own care.
Even more appalling is the treatment of those with visible disabilities. For instance, a fellow trainee with a known hearing impairment once asked for repetition during a sign-out with an attending. Instead of being understanding to his disability, the attending asked him, "Are you deaf, or do you not understand what I'm saying?"
When he responded, "I am sorry, but I am hard of hearing," he was met with silence.
This is unacceptable.
There is a simple solution – education. While many institutions have policies that reflect the ACGME requirements, there are no standardized practice or specific training for residents, fellows, faculty, and staff. I propose that every GME program creates a learning module focused on how to interact with learners with disabilities that is mandatory for all involved in graduate medical education. This module should explicitly outline the ACGME Guidelines pertaining to attending medical appointments and provide teaching toward working with learners with disabilities and/or chronic medical illnesses. I would then recommend that there is dedicated time in the training program for discussion among the trainees and faculty to identify potential issues within the program and pain points of ableism within training. There needs to be full support from leadership at every level of the academic medical system – including the division chief, department chair, designated institutional officer, and dean.
As physicians, our role is to be compassionate clinicians who relieve suffering and work toward curing disease. This responsibility extends not only to our patients but also to our colleagues. Regardless of our degrees, we are people first, and we must remain compassionate to all – including ourselves. As science and medicine continue to advance, we will see more students and trainees managing chronic illnesses and disabilities, demonstrating that one can balance personal health challenges while excelling in patient care. It is essential for graduate medical education to teach how to create and sustain an inclusive learning environment that supports all trainees. This begins with recognizing disability as an integral part of diversity.
“Do you consider yourself a patient or a doctor?” the medical student asked me.
“Both,” I proudly said.
How do you support your colleagues with disabilities? Or request that your colleagues support you? Share in the comments.
Dr. Rao is a physician-scientist specializing in pediatric hematology/oncology with a clinical emphasis on pediatric solid tumors and a research focus in using tissue engineering and biomaterials approaches to study cell-matrix interactions that guide chemoresistance in solid tumors. He is new faculty at the University of Washington/Seattle Children's Research Institute. He is proud to be the first faculty in the Ben Towne Center for Childhood Cancer and Blood Disorders Research to be funded through the Seattle Children's Research Institute Excellence in Research New Investigator Award, a program that supports faculty with backgrounds underrepresented in science, including those with disabilities.
Illustration by April Brust
