Lack of training hurts doctor-patient relationships.

About 54 million Americans have some type of disability, so it stands to reason that most physicians will see people with disabilities in their practices. However, physicians receive little training about how people with disabilities live their daily lives.

How does this lack of training affect doctor-patient relationships? Dr. Lisa Iezzoni addressed this issue in a perspective published in The New England Journal of Medicine in September 2006. She has conducted a Society-funded research project examining insurance issues and is now doing a study of mobility aid use among people with MS. She also has MS.

She observed:

* Physicians tend to ignore their patients' disabilities. "It's the elephant in the room--present, but unmentioned," writes Dr. Iezzoni.

* Physicians tend to "medicalize" disability as an illness. They may focus on one problem and not the bigger picture of wellness and care.

* Physicians, like society in general, tend to marginalize people with disabilities and make uninformed assumptions. People with disabilities believe that physicians do not recognize that they can lead rich and fulfilling lives.

A better understanding

How can these obstacles to understanding be overcome? By talking! Dr. Iezonni concedes that extra time for talk is harder to come by in the managed care environment. However, she believes her fellow health-care providers can do better if they make no assumptions and instead ask questions. Better communication will enhance the quality of medical care, she stressed.