How Do I Ask About Your Disability? An Examination of Interpersonal Communication Processes Between Medical Students and Patients with Disabilities

Abstract

Medical student behaviors were examined through digital recordings of interpersonal skills communication training framed around a brief curriculum on disability within a family medicine clerkship. This analysis focuses on interpersonal communication processes and ways medical students ask standardized patient educators about visually apparent disability (N = 142). Primary themes of asking about or avoiding disability were identified with regard to language and nonverbal communication in how medical students asked and whether they integrated chronic disability with new musculoskeletal pain complaints. Secondary themes related to timing and communication further contextualized the primary themes. Seventy-four percent of students asked about the disability. Analysis of feedback sessions immediately following the interactions revealed that more than half the students who did not ask about disability spontaneously recognized that they avoided disability language. Results suggest that some ways of asking about disability may inhibit patient disclosure and restrict relationship building. In particular, asking about disability, but then avoiding integrating disability disclosure into the treatment plan, or responding to disability-related disclosure with overly positive, infantilizing-type communication, may pose more difficult dilemmas than never asking about the disability. On the contrary, students who ignored disability altogether often also recognized they missed disability cues, thus providing a learning experience of considerable value. Underlying student attitudes and possibilities for integrating biomedical concerns with social–psychological impacts of disability are addressed.

The authors thank Shannon Carroll, Christina Cerutti, Colleen Coburn, Jen Gaze, Marjorie McCormick, Matt Morris, and Hilary Weismann from Boston College and Sara Rattigan from Tufts University School of Medicine, who worked on this project as research assistants.

The authors acknowledge the interaction team behind the project, especially Paula Minihan, PhD, MPH, MSW, from Tufts University School of Medicine (TUSM) and Linda Long-Bellil, PhD, JD, from University of Massachusetts Medical Center, who are crucial to the success of the ongoing project, as well as the dedicated TUSM faculty members, clinical and academic, who regularly share time to provide formative feedback for medical students. The authors also acknowledge the commitment, talent, and professionalism of the Standardized Patient Educators: Liz Casey, Jeanette Ector, Karen Foran Dempsey, Charlie Gamer, Lillian Johnson, Paul Kahn (1945–2010), Betsy Laitinen (1965–2007), Kia Scott (1970–2007), Robert Sneirson, and MacArthur Williams. In addition, Family Medicine Coordinators Rachel Fouche, Katina Kefalas, and Vanessa Rios are greatly appreciated.

Initial support for development of the standardized patient exercise was provided by a grant from the Massachusetts Developmental Disability Council and a federal Family Medicine Predoctoral Training Grant from the Bureau of Health Professions, Health Research and Services Administration, Department of Health and Human Services; continuing support for the educational interactions is provided by Tufts University School of Medicine through the Department of Public Health and Family Medicine and by the Office of Educational Affairs. Research support was provided by a Boston College Faculty Fellowship to the first author.