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Blindness sees no barrier

Osteopathic medical student Jeff Lawler studies a human bone in an Anatomy classAs a teenager Jeff had toyed with the idea of going to medical school, but no one in his family had ever gone to college. Academically and financially, it just didn't seem like a realistic option. But Jeff Lawler, now a first-year medical student, is reshaping perceptions of disability within health care education, and may ultimately impact the very definition of what a physician is.

Jeff, a 39-year-old native of Denver, Colorado, is blind. He was diagnosed at age 24 with Retinitis Pigmentosa, a degenerative disease of the retina. Within 10 years Jeff lost all vision, became severely depressed and questioned the worthiness of his life. "It took my blindness for me to focus and realize that I had the qualities that would allow me to be a physician," he says. "If I hadn't become blind, I know I wouldn't be here today. I would never be on my way to becoming a doctor."

In addition, at about the same time Jeff learned of his RP, his mother was diagnosed with breast cancer. Jeff wrestled with his depression while his mother fought her cancer. Watching her live and cope with the disease from which she eventually died helped him overcome his own depression and feelings of unworthiness, Jeff says.
"Losing my mom was more difficult than losing my sight," Jeff says. "I watched her battle [the cancer] and she didn't give up. So I decided, neither would I."

His mother passed away in December 1993. Jeff enrolled in the Colorado School for the Blind at around that time and it was at the Center that he became revitalized. He met the woman who is now his wife, Sandy, "a tiny, 100-pound woman" whom Jeff describes as "my rock." The Center's director, Diane McGeorge, also challenged him to build a new life by turning his disability into an advantage.

Equipped with an associate's degree, Jeff enrolled as a full-time student at the University of Colorado at Denver in the fall of 1994, majoring in biology. As a blind undergraduate student, he earned straight A's and ascended to the top of his class. The following summer he took an accelerated course in organic chemistry, a true litmus test of his academic skills and received an A+, the highest grade in the class. It was then that Jeff seriously considered his lifelong dream of becoming a doctor.

In 1998 Jeff took the Medical College Application Test (MCAT) and applied to eight medical schools. He was confident. "Medical school is very competitive," Jeff explains. "My MCAT scores were not super high, yet high enough. I knew I could be a good doctor and not just get through medical school, but be an outstanding physician."

Jeff was invited to interview at four schools, but Western University of Health Sciences (WesternU) - College of Osteopathic Medicine of the Pacific (COMP) in Pomona, California was the only one to offer him a seat. He just completed his first semester there and already has made a profound impression upon his fellow students and faculty. He navigates the WesternU campus effortlessly with the aid of his guide dog, Burke, and he recently scored A's on his histology and gross anatomy exams.

"I think Jeff has been an outstanding medical student up to this point. He is probably the hardest working medical student "I've ever seen," says Dr. James Jones, who is a professor of Jeff's at WesternU.

"I think Jeff is very motivated. He's a gifted and determined individual," says Dr. David Redding, who instructs Jeff in osteopathic manipulative treatment - a key component of osteopathic medicine, which is also known as "hands-on medicine." "His blindness has allowed Jeff to excel in certain areas, and touch is one of them," Redding adds. "He is palpating with a greater intensity than others are perhaps able to. He may actually have an advantage there."


Jeff navigates the WestrnU campus with the assistance of his guide dog and his classmate Pinella Holder
Below: Jeff Lawler accompanied by his guide dog, Burke, recieves his first laboratory smock along with a congratulatory handshake at WesterU's White Coat Ceremony
While Jeff's professors share praise for his early efforts, they also voice serious concerns regarding clinical education and academic evaluation.

"My greatest concern is when he goes on rotations," says Dr. Redding. "How are hospitals going to accommodate him? Clinical sites may not be able to accommodate him as well as we have been able to here on campus. I question whether many physicians would have the time or desire to do that. Things move pretty fast in the ER room for example. Will he be able to keep up? I can't answer that question at this point."

Jeff entered COMP just a year after WesternU founded the Center for Disability Issues and the Health Professions (CDIHP). Almost by fate, the timing of his application was impeccable. During that same period, WesternU President Philip Pumerantz, Ph.D. announced that his university was establishing a Center for Disability Issues and the Health Professions (CDIHP).

"One of the most profound shortcomings we face is a lack of understanding among health professionals regarding the treatment of persons with disabilities," says Philip Pumerantz, Ph.D., WesternU's president. "The disabled community has emerged as one of the fastest growing and least understood minority groups within our society."

People with disabilities constitute close to 20 percent of the U.S. population currently, and their numbers are expected to multiply dramatically as the number of people over age 65 doubles within the next 30 years. Many will develop chronic and multiple illnesses that will diminish their physical and cognitive capacities. "These patients will require extended consultations, complex explanations and plenty of compassion and understanding," Dr. Pumerantz says. "That is why we founded the CDIHP."

To head the CDIHP, WesternU hired Brenda Premo, the immediate past director of the California State Department of Rehabilitation and a nationally recognized advocate for disabilities awareness. Under Premo's leadership, CDIHP's mission is to bring greater awareness of disabilities issues to health professions curricula, and to improve access for people with disabilities to health, health education and health care services. In addition, Premo has stated that she intends to actively recruit qualified health professions students with disabilities.

"Students gain an incredible amount of knowledge and experience directly from their peers," she says. "Bringing students with disabilities into our academic programs sends a clear message to their colleagues that these are able and capable people. It shatters stereotypes and misperceptions from the first day of class." Jeff is among three students with disabilities to attend WesternU since the CDIHP's founding. A young woman of short stature has entered the University's College of Pharmacy, and a young man with two fingers missing from his left hand, is among COMP's first-year students.

Premo agrees that completing rotations as a blind medical student will present numerous challenges for Jeff. "There will be preceptors with the same biases and fears that our faculty originally expressed," she says. "We will have to seek out clinical instructors who are willing to expand their experiences and their expectations. Preliminary discussions already reveal four or five possible rotations sites with preceptors who are willing to try. It's a matter of desire more than anything else. I won't accept the use of the word "can't." Blindness is not the barrier obstructing Jeff's future. It is the fears and anxieties of the people around him that threaten to impede his success."

How will the faculty teach and test a medical student with disability? What are the essential technical standards required for becoming a physician? These are key questions that will need to be answered if WesternU is to enroll more students with disabilities in the years to come. "We have to determine fair methods of evaluation without making wholesale exceptions to the curriculum," says Dr. Jones. "Accommodation for disabilities cannot equate to complete elimination of the requirements that others are expected to meet. We are also re-evaluating the basic physical criteria needed to become a complete physician. Should all of our graduates be able to intubate [insert a breathing tube into a patient's trachea]? Should they be able to read an X-ray or an EKG? These are important questions."

"I agree that these are important questions," says Premo. "Guidelines for instructing and evaluating disabled medical students will have to be established, but that isn't Jeff's problem at this point. It's the University's problem to solve."

"We have to ask ourselves in ADA (Americans with Disability Act) parlance, what are the essential functions of the job," says Julie Madorsky, M.D., a clinical professor of physical medicine and rehabilitation at WesternU and a member of the CDIHP Advisory Board. "This is a complex and difficult question for physicians, considering that medical students are expected to be almost omnipotent."

Dr. Madorsky defines "omnipotent" as the capacity to succeed in every field of medicine or surgery, be it clinical, academic, administrative or research. "Of course the reality is that none of us is omnipotent," she says. "Regardless of the presence or absence of physical disability, all medical school graduates eventually make career choices that align their professional activities with their special talents, interests, aptitudes, strengths and weaknesses. The essential functions of a physician are health maintenance, and the diagnosis and delineation of treatment of disease and disability. And these are all, first and foremost, cognitive tasks."

Jeff isn't the first medical student that is blind in the U.S. According to Premo, there are about a dozen physicians that are blind she knows of who are practicing in the United States, including David Hartman, M.D., a psychiatrist practicing in Salem, Virginia; Stanley Wainapel, M.D., clinical director of rehabilitation medicine at Montefiore Medical Center in the Bronx, New York; Stanley Yarnell, M.D., medical director of rehabilitation medicine services at Saint Mary's Hospital in San Francisco, California; and Iliff Jeffery, D.O., an osteopathic manipulative medicine specialist in Provo, Utah. But Jeff is probably the first medical student that is blind with an institution behind him that is pressing to reshape health professions curricula.

Does Jeff feel the pressure of being a trailblazer for other health professions students with disabilities? "I have anxieties, just like any other medical student," he admits. "But I don't have fear. I'm aware that there will be many obstacles ahead to work through, but I am confident in my abilities, and I have a lot of faith in the people who are supporting me, including Sandy."

"That's why we're here," Premo says. "We are here for people such as Jeff to have careers based on what they can do, and not be limited by what other people believe they can't do. I would encourage any young person with a disability with an interest in the health professions, who has a knack for the sciences and biology and a desire to help others, to consider a health care career."

For more information on the Center for Disability Issues and the Health Professions, call (909) 469-5380. Or e-mail Premo at bpremo@westernu.edu.

 

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