FDR Issue
FDR: Splendid Deception
Blindness sees no barriers
Think Quest
Blindness Sees No Barriers at Western U
As 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."
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 HYPERLINK mailto:bpremo@westernu.edu
bpremo@westernu.edu