On this episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole examine an article published in CMAJ titled, 'Tackling barriers to Canadian medical school admissions for students with disabilities.' The analysis highlights how medical education has historically devalued or excluded trainees with disabilities and emphasizes the need for more flexible and inclusive admission processes.
They are joined by Shira Gertsman, the lead author and a medical student at McMaster University, who shares her personal battle with Crohn's disease and the hurdles she encountered applying to medical school. Gertsman underscores the critical need for accommodations for individuals with disabilities and the importance of greater representation and understanding within the medical field.
Next, the hosts speak with Dr. Caroline Bowman, a family physician who developed multiple sclerosis mid-career, to discuss her initial symptoms, her fears and concerns, and the impact of MS on her ability to work as a family physician. She also talks about the challenges she faced in accepting her disability and the shame associated with it. Dr. Bowman offers her thoughts on how the medical profession can be more accommodating and understanding towards physicians with disabilities, and the benefits that both physicians and patients can gain from addressing shame and creating a more compassionate culture in medicine. The discussion acknowledges how strains in the medical system reduce flexibility and challenge its capacity to make systemic changes.
This podcast has been sponsored by MD Financial Management. Click here for more information.
Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.
You can find Blair and Mojola on X @BlairBigham and @Drmojolaomole
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The CMAJ Podcast is produced by PodCraft Productions
On this episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole examine an article published in CMAJ titled, 'Tackling barriers to Canadian medical school admissions for students with disabilities.' The analysis highlights how medical education has historically devalued or excluded trainees with disabilities and emphasizes the need for more flexible and inclusive admission processes.
They are joined by Shira Gertsman, the lead author and a medical student at McMaster University, who shares her personal battle with Crohn's disease and the hurdles she encountered applying to medical school. Gertsman underscores the critical need for accommodations for individuals with disabilities and the importance of greater representation and understanding within the medical field.
Next, the hosts speak with Dr. Caroline Bowman, a family physician who developed multiple sclerosis mid-career, to discuss her initial symptoms, her fears and concerns, and the impact of MS on her ability to work as a family physician. She also talks about the challenges she faced in accepting her disability and the shame associated with it. Dr. Bowman offers her thoughts on how the medical profession can be more accommodating and understanding towards physicians with disabilities, and the benefits that both physicians and patients can gain from addressing shame and creating a more compassionate culture in medicine. The discussion acknowledges how strains in the medical system reduce flexibility and challenge its capacity to make systemic changes.
This podcast has been sponsored by MD Financial Management. Click here for more information.
Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.
You can find Blair and Mojola on X @BlairBigham and @Drmojolaomole
X (in English): @CMAJ
X (en français): @JAMC
Facebook
Instagram: @CMAJ.ca
The CMAJ Podcast is produced by PodCraft Productions
Dr. Blair Bigham:
I am Blair Bigham
Dr. Mojola Omole:
I'm Mojola Omole. This is the CMAJ podcast.
Dr. Blair Bigham:
Jola, today we're talking about an analysis published in CMAJ entitled, “Tackling barriers to Canadian medical school admissions for students with disabilities.” This analysis really outlines how medical education has historically devalued trainees or even excluded trainees who have disabilities and talks about how inflexible the admission process is. Now, it's not a research paper, it's an analysis, but it's drawing together as much as we know about the topic and effectively has come to the conclusion that we don't do a very good job of accommodating people who have a disability who want to be in medicine.
Dr. Mojola Omole:
This is a really interesting topic because when we talk about having inclusion and equity and accessibility in medicine. This is a really glaring area that many medical schools struggle with because of, I think, part of it is that we have rigid standards of how to get through the process, how to take 4,000, 6,000 applicants down to a number that is manageable. However, I do think that if we want to address equity into the medical school admission processes, we have to have better pathways and better algorithms when we're looking at people who might have disabilities.
Dr. Blair Bigham:
Absolutely. And my initial reaction here before we speak to our guests is that a lot of the time when you think of the two words disabled physician, you just jump straight to a neurosurgeon who's unable to operate because of a disability. But there's so many different types of physicians and so many different types of disabilities that I'm thinking we should probably be doing a better match of pairing people to this profession.
Dr. Mojola Omole:
For sure, and actually, I know of different physicians, different surgeons who have different limbs missing, different fingers missing, and they're successful surgeons. And so I think that that paradigm of viewing, having people who have disabilities and not being equated to physicians is quite antiquated. And we also have to keep in mind that mental illness is also in the spectrum of having a chronic illness and being classified as having a disability.
Dr. Blair Bigham:
Absolutely. Not all disabilities are visible.
Dr. Mojola Omole:
We're going to speak with the lead author of this article who's a current medical student at McMaster University, and then we're going to hear the experience of a physician with a disability, which started much later on in their career, to find out how disability shapes your career at the beginning and then midway through your career.
Dr. Blair Bigham:
Let's get to it.
Shira Gertsman is the lead author of the analysis in CMAJ. Shira is in her final year of medical studies at McMaster University. She's on the board of directors for the Canadian Association of Physicians with Disabilities, and she's one of the founding members of their trainee unit. Thank you so much for joining us today, Shira.
Shira Gertsman:
Thank you so much.
Dr. Blair Bigham:
Shira, can you tell us a little bit about your own experience with disability?
Shira Gertsman:
Yeah, absolutely. My journey to identifying as someone with a disability has been a long one. I would say prior to medical school and getting involved in this community, I would have identified as having a chronic illness. I was diagnosed with Crohn's disease when I was 13, and it's definitely been a difficult journey and impacted my life and my education in many different ways, from the disease itself to all the complications and repercussions of that.
And then when I started medical school, I started to get involved in the community because I found it a very isolating experience. I didn't really know anyone else in medical school who had any sort of medical conditions and had certainly been actually discouraged from pursuing the field of medicine because of my illness. And that's when I learned that disability is not just what we might picture in terms of mobility impairment, for example, although that certainly counts. But disability is really any kind of impairment, physical, cognitive, psychological, that causes some people not to be able to fully participate in elements of society because of societal and contextual barriers. And so as part of that, I've really learned that having a chronic illness like Crohn's disease can absolutely be a disability. It's very contextual and in medicine in particular and in medical training, I have found it to be something that can be quite disabling.
Dr. Blair Bigham:
I'm curious, tell me about your experience in the application process to medical school and how your Crohn's disease played a role in that.
Shira Gertsman:
Absolutely. When I was in high school, I had thoughts that maybe I would want to be a doctor someday, and I ended up moving away from it throughout most of my undergrad because I was pretty discouraged by the feedback I got. I unfortunately had some flares during my undergraduate degree, and it forced me to take a part-time course load. I was able to continue studying on my own to make sure that I was never off school entirely, but I wasn't always taking that full five courses a semester when I wasn't well. And it was very interesting because I had mentors who really encouraged me to pursue medicine and wrote references for me, and then when I would disclose what I was going through, their attitude toward me really changed and I got direct feedback that this really wouldn't be a good field for me, that I wouldn't really belong, that I wouldn't really be supported.
And so I actually refrained from pursuing medicine for a while and in my last year decided that you know what, I was going to go for it and unfortunately during the admissions process continued to encounter barriers in particular with respect to the times in my education that I did take a part-time course load. I had been confident that if I spoke to schools and showed that during the time that I was taking the part-time course load, I had medical documentation, it was all arranged with the school. But unfortunately when I spoke to schools about that, they said they didn't make exceptions to these policies, which was another thing that signaled to me that maybe this wasn't a field that would be accepting to me.
Dr. Blair Bigham:
In terms of admissions policies and the institutional approach to this, what did you experience in terms of any type of accommodation or consideration for those abnormalities, I guess they would consider them on your application?
Shira Gertsman:
I didn't have any particular accommodations during the admissions process in the end. I found it quite different school by school. I ended up going to McMaster, which again, it was a number of years ago now when I was applying, but it doesn't take into account the number of courses that you take. That's not one of their requirements, so it didn't actually impact my application. I was evaluated like any other applicant.
There were some schools that I found had some really positive measures in place. For example, in the Prairies, there were some schools that offered the opportunity to write an adversity essay, to write about anything that you didn't feel fit into a typical extracurricular experience that might be in a normal application form, but you felt helped you grow or develop or would help you be a better physician in some way. And I really appreciated those opportunities to describe my experience because I think it's not just that my illness made me a burden in some way or a lesser applicant that needed to be accommodated, but rather my experience being in the hospital, having a chronic illness actually I think provided me with a lot of empathy and understanding of the medical system that would actually make me an even better candidate to be a physician.
Dr. Blair Bigham:
This is very interesting because I can imagine that institutions would say, "We want to be fair, and so we have set a bar, we've set a standard and we just can't accommodate certain situations, or we just can't review every single claim of a disability and judge them all." They would have maybe a list or something. What's your reply to that pushback that institutions might have in the name of being fair or being systematic?
Shira Gertsman:
Absolutely, and I think there are different levels of this. I think the reality is that some schools say we couldn't possibly review a piece of writing for every applicant, but there are many schools in Canada where writing four to five essays is a standard part of their application. There are absolutely schools that do this. I think I've also been faced when trying to advocate for more accessibility or more transparency of accommodations with the response that, "Oh, if we do this, then everyone will want accommodations." And the reality is that the research shows that applicants to medical school, medical students, and even residents are extremely unlikely to report their disability and ask for accommodations even when they're available due to fear of stigma and discrimination. And so-
Dr. Blair Bigham:
Oh, interesting.
Shira Gertsman:
Yeah, so even there was a study done in the US that showed that out of American residents, I believe they were first year residents who identified as having a disability that required accommodations. 50% did not ask for accommodations and out of those, 60% identified the reason as fear of discrimination, so we really-
Dr. Blair Bigham:
Oh, wow.
Shira Gertsman:
Yeah, so we really need to keep in mind that when the response is that everyone's going to try to take advantage of this, this is actually something that people have a really hard time identifying with, and part of that is because of how stigmatized it is and how secretive people feel they have to be.
Dr. Mojola Omole:
Maybe if everyone's going to ask for it, maybe everyone needs it. Maybe we need to reimagine the way we do medical education and the way we practice medicine that allows for diverse people to actually work in the field.
Shira Gertsman:
Absolutely. I think that's another really key point is that we, as physicians, I think we often have a dichotomy of sick versus well or physician versus patient. And the reality is that disability is a spectrum and there's permanent disability and there's temporary disability and most of us, if not all of us, at some point in our life are ill. Or we may have other situations like loved ones who are ill or deaths in the family or other things that we encounter. And having a culture of medicine that is more flexible, more accessible, more compassionate, more open to people expressing their needs and vulnerabilities, I think doesn't just benefit a specific subset of students. It really benefits everyone.
And these inflexibilities in the admissions process don't just impact students with medical conditions. They also impact students that have really shown resilience in other ways that schools say that they're looking for. For example, I heard the story of a student who had deaths in their family and had to do a part-time course load while they were taking care of the children in their family who no longer had a caregiver. And that's an incredibly challenging experience that would allow them to grow a lot and have a lot of understanding and empathy and it's something that actually should make them an even better candidate, but instead disqualifies them from applying to many schools.
Dr. Blair Bigham:
Right. You've been an advocate in this space for a while now. You've been presenting at conferences, and I'm sure you've heard lots of stories like that. How are you being received in general? Obviously there would be people who resonate closely with this, but are you getting any pushback? Are you getting any naysayers?
Shira Gertsman:
Absolutely. It has been fascinating to me in this work to see how controversial this kind of advocacy is. One contrasting experience that I had was presenting at two conferences back to back, and the first one was an interdisciplinary social accountability conference in healthcare. And so there were many people there with disabilities on the panel, even coordinating the conference itself, people from different disciplines, a lot of allied health, and the study was received super positively. We had a lot of interest and it actually was awarded first place at the conference. And then the following week I presented at a general medical conference and the response really couldn't have been more opposite to be honest.
What really shocked me was that physicians who I consider really amazing people and very kind and accepting people would approach me and have questions that I knew they were not meaning to be harmful or offensive in what they were saying, but it was really just stating facts of, "Well, of course people with disabilities can't be physicians. That wouldn't even be safe for patients. We can't even consider it for those reasons." And I think it shows the lack of understanding of the heterogeneity of disability, what disability is.
And I think the frankness that people have used, just talking to me about this, I think first makes me realize that they probably have no idea that I even identify as part of this population because I am about to graduate medical school. And for them to say, "Oh, someone with a disability couldn't be a medical student," they're not assuming that I am in that population. And it also really shows the attitude in medicine of exclusion towards these individuals and lack of viewing them as competent.
If I could just tell a very brief anecdote. There's a resident at McGill, Marie Picot, she's spoken publicly about this as well. She has a disability where she has only one hand, and she was born with this. And it's fascinating to hear about her story in medical school where people would assume that she couldn't do procedures, for example, that she couldn't suture, that she couldn't intubate. And for her, she's lived her whole life this way. She doesn't view the world in how to do things the same way as someone with two hands does. So many things are just obvious to her that even myself, I would assume that can't be done because I've never even fathomed how that could be done.
And what she emphasized was that she actually really loved emergency medicine and she learned to intubate. She was great at suturing. They actually used her to teach suturing to a lot of people. She did it in her own way, but it was frustrating because she would feel a lot of pressure that if she didn't intubate successfully the first time or if she struggled with a skill, it was automatically considered to be that she can't do it because of her having only one hand rather than the fact that pretty much all medical students don't intubate successfully on their first try. There's just automatically, anything is just attributed to that disability than just the fact that you're a learner.
Dr. Mojola Omole:
What are some of the researches that have been shown regarding biases against people with disabilities in medicine? Is there some evidence that shows that there is bias against them?
Shira Gertsman:
Yeah, there is some preliminary evidence that I wouldn't say there's a huge database. I think this is an area for future study. There was a really interesting survey done at the University of Calgary among medical students. It was a fairly small study published in Canadian Family Physician in 2020 which was discussing this exact concept. And they just pulled medical students at the school as to whether they would be comfortable with someone in a wheelchair being their physician and they broke it down by specialty, so family physician, surgeon and obstetrician. And what they found, even though it was quite a small sample, but they found that students came into medical school already with feelings that they would not feel comfortable with someone in a wheelchair being their physician. More students were comfortable with their family physician being in a wheelchair than with an obstetrician or a surgeon.
And I think that it shows a potential that if students are entering medical school with these views, that's something that we can start addressing right off the bat. It's not necessarily something that they only develop during their training. And I think it also, it must translate to the way that we treat patients. There is much more robust evidence on disability bias and ableism towards patients. And I think that when we don't view people with disabilities as competent colleagues, then that necessarily means that when we treat patients with disabilities, we don't view them as equals, and I think that is a problem in and of itself.
Dr. Mojola Omole:
Right, and I would also go further and say that part of not talking about and those prevailing attitudes regarding physicians with disabilities is that physicians who have disabilities hide them and that actually becomes unsafe, especially when we start talking about mental health disabilities and that people find very maladaptive ways to cope with it. And if we're talking about physician burnout, physician wellness, part of it is understanding that a lot of us... I openly say I have a chronic disease. A lot of people hide it because they are afraid of the stigma and afraid of comments like that from, maybe, patients. And this actually leads to worse health outcomes because you're not performing at your best self. If your best self needs accommodations to provide the best care, that's fine, and that's the way life is. We're supposed to give each other grace in life and in work.
Shira Gertsman:
Absolutely. I couldn't agree more.
Dr. Blair Bigham:
And this gets at one of the things you mentioned in your analysis, which was the need for creativity and this open-mindedness to find solutions. Tell me a little bit more beyond admissions, what sort of practical steps could we all be taking, or particularly institutions be taking, to allow people with disabilities to thrive as physicians?
Shira Gertsman:
I think one of the things we need to do is just open the conversation about it and that's something I've been really very passionate about. I'm really grateful to the CAPD for helping happen because I think that right now people with disabilities feel like they really need to hide and that prevents issues from being raised and creative solutions from being raised. And I think we have to shift the culture to really value these individuals and what they can contribute so that they feel comfortable coming forward with those ideas.
I think we need more representation of folks with diverse experiences on panels and boards that have decision-making capabilities because just like in Marie's story, there are so many things that if you don't have that lived experience, you might not even cross your mind. And the reality is that a lot of things we do as physicians and in hospitals, the vast majority of patients, whether temporarily or permanently, would have a disability in some way when they are being seen in the hospital. And there are so many reports of hospitals and medical care being inaccessible in so many ways, and I think the best people to bring solutions are people with that lived experience. I think incorporating those, whether that's more physicians with disabilities or even incorporating patients who are not in medical training, but just really listening to their experiences, taking them seriously and considering their ideas because they have truly wonderful ideas that I think are often missed.
Dr. Blair Bigham:
Sure. That was terrific. Thank you so much for your leadership on this and for joining us today on the podcast.
Shira Gertsman:
Of course. Thank you so much for having me.
Dr. Blair Bigham:
Shira Gertsman is the lead author of the analysis in CMAJ on physicians with disabilities, and she is a final year medical student at McMaster, as well as a board member at the Canadian Association of Physicians with Disabilities.
Dr. Mojola Omole:
Shira's study focuses on people with disabilities applying to become physicians, but of course, as we know, disability can become a reality for any physician at any point in their career. Dr. Caroline Bowman has been a family physician in Wasaga, Ontario for 12 years. After running a busy family medicine practice, her life took an unexpected turn. In 2017, she suddenly experienced a range of troubling symptoms. Caroline, thanks for joining us today.
Dr. Caroline Bowman:
You're welcome.
Dr. Mojola Omole:
Let's just go back to 2017. Can you tell us what you were noticing and how did it progress from there?
Dr. Caroline Bowman:
I was finishing up my charts at the end of a day at the office, it was actually seven years ago just this past week, and I noticed that my left thigh was numb and just assumed it was meralgia paresthetica. Was rushing to finish up my charts, go grab my kids from swim practice. But over the next about 24 hours, that numbness moved from my thigh all the way down my leg and then up to about my axilla and was completely numb to pain and temperature. My husband actually is a physician as well, and he caught me in the bathroom using a pin to find a sensory level, and at that point, realized that it was not something we could ignore.
Dr. Mojola Omole:
Yeah, and how did things progress after that?
Dr. Caroline Bowman:
I ended up going to the emerg that night. In Collingwood, we don't have an MRI, but had a CT head, which was normal. Was lucky to be able to get an MRI within a couple days. Then I had the diagnosis of MS fairly quickly, which is I guess lucky in some ways because sometimes it takes a lot longer. I was treated with IV Solumedrol for five days, which was very good to have, it cleared up the numbness and also had lots of mania, which got us through that initial week. And then after that, the numbness had cleared, but what I was left with was intense fatigue, which was a pretty big change from my previous baseline.
Dr. Mojola Omole:
What did you first think or what went through your mind when you got the diagnosis? Or at least maybe confirm the suspicion of what you were thinking already?
Dr. Caroline Bowman:
Oh my gosh, I mean, it was pretty scary. My aunt had MS and she was diagnosed probably in her twenties. She was in a wheelchair when she was in her thirties, and she actually died of sepsis related to complications of indwelling catheter in her fifties. I had a fairly extreme and scary vision of MS in my mind. I think probably the first thoughts I had really were how I want to get through until my kids are out of the house. That was the little bargain I was making with the universe and was like, "Let me be able to be functional in participating." I was asking for 10 years, which now that I'm seven years in, I'm like, "Oh, I'd like more than that."
Dr. Mojola Omole:
Yeah. Maybe 20, maybe 30 more. When did you first begin to see yourself as that this is a disability and that you get that you're disabled?
Dr. Caroline Bowman:
That's a good question. I guess I'm still working through, I'm learning a lot about disability. I'm not really sure that I relate at this point to the word disability, although I'm looking at the definition from Shira's paper. Any impairment in interaction with the barrier that hinders full and equal participation in society. Again, I've had to make pretty significant changes to my work to accommodate fatigue, but I'm also, I still very much feel like I'm participating in society. I don't know, I'm really working through that. And at this point I've made some really great friends and really enjoyed connections once I've opened my mind to being part of a disability community. But I still don't know that I am at the point that I... I haven't really brought it in so much as part of my identity, I guess I would say.
Dr. Mojola Omole:
Do you think part of that struggle, Caroline, is because of the position that we have as physicians, and that's a huge switch to go to viewing yourself as having a disability?
Dr. Caroline Bowman:
Definitely, yeah. Again, this is the work I am doing personally right now is trying to go through and understand what are all the messages that I've internalized both before I went into medicine, but then really those were, I think, strengthened throughout our medical training about what it means to be disabled. A lot of messages around tying worth to productivity and I definitely was a pretty productive person, and definitely that's been a big part of my identity. I've been really working through a lot of that and trying to read a lot and trying to speak to people and trying to deconstruct some of that identity piece.
Dr. Blair Bigham:
Can you let us in a little bit more about that inner dialogue you're having about, maybe this is the wrong term, but coming to peace with the label? Is there something there that you're really struggling with?
Dr. Caroline Bowman:
Yeah, that's a good question. Let me see. I'll do my best to answer that. I guess in some ways, fatigue really has been the main challenge. I think we really pride ourselves as physicians of being able to push through fatigue. Residency is all about pushing through fatigue. Blair, I think you're an emerg physician. It's all about pushing through fatigue.
Dr. Blair Bigham:
I have never been tired in my entire life.
Dr. Caroline Bowman:
We also have, I have clear memories of being taught about things like fibromyalgia or chronic fatigue syndrome and some of those negative connotations that we have about people who are tired. And so for me to accept that fatigue is really the main reason that I've had to make these changes, it feels shameful. There's definitely a lot of shame associated with that. I think when I had my physical disability last fall, that was more obvious from the outside. Okay, she can't really walk. But actually if it had just been that, I think that would have been less challenging for me. I would have had to figure out how to get to work, how to move around and that kind of thing. But the energy and the fatigue piece, there's not an easy workaround for it. Yeah, I think having, actually probably being, more disabled than I look like on the outside. And then the other part is it's unpredictable. I think it's really, it's hard to wrap my head around and hard to explain.
Dr. Blair Bigham:
Over time, how did your MS interact with your ability to work?
Dr. Caroline Bowman:
Basically, I didn't actually even take any time off work when I was first diagnosed and my plan was just to continue, just carry on as usual. And within a few weeks I realized that I was struggling. I was crying on my way home from work every day. My mind was foggy, having a hard time completing charts. Started gradually picking little pieces off. I was doing some leadership roles that I didn't really care that much about, so I stepped back from those. When I could get a bit of locum coverage, I got that. I was picking apart little pieces and then realized that I actually needed a significant break and was able to book a locum for four months in September, so about nine months after my diagnosis. I took four months off at that point.
And then after that, so January 2018, I thought maybe I'll just be ready to go back and things will be okay and realized I was still struggling, so resigned from another leadership role, a bigger one that was one I really liked, but let that go. I stopped doing call. I had been doing call up until then and stopped doing that. It's been a gradual picking apart of what are the different things I can easily get rid of and then into the, okay, what are the things I like but don't have space for?
And then I actually had another significant relapse starting September 2022. That relapse lasted actually for months, and I had leg weakness. I was using a walker and a wheelchair for a couple months, as well as really intense fatigue, so even worse than the baseline. I've actually had pretty significant recovery from that, but made a really hard decision that I needed to give up my family practice. That is officially happening February 1st, but I've had locum coverage. I haven't actually been back to my family practice since that relapse, but the official transition is just about to happen.
Dr. Blair Bigham:
Caroline, maybe this question is premature. Maybe you could answer it in a few years for us maybe, but how could medicine, this big nebulous medicine, be more welcoming, be more accommodating, be more understanding, so that when people mid-career have a challenge like you've had, they can continue to thrive and feel less of that shame or less of that sense of failure?
Dr. Caroline Bowman:
That's a good question too. I mean, I think a big problem is that we have no redundancy in staffing. I think until we've got more people so that you don't have to be dying before you call in sick, it's going to be a hard thing to change. Another thing, I think we need to talk about shame in medicine. I did a talk at the Canadian Conference for Physician Health about shame this fall. I teach residents and I've been talking about shame with them because I think just actually knowing what that emotion is, identifying it, and then after talking about how to work through it, I think that can make some change because I mean, there's for sure more physicians struggling with whether it's chronic disease disability than are reporting it and I think shame is a big piece of that. But if we don't have language around shame, if we don't understand how to work through shame, if we don't figure out how to find some belonging, people are going to keep doing that quietly, accommodating themselves in a way that they don't feel like they have to share that.
Dr. Mojola Omole:
How do you think physicians and patients would benefit for this shift? Because I do think shame is probably the number one driver of why we don't report what is happening to us and why we keep trying to push through. If we're able to actually name it and stop doing it, how would this benefit both our physicians and patients on how we view disability in medicine?
Dr. Caroline Bowman:
That's a good question. I mean, I think it's clear to me how it would benefit physicians because I think that when we don't address shame, there's often unhealthy ways of coping with shame, whether it's numbing, so alcohol or other ways that we can use to try to numb that, or disconnecting from other people or discharging that shame on other people. I think it's clear how if we could work through that culture shame a little bit.
I mean, I think anything that's good for physicians is probably good for patients too. I think that we are more likely to show up as compassionate caring physicians for our patients when we're taking care of ourselves. And again, the only caveat is that we don't have enough people. I do sometimes worry that until we have more people, there could be some impact on patients if physicians start staying home when they're sick or taking time off and then maybe there's not somebody to see patients, there is potential for some challenge for patients with that. I think overall, I think a more compassionate group of physicians is overall going to be better for patients, but it's not straightforward.
Dr. Mojola Omole:
Thank you so very much for joining us today.
Dr. Blair Bigham:
Thank you.
Dr. Mojola Omole:
Dr. Caroline Bowman is a family medicine physician joining us today from Collingwood.
Blair, what were your key takeaways from the discussion that we had?
Dr. Blair Bigham:
I think my first reflection is just how with creativity and flexibility, people can thrive so much despite a disability, but our system just isn't set up to be either of those things. Everything is done by rote. It's the way we've always done it. We're a very, we value tradition, we value history, we value this crazy work ethic, and we max every single part of the system out so that there is no flexibility to use a different tool, use a different strategy, use a different schedule so that you can contribute all of the amazing things that you have within that system. And so people feel excluded, they get excluded, they resign their practice.
It's a shame. The shame should be on us as a profession for creating this environment where people sulk around not even wanting to ask for help or accommodation because they feel that they will be so harshly judged or made to feel guilty or excluded from practice. It's very eye opening.
Dr. Mojola Omole:
Yeah, what was going through my head was two things that you said, because I think oftentimes we view things as despite of where it's not despite of, it's just who you are. As someone who has chronic health issues, it's learning that there's just going to be different days. And we don't have a system similar to what Dr. Bowman said that has any redundancy in it. And as you said, the things that we take pride in are not the people who work in the system, and I think that that is where the problem is. And as someone who spends quite a lot of their work on looking at equity and inclusion, this is a huge part of it.
It's about making sure that the system to get to be a doctor is equitable and allows other people who don't necessarily, who have been marginalized in society. And so those are people with disabilities to also participate in the process of being in medicine, and once they're in medicine, to reimagine how we can do work and that it's not always about making accommodations. It's literally just about having imagination of how someone can function and to move away from the paradigm that you have to look a certain way, be a certain way to be this type of physician.
Dr. Blair Bigham:
Mm-hmm. And I wonder if the reason Caroline and people in her situation feel the way they feel is because we have excluded those people with disabilities from admissions right from the beginning. And so that culture that we have has never been challenged. It's always just been allowed to continue the way it is because we don't let people who could try to change it even into the inner circle. And I wonder if that's going to change with medical school admissions at all in the next five to 10 years, or if we're just going to continue to keep the people who have the ability to inspire the change and lead the change out of the system.
Dr. Mojola Omole:
What I think is that part of the problem that you asked, are we going to let people... I'm someone who 50 years ago was not someone who was necessarily welcomed in medicine solely because I'm Black. And I can say that because my father was one of those people, and the horror stories that he has from residency is appalling. The struggle for equity, whether it's for racialized people or people with accessibility, is the same. It's that everyone is part of our society. Our society, our medical training and the practice of medicine by physicians should reflect our population. And that's having different kinds of physicians, whether it's based on religion, ethnicity, or ability, be represented in practicing medicine.
That's it for this episode of the CMAJ Podcast. If you like what you heard, please give us a five star rating wherever you get your podcasts, share with your networks, and please leave a comment. The CMAJ Podcast is produced by Neil Morrison at Podcrafts Production. Thank you so much for listening. I'm Blair Bigham.
Dr. Blair Bigham:
I'm Mojola Omole. You do a really good Blair Bigham.
Dr. Mojola Omole:
Thank you.
Dr. Blair Bigham:
Until next time, be well.