Making healthcare accessible for patients with disabilities

Medicine remains frequently inaccessible to people with disabilities, despite their higher-than-average need for healthcare services. On this episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole tackle the systemic barriers that patients with disabilities face, from inaccessible clinic spaces to discriminatory attitudes.

The discussion is inspired by the CMAJ practice article, "Five ways to support people who use wheelchairs," authored by Dr. Lisa Freeman. Dr. Freeman, a public health and preventative medicine physician who uses a wheelchair, shares her lived experiences navigating a healthcare system riddled with obstacles. She introduces practical steps that physicians can take to make their practices more inclusive, such as improving communication, ensuring referrals are effective, and addressing physical accessibility.

David Lepofsky, chair of the Accessibility for Ontarians with Disabilities Act Alliance, explains the legal obligations that healthcare providers must meet to comply with human rights and accessibility laws. He offers actionable guidance on how physicians can reduce barriers, from small changes like posting signage to long-term planning for accessible infrastructure.

This episode underscores that accessibility is both a legal requirement and a fundamental part of equitable patient care. It challenges physicians to take immediate steps toward making their practices more inclusive for patients with disabilities.

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

Transcript

Dr. Blair Bigham:
I'm Blair Bigham.

Dr. Mojola Omole:
I’m Mojola Omole. This is the CMAJ Podcast.

Dr. Blair Bigham:
Alright, Jola. Today we are talking about all the different ways that medicine is inaccessible to a large portion of our patients.

Dr. Mojola Omole:
And what really sparked us to want to discuss this was there was an article, a practice article in the CMAJ titled Five ways to support people who use wheelchairs. And the author of it, Dr. Lisa Freeman, who also herself uses a wheelchair, lists some very common sense ways that we can make our practices more accessible, especially some of us who are office-based practices. And also, there were parts of it that were quite shocking to me as I was reading it.

Dr. Blair Bigham:
Definitely shocking, and although a lot of our tips did seem common sense, some of them also seemed relatively expensive or difficult. And not to say that they shouldn't be done, but we sort of thought, how do you actually achieve this when people are already really busy, when healthcare already has not enough dollars to go around? So in addition to talking to Dr. Freeman, we're also going to be talking to a lawyer to find out not only what we should do, but what we have to do. David Lepofsky is chair of the Accessibility for Ontarians with Disabilities Act Alliance, and he's going to lay out the law and legislation that physicians have to follow.

But first, let's talk to Lisa Freeman about how we can support people who use wheelchairs. Dr. Lisa Freeman is a public health and preventive medicine physician. Lisa, thank you so much for joining us today.

Dr. Lisa Freeman:
Thank you. The pleasure is mine.

Dr. Blair Bigham:
Let's start with a little reality check here. Can you share some concrete examples where you yourself have faced challenges receiving medical care because of accessibility barriers?

Dr. Lisa Freeman:
Absolutely. So it happens in a lot of different ways. So I've been refused referrals. So a physician has told me, you use a wheelchair, what's the point? So that's the first type of refusal of care.

Dr. Blair Bigham:
Okay. Can we just pause there? I don't want to pry too much, but that sounds pretty egregious. What were the circumstances there?

Dr. Lisa Freeman:
So it is and it isn't, but physicians do this all the time. So we decide based on somebody's age, perhaps based on what we know of a label or a diagnosis, what care might be quote-unquote appropriate or useful for them. So disability is another aspect that physicians consider. So just like some physician might say that patient is 85, that's an inappropriate procedure for them based merely on their age, physicians say, well, that person perhaps uses a wheelchair or doesn't walk as much. So that's the first type of discrimination or refusal of care that I've experienced.

Dr. Blair Bigham:
Can you share some other examples of how people face barriers to care?

Dr. Lisa Freeman:
Absolutely. So for example, personally I have been referred for care that is inaccessible. So I've been referred to places like physical buildings that have stairs only to enter. So that's not an effective referral for me. At least I'm getting a referral, so I'm not being told right away, no, you don't deserve the referral, you're not worth it. But it's not an effective referral if the place I'm referred is not accessible to me. So I'd say that's the second type of barrier I've personally faced. And there's a lot of literature showing other people face,

Dr. Blair Bigham:
Sorry, this is just mind blowing that, I mean, I get that maybe a building might not be accessible, it doesn't make it right, but for people just to refuse a referral based on being in a wheelchair or using a wheelchair sounds wackadoodle.

Dr. Mojola Omole:
I didn't know you could do that.

Dr. Blair Bigham:
That. How often does this happen? How widespread is this?

Dr. Lisa Freeman:
I have not been able to find information to answer that because as a healthcare system, we don't collect that data. So there's no kind of check box necessarily on a form that says, do you have a disability? What is the disability? Has that impacted care? Anecdotally, some form of refusal of care, whether that's coming from a physician saying, no, I'm not doing that for you because of your disability, whether that's the middle part where the building, clinic, or procedure isn't accessible, happens frequently.

There's also small pieces of inaccessibility, like I've gone for imaging, for example, where the cubicles to change are not accessible. So my option is either to change out in the open, to maybe go on some sort of adventure to find the one bathroom that is accessible to change in, or to make the, quote-unquote, choice not to follow through with that referral. And of course, that, depending on the person and what other discrimination, what other difficulties they're facing, can be another form of inaccessible care—that you cannot access care in a safe or dignified manner.

Dr. Blair Bigham:
Not being able to get the care or to have the referral be effective is one thing. I'm sure we're going to talk about that more in a minute, but just on a human level, how does that leave you feeling when a referral is rejected or you show up for a referral and you can't even get in the building?

Dr. Lisa Freeman:
I've luckily not ever showed up and not been able to get in because I phone ahead, because I know that physicians are not thinking about accessibility. They're not thinking if the patient can actually get into or access the referral. So thankfully I haven't been stuck on the side of the street, but there's a lot of emotions. So I think perhaps especially as a physician where I've been trained in how things are supposed to work, there's a lot of frustration that things are not working as they should or as I was trained. As a public health physician, I've done a lot of professional work on equity, anti-racism, access, and so there's always that piece of frustration there that I spent years doing this and oh, it's all for naught. There's also an aspect of personal frustration or personal annoyance, and then you kind of get that continuum of emotion from annoyance or frustration to more to anger perhaps depending on the situation. So there's lots of emotions.

Dr. Mojola Omole:
What do you think that this just communicates to people with disabilities when they're just all of these barriers for them to just get basic healthcare?

Dr. Lisa Freeman:
So it's a very clear communication that physicians personally, often if you're face-to-face with someone who's denying you care, don't care, that physicians in that situation don't see you as valuable, as worthy, don't see you as a person as they would someone else. It's also a clear communication from systems. So when we design a building, an institution that's inaccessible, that's a clear message that people with disabilities are not being thought of, are not included, are not important. When we have systemic policies, when we have procedures that allow those buildings to be built without elevators, ramps, accessible washrooms, et cetera, that's also clear communication that people with disabilities are not seen as equal, are not seen as worthy. So it's multiple levels of communication that you're not worth it, you're not as important.

Dr. Blair Bigham:
There's clear implicit bias here, but in your article you sort of hint at an explicit bias. You write some physicians report they do not want patients with disabilities, nor are they comfortable caring for patients with disabilities despite that being such a large population of people seeking care. That comes from surveys or studies?

Dr. Lisa Freeman:
Yes. So it depends on their research. So there's a lot of research around patients with intellectual disabilities or developmental disabilities that physicians refuse to care for, for example, a 20-year-old who has a developmental or congenital disability. And so that's a little bit of a separate topic in a way because that's, I guess, a certain focus of discrimination. But in general, no. When we talk about discrimination against people with disabilities, it's all disabilities and it's very heterogeneous and it really depends on who's defining the disability and what it is that is coming across as the discrimination. So physicians often don't say to me because you're female, this is why I'm doing this, because we've recognized that form of sexism isn't appropriate, but it is apparently still appropriate for a physician to say, no, you're coming to me with a wheelchair, I'm not going to do that.

Dr. Blair Bigham:
Where do these attitudes come from? Are they slipping through the cracks of medical school admissions and all of the summative evaluations in training? Or do these attitudes get born in training and in medical culture?

Dr. Lisa Freeman:
So a little bit of both. The way we conceptualize disability in society influences how we conceptualize disability as physicians, because physicians are people, we're part of society. However, medical training very much medicalizes disability. So we talk about a medical model of disability that's often focused on in medical training, which very much situates disability as a deviance, a deficit, a problem individual in that person—they are responsible for it. Other models of disability are talked about a bit in medical training, like the social model that really looks at an interaction between the person and environment. For example, for me says, yes, I have a disability and I use a wheelchair, but the limitation or the issue or the problem really happens when the environment is not accessible to me. I think your question of where's the issue, where does it start? It's everything. It's the bias in society, it's the way we do training and the structures and systems that show who's important, who deserves care within that training.

Dr. Blair Bigham:
So let's dissect those one at a time. What would you have to say, or what do physicians who might recognize that they're not all that comfortable caring for people with a physical disability—what might you say to them? Where's a step they can take to change that?

Dr. Lisa Freeman:
Yeah, so again, it's going to depend on the physician. Different people respond differently, but I always ask people how many people wear glasses? Because technically if you wear glasses, you are using an assistive device. So your glasses are a wheelchair for your eyes or a wheelchair for your vision. So a lot of people won't say, I am visually impaired, or I have a visual disability. They'll just say, I wear glasses. So we normalize that type of disability or that type of difference. So sometimes talking about the way we label things and what counts or what doesn't count as a disability helps physicians to see that, okay, so that's just a pair of glasses for your legs. The bit of humor in that can help as well. For other people, forming a sort of analogy to a different type of ism can help people. So they realize that back in the day when racism was more accepted or sexism was more accepted, right now we're behind in fighting against ableism, in improving accessibility, in improving inclusion of people with disabilities.

But we've started—still a long way to go, but we've started—for example, understanding that sexism is not acceptable or appropriate, nor is racism. So starting with helping people understand what disability is, how it might relate to other things they've adapted to or learned about can help. Also, a big part for me is that the things that I need that are absolute necessities, like a ramp, an elevator, level entry, make your life as the physician I'm talking to much easier. So once people realize that a curb cut that's so much easier to go up onto the sidewalk with, especially if they have a wheelie suitcase or a grocery cart or a children's stroller, is actually something that's an accommodation that people with disabilities have fought for.

The captioning on TV, the voice control of your smartphone—all of those are accommodations for people with disabilities. They make your life so much easier. They're a necessity for a lot of other people with disabilities. Then often physicians are willing to think a little bit differently about, oh, maybe if I put in a lowered counter in my clinic, that's better for people using a wheelchair. It's also better for someone who'd like to sit down. It's better for my staff. It gives an option. They can see things with a bit of a wider view.

Dr. Blair Bigham:
You mentioned things like ramps, elevators, lower exam tables. I imagine that you would often hear from family docs like, I don't own the building, I just rent space, or that type of modification is really expensive and my clinic can't afford that. What do you say to some of that pushback when physicians say, I just can't modify the physical space of the clinic?

Dr. Lisa Freeman:
So it really depends on what sort of circumstance the physician is in. So basically, if you are in a clinic, a location that's inaccessible, you can leave. So you can move to a clinic that is accessible, you can modify your clinic, and yes, some things are more difficult, some things are easier, but you have those two main options. In terms of how you actually go about that, again, it really depends on the setup of your clinic, your jurisdiction. There's a lot of funding, especially in provinces and cities that have more and more legislation around accessibility. So once we have laws in place, funding often comes with that. I've had physicians tell me that they looked into all the funding and the effort to actually go through it and apply for it and get it was more than just writing it off as a business expense.

So again, it's really going to depend on the setup, the jurisdiction, what information people have. Sometimes when you really feel stuck that, for whatever reason, you can't go work in a different location, you can't renovate something, just sharing information, posting on your website: My clinic is inaccessible —there are five stairs—can help referring physicians so that they don't refer to you and put the patient in a difficult position.

But I think physicians sometimes also forget that at the base or at the most basic level, if you're working in a clinic that's inaccessible, you've made that choice. It might've been 10 years ago that you made it. You're not necessarily choosing it today, but that's a decision you've made, and you can make a different decision. We can make decisions to improve inclusion, for example, for people with disabilities.

Dr. Blair Bigham:
I think that's a great place to wrap it up. Lisa, this was so helpful. Thank you so much, Lisa.

Dr. Lisa Freeman:
You're very welcome.

Dr. Blair Bigham:
Dr. Lisa Freeman is a public health and preventative medicine physician and is the author of the article in CMAJ, titled Five ways to support people who use wheelchairs. She joined us today from Montreal.

Dr. Freeman laid out what physicians should do to make our clinics and medical resources accessible, but what exactly are they required to do? What are the legal obligations for physicians to make sure their spaces are accessible and compliant with the law?

David Lepofsky is chair of Accessibility for Ontarians with Disabilities Act Alliance. He's a Canadian academic, a retired lawyer, and was named one of Canada's most influential lawyers in 2010. David, thank you so much for joining us today.

David Lepofsky:
Great to be here.

Dr. Blair Bigham:
Tell us, what are the legal frameworks that physicians need to know about that govern accessibility requirements?

David Lepofsky:
The source of the doctor's obligations, no matter where you are in Canada, comes from multiple laws and they all converge, and the strongest one is the one that prevails. So every province has a human rights code, which bans discrimination in employment, but also in access to goods and services, and healthcare is a service. So that's covered—a ban on discriminating because of disability.

Similarly, the Supreme Court of Canada, actually in one of its most compelling rulings on the rights of people with disabilities under the equality rights provision of the Charter of Rights, Section 15. It ruled back in 1997 that that includes a duty for hospitals to provide accessible services, and that arguably extends to the physicians who are delivering them there. And even though the Charter of Rights doesn't typically apply to the private sector, the Supreme Court said where the private sector is delivering a public program like healthcare, it does. As well,

two other possible sources: at least half the provinces in Canada have an accessibility law. Like here in Ontario, the Accessibility for Ontarians with Disabilities Act. Now, if they're effectively implemented to set accessibility standards in the area of healthcare, that can apply too. And as well, depending on what your regulatory college does in your particular province, they may have a non-discrimination requirement in your code of professional conduct. So whichever it is, one way or another, there is this duty.

Dr. Blair Bigham:
So in plain terms, what is the duty? What is the obligation that physicians have to meet to abide by those laws?

David Lepofsky:
So first, you need to know that not discriminating because of disability doesn't just go as far as saying, don't refuse to serve people because they have a disability. Though we did hear Dr. Freeman talk about some physicians who just don't want to serve people with disabilities. That is a flagrant violation of the human rights code. But beyond that, equality in all of these laws includes a duty to accommodate the needs of people with disabilities so that they can fully benefit from the service you provide—in this case, physician services.

Now, is that an unlimited duty? No, it's not unlimited. It's up to the point of undue hardship. But the burden is on the service provider to prove they couldn't do anything more, that it was impossible to do anything more without undue hardship. And the duty varies depending on the size of the operation. If it's a hospital or a big clinic, we expect more than a sole practitioner.

Now, let me answer your very focused and very fair question. A doctor does not necessarily know what disabilities people have or know what the needs are. The compelling first step is to ask. It helps if your service lets patients know on your phone, voicemail, on your welcome when patients get there, that we aim to do our best to accommodate the needs of people with disabilities. If you have any disability-related need, please let me know what it is. Let me know as early as possible, and then we could do our best to address it.

And the duty to accommodate, according to the Supreme Court of Canada, includes a duty to investigate solutions. It's not just a matter of me, the patient, coming to you and saying, here's what physicians need to do for me. It also includes a duty if you don't know what to do or if you're pondering that it may not be possible, to investigate alternative solutions.

Dr. Blair Bigham:
Give me an example of something that doesn't quite meet the threshold of undue hardship.

David Lepofsky:
I tell you, we all, as people with disabilities, could give you lots, but I'll give you a few from the perspective of a blind person walking into a physician's office and being told, here, we have a form you got to fill out with your medical history, and it's in print or it's on an iPad, but it's not an accessible app—because there are accessible apps that we could use on those devices, but some may not have them.

So it might seem intuitive. Well, the staff can help fill 'em out. I've been in a physician's office where the person at the front desk asks you to fill it out. Then I explain, I got this white cane here, I can't fill it out. Could you assist me? And they start asking me in the open waiting area so other patients can hear me answer about my intimate private medical information.

Now, I know enough to say, excuse me, can we go into another room to discuss this? But any number of individuals with disabilities might not. How about if you don't have an accessible washroom in your facility, in your office, knowing where the nearest one is. So you, having worked out with somebody down the hall in another office that may have one.

I received an email from—I go to a wonderful physician who's part of one of those large national health services, and they send an email saying, please pay us 150 bucks and we'll cover those prescription renewals and so on. Except the email is not written in an accessible format. So what the email said is, please pay $150 to get coverage for the following services, and I can't read the services. Or please book your appointment online, but the website is not accessible.

Now, for some offices, you might think the solution is just saying, hey, call the front desk. And that may be an effective solution for some, but some offices try to call the front desk and you are waiting on hold forever, or you can't get through, or the person at the front desk doesn't know that they should be helping you with this.

Now, should we have physicians having to reinvent the wheel each in their own office? No. There's ways to make this way more efficient. One way is to get your medical association or in your province to call on them to work with physicians to develop strategies for dealing with all of this that individual physicians can opt into or draw upon so that they don't each have to reinvent the accessibility wheel.

Dr. Mojola Omole:
So this is really fascinating for me as a specialist who sees patients in the clinic. You've been talking about filling out forms and we're talking about accessibility, but you mentioned about giving out pamphlets because I give out, I make my own pamphlets for everything, but never thought about even just like you mentioned, some people with intellectual disability, dyslexia. I'm even just thinking the language that these are all things that I wouldn't, if I wanted to revise all of the things that I do already to make it more accessible, I wouldn't know where to start and what group. Not that one disability wins over another, but what would give, because we have a lot of young doctors, new grads, medical student residents who listen to the podcast. So as they're planning their practice, how can they build in accessibility into their practice?

David Lepofsky:
What your question points to is a reality that I suspect some of our listeners don't know, and that is this: people with disabilities are disproportionately the users of our healthcare system, either people with a permanent disability or because of accident or illness, a temporary disability. And yet our healthcare system is replete with disability barriers, systemic disability barriers. We need our medical schools to train physicians on this.

My view is that it's understandable if people feel overwhelmed, thinking, I don't know where to start, so I am not going to start. Anything you do to tear down any individual barriers in your practice is going to help—anything you do. But one of the easiest things you could do is by, if you put on your notification to patients, including first contact at the front desk or whatever, if you have any disability-related needs, let us know and we'll do our best. That alone will let you know what you have to do, even if you hadn't thought of it before.

Here's another easy one. You were talking about people with intellectual disabilities, some people with intellectual cognitive disabilities and frankly other kinds of disabilities as well have reported that when they go to the doctor, some doctors—I don't mean all or even most, but some doctors—will talk to their support person, not directly to them. Well, that's seriously problematic, and it's important to communicate directly with your patient, and the support person could be helping cue you if you are using complex language and you need to explain things in plain language.

And listen, I sympathize. We lawyers are horrendous at using plain language, and it's an area where we've got to learn to do better for all clients, and I suspect for lots of patients, it's an important need.

Dr. Blair Bigham:
David, what about some barriers that might require a change in infrastructure? When does removing a barrier become prohibitively expensive or difficult? Is that a defense that a facility can use?

David Lepofsky:
Well, undue hardship can be based on cost, but you're expected to make serious and substantial efforts. And that can include coming up with alternative venues, or it could involve saying, if you can't do it all this year, that doesn't mean you don't have to ever do it.

So for example, if you're looking to relocate your practice in the next five years, looking for an accessible location. If you move into a new location that's inaccessible, that's creating a new barrier, and it's going to be hard to justify. Well, I could have picked an accessible place, but I didn't. That's not a cost issue. That's a deliberate decision that actually created a new barrier.

Dr. Blair Bigham:
David, if a hospital or a clinic or a landlord or a physician doesn't meet these legal requirements, is there a pointy end of the stick? What are the consequences that can occur from non-compliance?

David Lepofsky:
Well, in each province, they could face a human rights complaint, which means litigation. It could mean a hearing, it could mean orders to bring yourself into compliance and monetary compensation orders. So it's not just a, “hey, we'd like you to do it.” There is a legal enforcement regime. They vary from province to province and how they're structured. But where there is a contravention or where there's an allegation of a contravention and it gets to a hearing, you're now into a full legal proceeding, which nobody wants to have to deal with that.

But think of it not just in terms of the stick but the carrot. This is about the core of the Hippocratic Oath, right? This is about serving all people—in the case of patients with disabilities, among the most vulnerable and the most needy. So it happens with what the human rights code requires is commensurate with what I anticipate is what all our listeners went into medicine to do anyway

Dr. Blair Bigham:
David, that was beautifully said. I want to close on a more personal anecdote. You're blind. Tell us about some of the interventions that you've noticed in healthcare that remove barriers and accommodate your disability and what that means for how you go about your day.

David Lepofsky:
I will tell you that I've had, fortunately, any number of excellent doctors who before they do something, they walk in the room and they say, we're walking into a treatment room. There's a chair ahead of you on the left. How may I best show it to you? So they don't grab me and push me into it. They've said, we're now going to do a procedure or let me describe it to you before I do it. I am going to put my hand on your back. I am going to give you whatever it is. They provide audio description to me. Again, it doesn't cost you a dime. It's common sense. It makes it that much easier.

Now, I'm not shy, as you may have guessed, so I may ask, what are you doing? But for others, it might be a scary place and they don't know to ask.

Dr. Blair Bigham:
It sounds like, David, the takeaway here is that physicians just need to ask, right? We just need to ask upfront and then do what we can to make accommodation so that life can be just a little bit easier on that interaction.

David Lepofsky:
And the other thing to do is take a look at your practice, or if you're in a hospital, insist that they establish an accessibility committee where they can identify the recurring barriers and they can try to come up with systems that are going to accommodate people without having to even ask. And you can do a lot of it pretty quickly because there's a ton of low-hanging fruit.

Dr. Blair Bigham:
David, excellent place to close. Thank you so much for joining us.

Dr. Mojola Omole:
Today. This is so great, and this is really informative for me. And just even the simple thing of having a sign in my office, I'm going to get them to make one today.

David Lepofsky:
That's fantastic. Thank you all very much.

Dr. Blair Bigham:
Thank you. David Lepofsky is the chair of Accessibility for Ontarians with Disabilities Act Alliance. He joins us from Toronto.

Jola, you're a surgeon. You see people in clinics. I see people in hospitals that are generally adequately designed, I guess at least in the emergency department. I'm on the ground floor. What's your takeaway from this?

Dr. Mojola Omole:
So it was a lot of food for thought for me in terms of looking at disability. But I guess I assume that people would think that, oh, she's a nice doctor, so she would be accommodating. But I do think there's a big part of it of just having a sign that says, if you have a disability, please let us know. Or telling them when they're having their secretaries always call to remind them of the appointments. And just to say to somebody, if you have a disability or to whoever their caregiver is, please let us know so we can accommodate.

And I think oftentimes we think that those kind of things are—I do honestly think when people wear the rainbow pin as extremely performative, but this is actually something that could really open up conversation with people. And the other thing I was thinking about is that we do not talk about accessibility in training at all. And I think part of that goes back to one of our pet projects, which is understanding that when we have diverse people in medicine, we learn about the different challenges and struggles people have.

Dr. Blair Bigham:
. Absolutely. I want to comment on both those themes that you mentioned. It does seem so simple to just say, hey, is there an accessibility thing we should be aware of? Is there a disability that we can address for you?

Because when I originally hear Lisa speak about all this, I go, oh, man. I mean, it does start to sound expensive. You basically need to start building from scratch or moving out of an older facility into a newer facility that already is compliant with the law. But so much of this does seem to just get down to those basic human elements of, hey, let us know what we need to know and how we can help you best. That seems like a small step, like the sign in the office, like the secretary asking when they call to remind you of an appointment—something everybody can do tomorrow to start addressing this issue.

Dr. Mojola Omole:
And also realizing that with a lot of clinics, they've switched to you booking your own appointment online. I have issues with those because not everyone has reliable internet or even has the ability to do it. I don't honestly think my 80-year-old mom will be able to book her own appointment online. I would have to do that.

Dr. Blair Bigham:
And this is where I think maybe the language needs to shift. Lisa used the term "effective referral." That's not a term that I had heard before we did this Podcast. And so I think that concept of it's not just, have I done my job by referring to someone, but can I actually make sure that the patient is going to be able to complete that referral?

  And also for newer doctors, for newer clinics, just to recognize, start off right by making sure that your building has what it needs. It's going to go a long way.

Dr. Mojola Omole:
I think it's basically infusing accessibility into your practice, right? It's the same as when we talk about any sort of equity from an equity lens, is that if it's not in the foundation, then it's going to always be an afterthought. So when you're coming out and you're starting, those are the things that you think about. Is this building accessible for patients? Is there accessible bathrooms? Can I move a chair if someone needs that? Can I ask for my name to also be in braille? Are there things that I can do in the office I can ask for when you're signing to make sure that this space and also who you hire would be able to help to accommodate patients with disabilities?

Dr. Blair Bigham:
And it's not just a nice to do, it is. It's a requirement, and you can end up in pretty hot water if you don't. So just start the conversation, ask, have a sign up. Make it obvious that you are open to understanding how best you can help somebody be accommodated.

Dr. Mojola Omole:
I mean, honestly, it comes down to we all just need to really be nice.

Dr. Blair Bigham:
Like you and I.

Dr. Mojola Omole:
Yes.

Dr. Blair Bigham:
And our producer.

Dr. Mojola Omole:
The beacon of kindness.

Dr. Blair Bigham:
Yes. Very nice.

That's it for this episode of the CMAJ Podcast. Thank you so much for listening. If you have a chance, please do help us spread the word by liking or sharing the Podcast wherever it is you download your audio, or just tell your friends when you're in the break room.

The CMAJ Podcast is produced by PodCraft Productions in Ottawa. I'm sorry I didn't make a joke about Ottawa and it threw all of us off. I'm Blair Bigham.

Dr. Mojola Omole:
I'm Mojola Omole. Until next time, be well.