Dr. P spent the last decade at a small, busy community practice in Colorado. After years of wearing lead protection and unfavorable ergonomics, her neck and back pain became increasingly difficult to ignore during IR procedures. Furthermore, she developed numbness in her dominant hand and worried she might lose the tactile feedback needed to do her job. She underwent a routine operation to manage her numbness, but woke up with worsening of her condition. The surgeon said her numbness would improve with time, but it didn’t. She did her best to keep working by doing a few small cases while battling to collect disability. Her practice was supportive at first, but she ultimately felt unable to continue her work—”you either have it, or you don’t.”
Dr. R is faculty at a prominent medical center in New York with metastatic lung cancer. He attended faculty meetings, published, did cases and taught fellows and residents all while undergoing a debilitating chemotherapy regimen. He is still nowhere near 100% but feels that even at 50%, IRs are more productive than others.
These are two of the multiple stories of IRs with disabilities (details changed for anonymity). Disability and impairment among physicians are generally considered taboo topics,1 particularly in specialties like IR that praise technical ability as a key virtue.2 Nevertheless, IRs and those entering the field are not immune to impairment and, in some respects, they are more vulnerable. Physicians have similar impairment rates as the general population1,3 but tend to be driven perfectionists, which can cause them to delay seeking help.4 There is often a connotation in medical culture that one either has what it takes to make it in a field or does not.5 Impairment in IRs can develop mid-career due to increased rates of musculoskeletal problems, cataracts and possibly cancer among image-guided interventionalists, creating another unique challenge.5,6 Impairment can also be a normal part of aging.
The language here is critical. “Disability” and “impairment” are generally considered to be related but are not synonymous.3,7 “Impairment” tends to describe a deviation from a physiologic norm, while “disability” refers to a limitation of activity. For example, the numbness and weakness in Dr. P.’s hand is an impairment, while her inability to thread a wire with that hand is a disability. There are also additional types of disability and impairment beyond physical, including cognitive and psychological disabilities, which can be even more stigmatizing.
“Impairment” tends to have pathologic connotation—something that should be fixed or corrected if possible. For example, substance use disorder is considered a common type of physician impairment with roughly the same rates as the general population. “Disability” has historically also been considered pathologic, but it can also be a positive and central part of one’s identity.8 It may motivate someone to become a physician in the first place and help them better connect with patients and improve their care. Thus, it can be offensive to assume someone’s disability is something that needs to be fixed or corrected merely because it is different.
There are currently limited specialty-specific resources to support members of our IR community with an impairment or disability. Some, even those with a disability, may feel these resources unnecessary and view their disability as a challenge to overcome to prove their tenacity. Unfortunately, this is not possible for everyone and may cause others to feel that there is no place for them in the field.
While there are functions one must be able to perform to practice IR, there is also a range of disabilities that may simply require accommodations. The provision of reasonable work accommodations is required by the Americans with Disabilities Act (ADA).9 However, people with disabilities still often face discrimination and disparities.3,11 The experience can be isolating and we should be willing to support and include these members of our community. For example, we could create forums in our professional societies and events for these member to connect, much like we have for other groups. We could also curate a list of resources to help guide members who develop a new impairment or disability. In these small ways, we may normalize help-seeking behavior and foster a more supportive and inclusive professional community.
References
- Gunderman RB, Grogan K. Physician impairment and professionalism. AJR Am J Roentgenol. 2012;199(5):W543–4.
- Keller EJ, Vogelzang RL. Who we are and what we can become: The anthropology of IR and challenges of forming a new specialty. J Vasc Interv Radiol. 2018;29(12):1703–4 e2.
- Iezzoni LI. Eliminating health and health care disparities among the growing population of people with disabilities. Health Aff (Millwood). 2011;30(10):1947–54.
- Keller EJ. Philosophy in medical education: a means of protecting mental health. Acad Psychiatry. 2014;38(4):409–13.
- Klein LW, Miller DL, Balter S, Laskey W, Naito N, Haines D, et al. Occupational health hazards in the interventional laboratory: Time for a safer environment. Catheter Cardiovasc Interv.
- Orme NM, Rihal CS, Gulati R, Holmes DR, Jr., Lennon RJ, Lewis BR, et al. Occupational health hazards of working in the interventional laboratory: A multisite case control study of physicians and allied staff. J Am Coll Cardiol. 2015;65(8):820–6.
- Lowe J. Impairment versus disability: What’s the difference? Prof Case Manag. 2010;15(4):222–3.
- Self-identifying as disabled and developing pride in disability aid overall well-being. ScienceDaily [Internet]. 2017 July 22, 2020. Available from: com/releases/2017/08/170828164118.htm.
- Rothstein L. Impaired physicians and the ADA. JAMA. 2015;313(22):2219–20.
- Medicine AFABoI, Medicine A-AFACoP-ASoI, European Federation of Internal M. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136(3):243–6.
- Moulton D. Physicians with disabilities often undervalued. CMAJ. 2017;189(18):E678–E9.
