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 bpremo@westernu.edu.
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