Inside Medicine: A dilemma over disability

  • July 5, 2008
  • Bruce Bromley

By Dr. Michael Wilkes
Published 12:00 am PST Sunday, March 2, 2008
Story appeared in SCENE section, Page L7

I stood in the supermarket checkout line, holding far too many items to stand comfortably. A man whose appearance suggested that of a lumberjack stood at the front of the line, arguing with the cashier. It seems that his credit card wasn’t working, and he had no cash. Furious, he left the line and stomped out.

Next in line was a woman in a wheelchair who bought a small bag of groceries. I was next. As my items were scanned, I watched as the woman skillfully maneuvered her wheelchair out the door.

As I walked to my car, I saw the lumberjack climb into his large pickup, which was parked in a nearby spot for disabled drivers. His DMV disability placard was hanging in the window. I then saw the older woman in the wheelchair attempting to load her groceries into a car parked farther from the store than I was. As I offered to help her, she explained that every time she shopped at the store, the disability parking spots were filled.

The next morning, a woman with diabetes, 65, came to the office for a routine checkup. Just as she was about to leave, she remembered to ask me to sign a DMV certificate of disability. When the form is signed by a health care provider, a person with serious trouble moving, a heart condition, lung disease, a bone or muscle disorder, or missing limbs can get a disability placard. I had cared for this woman for several years and knew she had none of these, other than being overweight, which certainly made movement a bit more difficult. Every visit, for as long as I could recall, I encouraged her to exercise regularly, including walking as much as she could.

My thoughts flashed to the disabled woman in the parking lot and the man who at least appeared to be physically fit parking in the spot reserved for the disabled.

I explained, “I wish I could provide you the signature, but the state requires me to certify you have a serious medical condition which limits your ability to move.”

“Doctor, last visit when I told you about my hip pain, you told me it was probably early arthritis, didn’t you? And isn’t that a serious condition that impacts movement? And what about the anxiety I get over having to park far away – isn’t anxiety a disability?” she asked.

Sometimes they are, I explained. But her condition was mild, and exercise could only help. She was not convinced and asked to speak to my supervisor. In my practice, I don’t really have a supervisor, but I gave her the name of the department chair whom she could contact with a complaint. She was furious and said she would indeed contact him, and would report me to the licensing board for discrimination against the disabled. In the meantime, she told me, she would find a new doctor who would treat her with respect.

On the one hand, it would be easy to sign the DMV form; would it really make a difference if one more person had a disability placard? As a doctor, my first duty is ordinarily to my patients. Is this duty to provide only what a patient needs, or do I also need to provide what they want, be it an excuse for delayed air travel, an excuse for missing a class or a disability parking placard?

This woman convinced herself that society owed her a recognition of her perceived disability. My duty to the patient is to a degree constrained by my own values toward honesty and justice. I also have a social duty to protect valuable resources, and this can sometimes create a conflict with doing what is in any one patient’s best interest.

As the students watched this woman scold me, I couldn’t help but wonder if it would just be easier to have completed the form and maintained a good relationship with the woman. But what message would this teach the students and this woman? What would happen the next time she wanted a medication or a surgery that I felt wasn’t in her best interest?