Season 2, Episode 5: Diversity & Inclusion in Medicine

While the push for diversity in the medical profession is bigger than ever before, disability is not included. Jay is joined by Dr. Cheri Blauwet, a renowned physician and a wheelchair user, to discuss the major barriers confronting people with disabilities who pursue careers in medicine.  

 

 

 

 

 

 

Dr. Cheri Blauwet and host Jay Ruderman in the studio

 

Guest:

Dr. Cheri Blauwet is a specialist in sports medicine, an assistant professor of PM&R at Harvard Medical School and an attending physician at Brigham and Women’s Hospital and the Spaulding Rehabilitation Hospital. A graduate of the Stanford University School of Medicine, Dr. Blauwet completed her residency at Spaulding Rehabilitation Hospital/Harvard Medical School, where she served as Chief Resident, followed by a sports medicine fellowship at the Rehabilitation Institute of Chicago. Dr. Blauwet is a former elite Paralympic athlete, having competed in three Paralympic Games and bringing home a total of 7 medals. She serves on the Board of Directors of the Boston Athletic Association as well as the United States Olympic Committee.

 

 

 

 

Transcripts:

Jay Ruderman: Did your parents ever tell you, you could be anything you want as long as you’re a doctor? We all recognize the power of the white jacket, respected professionals with the power to heal. The medical community recognizes the need for diversity and doctors today come from different ethnicities, races, communities, and yet disability is often excluded it’s time. This often overlooked aspect of medicine is examined. I can’t think of a better interviewee than Dr. Cheri Blauwet to do just that.

Announcer: All Inclusive. A podcast on inclusion, innovation and social justice with Jay Ruderman.

Jay Ruderman: Welcome to All Inclusive. I’m your host, Jay Ruderman. Dr. Blauwet, welcome to the show.

Cheri Blauwet:  Thank you Jay.

Jay Ruderman: Dr. Blauwet it is a person with a physical disability and she’s a wheelchair user since a young age. She’s board certified in physical medicine and rehabilitation and sports medicine. She is an assistant professor of PM&R at Harvard Medical School and an attending physician at Brigham and Women’s Hospital and the Spaulding Rehabilitation Hospital. Dr. Blauwet, thank you for joining me today.

Cheri Blauwet:  It’s a pleasure to be here.

Jay Ruderman: So your career has been very impressive. But I’d like to start from the beginning. You as a young girl in Iowa had a dream of becoming a doctor. Was disability a concern in this process?

Cheri Blauwet:  You know, it’s a great question. Really my interest in medicine evolved fairly organically. As you noted, I did acquire a disability at a very young age and as I was moving through junior high and into high school, I was always fairly intrigued by healthcare settings. My mother worked in healthcare, so I would often go visit her at work for example. And I thought the hospital was a really exciting environment.

Cheri Blauwet:  And then because of my own experiences as a young person with a disability, I also naturally interacted with health care environments more than many of my peers. And I think those two things really came together to help to develop my interest in medicine.

Cheri Blauwet:  When I think about my early interests and how that then played into my plans moving into undergrad and furthering my education, I look back and I honestly think that I had almost a naivety regarding the fact that disability may have been a barrier. And when I think about that, I think it’s quite interesting. I do think that it’s somewhat of a product of being from that ADA generation, where as I was moving through my education, I simply, I did feel the liberty to kind of dream big regarding what I want it to be and where I wanted my to career to go. And also because I was involved in sport, I think that that also had a role in boosting my confidence and enabling me to see that I would be probably capable of engaging in a career in health care, being a physician.

Cheri Blauwet:  And so for all of those reasons, I really just plowed ahead. And when you’re interested in medicine, there are so many boxes that you have to check with regards to coursework and getting good grades and taking the MCAT. And that was honestly really my focus. As I progressed through, I’m sure that there were moments in which my disability probably was perceived negatively and could have created barriers. But through that phase really kept my head down and tried to focus on the task at hand.

Jay Ruderman: So let’s go back to when you were a young girl with a disability and first being treated by doctors and nurses. What was your experience? Was there any patronizing involved, overdue sympathy or what was your experience like with, with the medical personnel where you were?

Cheri Blauwet:  I definitely recall particularly like in adolescence and then moving into young adulthood medical encounters wherein you may be coming in with a simple issue. So say for example, an upper respiratory tract infection or a cold and sometimes they would be an overemphasis on your background disability or the provider potentially feeling as though that they needed to treat you differently because there was this background of a fairly significant disability that was somewhat distracting to the issue at hand. All of those things, I certainly remember taking into account and taking note of things that I would have wanted to see them be different and would want to do it differently in my own career.

Jay Ruderman: And what about today? Now that you’re an established physician working in hospitals, how do your colleagues react to you? Are you one of equals or are there issues that you deal with as a person with a disability who’s also a respected physician?

Cheri Blauwet:  A lot of it does depend on environment. So for example, I have the fortune of having my primary appointment be in the Department of Physical Medicine and Rehabilitation at Harvard, which is based at Spaulding. Spaulding is a very enlightened place and most of the professionals there and most of my colleagues there have a fairly deep experience and interacting with the disability community. So things are very fluid and I certainly feel that in that environment that it’s very easy to assimilate and simply be it natural colleague with people and to think about our tasks at hand as professionals.

Cheri Blauwet:  There are other environments in which although certainly you don’t feel as though there’s an overt sense of discrimination, there’s still a sense of being somewhat different and that inherent feeling as though one has to sort of, I guess you’d say over perform or overcompensate to fit in and just be part of the crowd. People in the sports medicine community don’t interact as regularly with people from the disability community. So in those environments I often find that it takes a little while. There’s often a period of just a little bit of natural hesitancy where people may not know exactly how to react to me being there and sometimes may overcompensate or worry about it even a little bit too much. It just takes a little bit more work to then build those personal relationships where people feel comfortable.

Jay Ruderman: And what about your patients? Can you talk a little bit about your interactions with patients, especially ones who are new that you haven’t interacted with before? What’s the reaction to you?

Cheri Blauwet:  So I find that patients who are younger, anyone really, I would say in their 60s or younger, it’s very clear that most of those individuals, most of those patients have been in an environment before, interacted with people with disabilities or have seen people with disabilities be in professional roles. And so it’s not surprising for their doctor to open a door and wheel into the room. Then there’s really no reaction at all. It’s just a typical encounter.

Cheri Blauwet:  Conversely, there are certainly other times where that door opens and there’s a moment in which you see a look of surprise in the patient’s eye or a look of confusion. In some circumstances, fairly rare, but it does happen, the patient will say something and say oh, I hadn’t expected my doctor to use a wheelchair or as they would say, often be in a wheelchair or something like that. And/or I’ve had just a few encounters where patients may say something that’s a bit more negative, like use language that isn’t does, I guess you could say what we would consider to be culturally appropriate or what I would prefer.

Cheri Blauwet:  And I find that most of those interactions are typically with older patients. And I think that stems from just the rapid evolution of disability culture and awareness in our communities and the presence of people in professional roles. And I think a lot of those older patients, if they do react or do say something that’s in any way skeptical or negative, it typically comes from just the lack of awareness regarding our lack of ever having been around people with disabilities in professional roles.

Cheri Blauwet:  So most of the time I certainly don’t take it personally or think that it’s anything malicious. I think usually it’s just ignorance honestly.

Jay Ruderman: So a recent report found that in medicine especially many students hide their disability out of a real fear of judgment bias and a skewed perception of their ability. Why do you feel that they have a fear to disclose a disability?

Cheri Blauwet:  We think of our prototypical doctor as a typically strong white male who is able to have an incredible amount of physical prowess. And so I think that there’s still a perception out there that demonstrating anything that could be perceived as weakness will be detrimental to one’s career in medicine or their ability to move through medical school and then advance into residency and beyond. There’s certainly been a lot of work towards thinking about issues of just diversity inclusion and medicine in general, beginning at the trainee level.

Cheri Blauwet:  I think there has come a broader recognition of disability as an element of that diversity. But a large number of initiatives have focused on issues related to gender or race ethnicity and have really left out disability to a large extent. So we’re sort of catching up in a way.

Jay Ruderman: Well, it seems like disability, even though people with disabilities are the largest minority in our country and our world population, they’re often the last to be considered part of a diverse group. And it’s only in recent years that there’s been a shift in attitudes of groups like the American Association of Medical Colleges to be more inclusive toward medical students and trainees with disabilities. What do you think is driving this evolution and what do you feel are the next steps?

Cheri Blauwet:  I think that a lot of that shift has come out of the fact that I go back again to the ADA generation and this cadre of students that are coming through high school and then undergraduate education with a vision or a goal to have a career in medicine. And those numbers increasing and there being honestly pressure from the community of students who are saying, look I’ve seen examples, I’ve seen role models, I’ve seen people who have done this. Or even if I haven’t, I think I can do it and I’m coming and I’m applying and there needs to be a good reason why I wouldn’t be admitted. And if I am admitted then I need to be accommodated.

Cheri Blauwet:  And so a lot of it I do think has been occurring in parallel with just a cultural shift that we see more broadly. And then also an increasing number of students who are coming to the table and wanting to apply.

Jay Ruderman: So do you see yourself as part of a growing movement of doctors with disabilities who are starting to change that narrative by saying it’s a disservice to both the medical profession and patients to exclude doctors with disabilities in the medical field? Are you part of that? Can you give us an example of maybe a way that you’ve challenged the community?

Cheri Blauwet:  Until now it’s only been more recently that we’ve started to talk about that and actually raise that as a problem and that it’s really sort of come out of the closet. And that’s I think been the results of what we’re initially informal coalitions of advocates that have now started to formalize a bit and bring together this conversation and be allies to one another, be mentors to younger people entering the profession and really to create more of a formal network.

Cheri Blauwet:  One group that’s doing a lot on this topic is the University of Michigan. They have several advocates both on the clinical side as well as in research that have been doing quite a lot of work to both do studies that show okay, what is the current proportion of medical students with disabilities that are currently matriculated in our schools to provide a little bit of data to backup what’s the community is saying and then also thinking about how to elevate that conversation with use of social media and so on. And so it is starting to coalesce. It’s really only been quite recent.

Jay Ruderman: Well, that’s awesome and thank you for your leadership on that.

Announcer: You’re listening to All Inclusive with Jay Ruderman. You can learn more, view the show notes and transcripts at rudermanfoundation.org/allinclusive. Please remember to subscribe, rate and review us wherever you are listening.

Jay Ruderman: You are an athlete. You’re a former Paralympic athlete in the sport of wheelchair racing and you competed for the United States team in three Paralympic Games, bringing home a total of seven Paralympic medals, which is very impressive. So congratulations. How did you start your career in athletics?

Cheri Blauwet:  My evolution of an athlete occurred over many years when I was a young person growing up in the Midwest. And my first exposure to adaptive sport was through the sport of wheelchair basketball. I initially didn’t necessarily latch onto it or love it or think that it was something that I would stay involved in.

Cheri Blauwet:  So my first hook was actually when I did discover some youth adaptive sports programs that were taking place in De Moines, Iowa, which was quite a drive from our family farm. And the way I discovered it was actually that our high school track coach saw a wheelchair racing exhibition event at the Iowa State high school track meet. He came back to school and told me that he had seen this and that he had been exposed to it and he encouraged me to try out for the track team the following year.

Cheri Blauwet:  And initially I completely blew him off and said, well that’s great coach, but I don’t play sports. I’m not really interested. But he was thankfully very persistent and being from a small community, of course everyone knows everybody and he was able to get other people in the community to also try to cajole me into going out for the team.

Cheri Blauwet:  So the following year I joined our high school’s track and field team. Of course I was the only student with a disability. And I went to practice and got a uniform. And of course this coach worked very hard to make it an inclusive experience. He would give me drills and training programs. But the reality was that I was the only athlete competing in most of those events. So I was about, again, about ready to throw in the towel. But at the end of that season we went to the state track meet and I ran into and encountered three or four other adolescent girls who are also competing in the sport of wheelchair racing and training with a wheelchair racing team in De Moines. And I was immediately intrigued by wanting to get to know them and to be a part of their community and to have peers and other teenage girls my age who also had disabilities, that that was actually the initial hook to stay involved.

Cheri Blauwet:  And with that I started to get to know other athletes, get to know coaches with expertise in adaptive sport. And then I started to get really hooked and began to see myself as a true athlete with potential to compete and to have talent in the sport. So as I continued through high school I very slowly but surely acquired still. I ultimately got a racing wheelchair which was appropriate and custom made for me. And with all of those experiences and with just the day to day training, eventually started to get good at the sport and then ultimately evolved into competing at the Paralympic level.

Jay Ruderman: Well first of all, congratulations. I’m in awe of your success and it just goes to show you the story of your coach. Leadership and someone that’s willing to engage in real inclusion and support an athlete with disabilities. Do you remember the name of your coach?

Cheri Blauwet:  Of course, yeah. His name is Jim Rosenblum and he’s still coaching both track and field and football.

Jay Ruderman: Yeah. Well congratulations to him because he was ahead of his time.

Cheri Blauwet:  He was.

Jay Ruderman: And another thing that I’m completely in awe as a Bostonian is that you were a two time winner of both the Boston and New York City Marathon. So congratulations on that. And I’ll also point out that although you’re no longer competing, you’re joining the US Paralympic team as their doctor. Can you tell me about this role?

Cheri Blauwet:  Just because you retire from the sport doesn’t it mean that you want to detach yourself from adaptive sports generally or the Paralympic movement. So immediately I started to look for ways to stay involved, to use my other professional roles to continue to contribute to the movement.

Cheri Blauwet:  So I had the good fortune in 2010 of being able to join the medical committee for the International Paralympic Committee. That’s been extremely fulfilling because we are the group that really works with the International Paralympic Committee to think about overall health and wellbeing of the athletes. Everything from providing sports medicine services at the Paralympic Games to thinking more broadly about things like policies that we know will help to protect athlete health year round. And that’s been really an incredible journey and really has honestly given back to me as well and helped me launch my career in medicine and being able to speak as someone with expertise in what we would call Paralympic sports medicine, which is now its own niche and developing field.

Jay Ruderman: A way to combat stigma is through education. One of the things that the Ruderman Family Foundation has done in partnership with Massachusetts General Hospital is to train medical professionals, doctors, nurses, orderlies, so forth, how to treat a person with a disability when they present themselves. We first started focusing on autism, but now it’s expanded into other disabilities. Can you talk a little bit about the person with the disability comes into the hospital, you see them as a patient. The entire staff within the hospital, do they know how to, not to single out your institution, but do people in the medical establishment understand how to treat a person with a disability?

Cheri Blauwet:  I think generally that many people in medicine, and if you think about it at all levels from people at the front desk in reception in a clinic to nursing staff to physicians, still a bit of, I guess you could say a hesitancy or even a fear around treating patients with disabilities. And I think that we see that at a few different levels. I think that first off, particularly in our Boston hospitals, to be frank, there are a lot of access challenges whether one has a physical disability or a sensory disability or an intellectual disability. Our hospitals frequently have fairly old infrastructure. They weren’t designed to be universal or to be welcoming towards people with disabilities. And so that is an issue and it’s one that does create challenges. And even challenges from the standpoint of knowing that a patient with a disability it may take a little of extra effort and that then can lead to more stigma, right?

Cheri Blauwet:  So access and overall accessibility is one issue. And the other primary issue is just an overall lack of awareness around disability or people with disabilities as part of a minority community and the whole issue of disability culture and the identity around disability culture. And I do think a lot of that goes back to our training wherein people spend probably 90% of their time thinking about what medical diagnoses cause disability and how to fix those things rather than thinking about disability as part of the human experience.

Cheri Blauwet:  And so again, when we think about the small amount of curriculum that’s applied towards things like how to best work with underrepresented minorities and issues related to cultural competency, it’s a very tiny portion of medical training and then disability within that as either nonexistent or an even smaller portion. It’s just hasn’t been addressed systematically to a large degree. There’s still a lot more work to do in that regard.

Jay Ruderman: I had a minor injury in sports. I wandered into an emergency room with a cane and was put into a wheelchair. And my experience was people stopped looking at me and started looking at the wheelchair or the cane. I don’t know if you’ve experienced that, how that makes you feel.

Cheri Blauwet:  Yeah, I mean I think there’s still, look, we come from a history of centuries of a medical model wherein people are seen from the standpoint of what is your diagnoses? What is your illness or your injury and how do we treat that? And if we can’t treat that or if we’re identifying that someone is going to move forward in life as someone with a disability, then there’s still an underlying current that we have failed or that we have not returned to someone to their ultimate state of health perfection, I guess you could say.

Cheri Blauwet:  And so that undercurrent, although even if it’s not talked about, it’s still where we come from and it’s a deeply entrenched part of the medical culture that we have to work very hard to move beyond. And we’re certainly doing better now than 10 years ago, but there’s a lot more work to be done. And that’s by I emphasize the importance of things like curriculum and medical schools, because we need to start influencing people’s biases at a very early point in their careers to then have a cadre and a generation of healthcare providers who see disability differently.

Jay Ruderman: Let me finally ask you, what more do you think could be done by the medical community, our listeners by us so the inclusion of doctors with disabilities becomes more regularized in our society?

Cheri Blauwet:  I think there are several things that are that are really important next steps. I think the first is continuing to raise awareness regarding, as we discussed earlier, disability as an element of diversity. There’s so much talk about diversity inclusion in medicine in general right now. Even making this simple change to ensure that we always talk about disability as part of those initiatives would actually make a huge impact because a lot of resources are going into that topic right now. Things like scholarships and fellowships towards diverse applicants for example.

Cheri Blauwet:  And just really making sure that when we talk about diversity, we always remember disability and really bring that conversation out of the closet and feel comfortable talking about it. That in and of itself will make a tremendous difference. And it will also elevate the conversation to continue to push us to bring disability out of the medical model.

Cheri Blauwet:  And the other thing that I think is a little bit more technical but equally important is reducing our barriers to entry. Because right now what happens is that so many talented young students at the undergraduate level look at the process of applying to medical school and interviewing and ultimately matriculating into medical school and see so many levels of barriers that they simply decide not to try. And there can be simple things that would be helpful with that. Things like looking at technical standards in admissions policies, things like ensuring that when we talk about that process, that we make it very clear that applicants with disabilities are welcome. And I think that would also make a tremendous difference.

Jay Ruderman: Well, I think that we all have to do a better job of educating more professionals in the field and persistently acknowledge and accommodate medical professionals with disabilities. I want to thank you, Dr. Blauwet for your important insights and for many groundbreaking things that you’ve done in your life and will continue to do so. Thank you for being our guest today.

Jay Ruderman: I think the best way to end this important conversation is with the great phrase that’s trending is that disability does not mean inability. Thank you.

Cheri Blauwet:  Yes. Thank you Jay.

Announcer:       All Inclusive is a production of the Ruderman Family Foundation. Our key mission is the full inclusion of people with disabilities in all aspects of society. You can find All Inclusive on Apple Podcasts, Google Play, Spotify, and Stitcher. To view the show notes, transcripts or to learn more, go to rudermanfoundation.org/allinclusive. Have an idea for a podcast? Be sure to tweet at Jay Ruderman.