By Craig Escude, MD, FAAFP, FAADM
This article was originally published in Helen: The Journal of Human Exceptionality, a publication of the American Academy of Developmental Medicine and Dentistry. We invite you to subscribe by visiting their site.
Let’s Get Something Straight: Ensuring Equitable Healthcare for People with IDD is not the “Medical Model!”
The “Medical Model” is a term used to describe an outdated way of viewing intellectual and developmental disabilities and is associated with the approach taken during the years when large numbers of people with IDD lived in institutions, where doctors and nurses were the primary drivers of service delivery. The Medical Model sees disability as a “defect” within the person and contends that the person needs to be “cured” or “fixed” in order for them to have a good quality of life. Seeing a disability as a deficit can lead to lower self-esteem and perpetuate the mindset among clinicians that people with IDD have a lower quality of life and do not deserve the same level of healthcare that people without IDD receive. The Medical Model can promote feelings of sympathy, pity, or shame towards people with IDD, and often, people are unaware of this bias.
The Medical Model has been rejected by many in favor of the Social Model of disability. This model focuses on the intersection between disabilities and the environment within which the person lives and promotes the creation of environments that are more accessible for all. The Social Model calls for an end to discrimination through education, accommodation, and the universal design of structures and environments to facilitate accessibility for everyone. Within the Social Model, there is an understanding that people with disabilities should have equitable access to qualified nursing, medical and other supports, sufficient to ensure they receive the same functional supports, preventive care, and ongoing medical care as people who do not have a disability.
Attaining disability clinical competency among healthcare providers and ensuring equitable access to health care for people with disabilities is in direct opposition to the Medical Model as is identifying health risks and educating supporters about how to recognize them and mitigate them. Educating healthcare providers and other supporters to meet the health care needs of people with IDD is exactly what the Social Model of disability calls for; changing the environment to better meet the needs of everyone. Having access to disability-competent healthcare providers who recognize the sometimes unique health needs of people with IDD, who understand the link between adverse behaviors and the need to look for underlying, treatable medical conditions, and who recognize that people with IDD are people first will go a long way to improving overall health, wellness and quality of life for people with IDD.
Let’s not say that the term “medical” is related to the medical model. Let’s not say that using the term “patient” to describe a person who is receiving healthcare suddenly takes on a derogatory meaning when applied to people with IDD. Anyone who seeks medical care is appropriately called a “patient.” And definitely, let’s not throw around the term “Medical Model” any time someone talks about the importance of equitable access to evidence-based preventive and ongoing healthcare for people with or without IDD. We should never go back to the medical model of disability, but advocating for well-trained, disability-competent clinicians and supporters of people with IDD who can recognize, prevent and appropriately respond to health issues is a far cry from the errant views of the past and are grand steps to reducing health disparities and achieving health equity for all.