Neither numbers nor definitions come easily when considering disabilities. Although 35 to 49 million Americans are formally classified as disabled,1 many more disabilities may be unreported or undiagnosed. Disabilities differ in kind and degree of functional impairment and in the role they play in shaping a person's identity.
In this issue we explore how the Americans With Disabilities Act (ADA) has affected medical education and medical practice, since the ADA's major provisions were implemented 5 years ago.2 Additionally, we were curious to learn about the experiences of individuals living with a disability. In our authors' candid accounts we saw their focus on adaptation and success rather than failure, and their development of insights and compensations that may bring a special compassion to the profession.
The medical profession has historically played an important part in the formation of attitudes toward people with disabilities.3 Physicians who themselves have disabilities have recently been at the forefront of legislative and organizational activism, especially since the Association of Academic Physiatrists began in the 1990s to advocate for improved matriculation rates of disabled students and retention of disabled physicians in medical practice.4
Nonetheless, misunderstanding and outright hostility continue to confront people with disabilities. As numerous court cases against health professions schools and other institutions of higher learning have attested in the past few years, these issues will probably not be settled quickly, definitively, or free of legal contention.5
To begin, we consider the basic nature of functional limitation and functional competence. Can competence be evaluated by the presence of specific abilities rather than the absence of all disabilities? Michael Reichgott proposes that new assessment models may offer greater equality of opportunity without compromising educational quality.
Such a proposal involves high stakes. Systems of evaluation delimiting the boundaries of medical education and practice have serious ramifications for those who find adaptation to traditional standards or systems of placement difficult or impossible. Mehri Brown and Kevin Takakuwa vividly describe the spectrum of disabilities from severe impairment to subtle differences in brain function. Cesar Aristeiguieta makes the point that the ADA may both heighten awareness of the prevalence of disabilities and encourage efforts in acceptance and retention of disabled medical students and professionals.
Finally, we examine the effects the ADA might have on those without disabilities. Alicia Conill, a medical educator, and Rochelle Haas, a medical student, describe connections between people with disabilities and people who do not think of themselves as disabled. In the wake of the ADA, medical education is irrevocably changing. We leave our readers to consider their part in its reshaping. What is fair? What is not? How do we find our way from one to the other?
Sun Yom S. Disabilities: Looking Back and Looking Ahead. JAMA. 1998;279(1):78. doi:10.1001/jama.279.1.77