All disabled people have the right to the highest attainable standard of health without discrimination on the basis of disability. This page centers disabled people's expertise to help healthcare providers deliver genuinely accessible, respectful, patient-centered care that goes beyond minimum legal compliance.
Disabled people experience significant health disparities—not because of their disabilities, but because of healthcare systems designed without them in mind. Research shows disabled adults have mortality rates nearly twice as high as non-disabled adults. Women with learning disabilities in the UK die 20 years younger than non-disabled women.
These disparities result from diagnostic overshadowing, inaccessible facilities and equipment, communication barriers, provider bias, and systems that treat disabled patients as problems rather than people. Healthcare providers who center patient autonomy and design for access can save lives.
Diagnostic overshadowing occurs when providers attribute symptoms to a known disability rather than investigating other causes. A person with an intellectual disability reporting stomach pain gets dismissed as "attention-seeking." An autistic person's descriptions of new symptoms get attributed to "anxiety." A wheelchair user's fatigue is assumed to be depression rather than investigated for other causes.
When providers assume symptoms are just part of a disability, they miss treatable conditions. Patients die.
Investigate all new symptoms thoroughly regardless of existing diagnoses. A new complaint deserves the same workup it would receive in a non-disabled patient.
Ask open-ended questions rather than leading questions that confirm assumptions. Let patients describe symptoms in their own words.
Consider biological causes first when behaviors change. Pain, infection, constipation, and medication side effects can all cause behavioral changes—don't assume the disability is the cause.
Allow adequate appointment time. Rushed appointments increase cognitive shortcuts and missed diagnoses.
Listen to patients and caregivers who know baseline presentation. When they say something is different, believe them.
Ask yourself: "What would I do if this patient didn't have a disability?" Then do that.
The 2024 Section 504 Final Rule established enforceable requirements for medical diagnostic equipment. Providers receiving federal funds must have:
Accessible examination tables: Tables that lower to 17-19 inches (wheelchair transfer height), with stable surfaces and adequate weight capacity.
Wheelchair-accessible scales: Large platforms, low profiles, and weight capacity of at least 500 pounds.
Accessible mammography equipment: Adequate clearance for wheelchairs beneath cameras.
Providers cannot deny examination to patients due to lack of accessible equipment. "We don't have equipment for that" is not an acceptable response. You must find solutions—portable lifts, trained transfer assistance, referral to facilities with appropriate equipment while you acquire your own.
Accessible examination rooms need:
Qualified ASL interpreters are required for complex medical discussions—informed consent, diagnosis, treatment planning, discharge instructions. Family members are not appropriate interpreters: they have confidentiality concerns, may lack medical vocabulary, may be part of the clinical problem, or may have conflicts of interest.
Written notes are insufficient for complex discussions. ASL is a separate language with different grammar than English—many Deaf people are more fluent in ASL than written English.
Give primary consideration to patient preference for communication method. If they request an interpreter, provide one. Video Remote Interpreting (VRI) is acceptable only when in-person interpreters are unavailable and equipment works properly.
Settlements exceeding $70,000 have resulted from interpreter service failures.
For hard of hearing patients who don't use ASL, try: facing the patient when speaking, reducing background noise, speaking clearly (not shouting), using written reinforcement for key points, and assistive listening devices.
AAC includes communication boards, speech-generating devices, text-to-speech apps, and other methods of communication beyond speech.
Give extra time. AAC takes longer than speech. Don't rush, finish sentences, or pretend to understand when you don't.
Speak directly to the patient, not their communication partner. The patient is your patient.
Wait for complete messages without interrupting.
Ensure device access throughout appointments—including during procedures when possible.
Ask how to best communicate with this particular patient. AAC users are experts on their own communication.
Use plain language. Avoid jargon. Explain concepts in simple terms.
Use visual aids—pictures, diagrams, models—to supplement verbal explanations.
Check comprehension through teach-back: ask patients to explain back what they understood.
Ask open-ended questions. Patients with intellectual disabilities may acquiesce (say yes to please providers) even when they don't understand or agree.
Allow processing time. Don't rush responses.
Speak to the patient, not only to companions. Assume competence.
Be direct and literal. Avoid sarcasm, idioms, and implied meanings.
Reduce sensory overload when possible: dim lights, reduce noise, minimize wait times in overwhelming waiting rooms.
Explain what you're doing before you do it, especially before touching the patient.
Allow processing time for questions and responses.
Don't require eye contact. Lack of eye contact is not rudeness or dishonesty.
Respect communication preferences. Some autistic people prefer written communication even if they can speak.
Ask about sensory sensitivities before procedures.
Identify yourself when entering the room.
Describe what you're doing and what you're handing them.
Offer arm guidance rather than grabbing; let them take your arm above the elbow.
Provide materials in accessible formats: large print, electronic documents compatible with screen readers, or audio.
Describe visual information verbally—what you see on imaging, what's on the form you're asking them to sign.
All adults are presumed to have decision-making capacity regardless of diagnosis. Capacity is:
Capacity requires ability to:
If capacity is in question, the proper response is careful assessment—not assumption of incapacity.
Supported decision-making allows people to receive help from trusted supporters while retaining the right to make final decisions. It's now recognized in many jurisdictions as an alternative to guardianship.
In practice:
Even patients with guardians retain rights:
Guardianship should affect decision-making authority, not how you treat the patient as a person.
Patients have the right to refuse treatment, including treatments you think they need. Refusal by a disabled patient is not automatic evidence of incapacity. Respect informed refusal while ensuring the patient understands consequences.
Disabled patients—especially those with intellectual disabilities, autism, or communication disabilities—are at high risk for pain undertreatment. Providers may assume they don't experience pain the same way, dismiss pain reports as behavior problems, or simply not assess pain because standard tools don't work.
Self-report is always the gold standard. Before assuming a patient can't report pain:
When behavioral assessment is needed, validated scales include:
CPOT (Critical Care Pain Observation Tool): Uses facial expression, body movements, muscle tension, and ventilator compliance or vocalizations.
FLACC (revised): Face, legs, activity, cry, consolability—with modifications for patients with cognitive impairments.
PAINAD: For patients with advanced dementia.
Movement may be required to detect pain behaviors—assess during repositioning or care activities.
In patients with intellectual disabilities or autism, pain may present as:
Don't automatically attribute behavioral changes to the disability. Rule out pain.
Many disabled people have histories of medical trauma:
Ask about preferences and triggers before procedures.
Explain what you're doing before and during.
Get consent for each step—not just a signature on a form.
Allow control where possible: positioning, timing, presence of support persons.
Recognize trauma responses (freezing, dissociation, panic) without judgment.
Don't restrain unless absolutely necessary for safety—and recognize restraint can be retraumatizing.
Research shows 40% of healthcare professionals admit negative attitudes toward patients with obesity, while 53% of women with obesity report inappropriate weight comments from providers. Disabled people face compounding bias when they are also fat.
Weight stigma in healthcare leads to:
Focus on health behaviors rather than weight outcomes. Discuss nutrition, movement, sleep, and stress management without making weight the goal.
Don't require weight loss as prerequisite for treatment—surgery, fertility treatment, joint replacement.
Address the presenting concern without making every visit about weight.
Use appropriate equipment: bariatric-sized gowns, large blood pressure cuffs, chairs without arms, scales with adequate capacity.
Ask yourself: "What would I do if this patient were thin?" Then do that.
When patients have caregivers, remember:
Caregivers have valuable information about:
When possible, create opportunities to speak with patients privately. Some patients may have concerns they won't voice in front of caregivers—including concerns about their caregivers.
Be alert for signs of caregiver abuse or neglect:
Caregivers may have their own health needs that go unaddressed. While the disabled person is your patient, you can acknowledge caregiver stress and suggest they also attend to their own health.
Disabled people have the same reproductive rights as non-disabled people:
Never assume disabled people are asexual, don't want children, or shouldn't have children.
Disabled people deserve the same quality of palliative and end-of-life care as non-disabled people:
Disability competency requires ongoing education, not one training session. Seek out:
Your disabled patients are experts on their conditions and their care needs. Ask them what works, what doesn't, and what they wish providers knew.
Organizations:
Training:
Guidelines:
| Instead of... | Try... |
|---|---|
| Assuming symptoms are "just the disability" | Investigating new symptoms thoroughly |
| Speaking to caregivers instead of patients | Direct communication with patients |
| Using family members as interpreters | Providing qualified interpreters |
| Examining wheelchair users in their chairs | Transferring to accessible exam tables |
| Rushing through appointments | Allowing adequate time |
| Assuming incapacity based on diagnosis | Assessing capacity for specific decisions |
| Requiring weight loss for treatment | Treating the presenting concern |
| Making decisions for patients | Supporting patient decision-making |
This page centers disabled people's expertise and is informed by disabled-led organizing globally. For questions or to suggest additions, see How to Contribute.