Episode 35: Dr. Bliss Temple

In this podcast, Dr. Bliss Temple discusses how #DocsWithDisabilities have the power to inform and improve healthcare all patients and how she brings her disability identity to her medical practice.


Bliss Temple, MD, is an internist at One Medical in San Francisco, CA. Bliss graduated from Duke University School of Medicine and completed her residency in internal medicine primary care as well as a primary care research fellowship at UCSF.

Bliss believes in building strong relationships and understanding each patient as a whole person - what their lives are like, what they care about, their concerns, and life goals in addition to their health conditions. She collaborates with patients to create evidence-based, proactive, and realistic plans customized to their unique needs and lifestyle. She's especially passionate about caring for people with disabilities, chronic health conditions, and complex life challenges. She's also very interested in mental and reproductive health.


Audio transcript

Lisa Meeks:

Doctors with disabilities exist in small but measurable numbers. How did they navigate their journey? What were the challenges? What are the benefits to patients and to their peers? What can we learn from their experiences? My name is Lisa Meeks, and I am thrilled to bring you the DocsWithDisabilities podcast. Join me as I interview Docs, Nurses, Psychologists, OT’s, PT’s, Pharmacists, Dentists, and the list goes on. I’ll also be interviewing the researchers and policymakers that ensure medicine remains an equal opportunity profession.
Welcome back to our listeners. Today, I have the pleasure of interviewing  Dr. Bliss Temple, who is an internist in the Bay area and a person with a disability. Bliss. Welcome to the show. Do you mind just taking a second to introduce yourself to the audience?

Bliss Temple:
Hi, thanks so much for having me. I'm delighted to be here because this is such an amazing thing to have us all having this ongoing conversation. I would have loved for there to be something like that when I was training. So as Lisa mentioned, I am a physician and I work in primary care. Um, my heart is really in being a generalist. I also am the medical director of my clinic. So an administrator as well, and I'm a person with a disability. I had an accident 30 years ago now, and I'm a wheelchair user. And also because of my disability, I have had to be a consumer of a lot of medical care, which I  think is very much something that informs the way that I provide care as well.

Lisa Meeks:
Well, wonderful. I'm so excited to have you with us today. When we reconnected about a month ago, we talked about you coming on the show and our research interests, and it was such a delightful conversation because one of the things that you and I are both committed to is figuring out how physicians with disabilities impact patient care. What is the pathway? And we talked a little bit about some interests that you have specific to healthcare providers with disabilities and patient care. Can you tell us a little bit more about that?

Bliss Temple:
Sure. I'm really happy to talk about it. I'll say first off that I am both super, super interested in this topic and feel like it's really important. And also feel like I've been trained in this academic way to always feel like, Oh, there has to be an evidence basis for everything you do. And this is really an area where, because I was trained by almost no one with a disability, and there isn't a lot of literature about this, and we don't know a lot about what it is that's different about how physicians with disabilities practice. This is really an area where I'm interested in passionate and over time, I've really developed a style and believe that I do some things that are different with patients with disabilities and approach things in a very particular way because of my own disability. But I also don't really know what other physicians are doing. I have all these ideas and I would love the share them.

I'll talk a little bit about just sort of generally how I think about this concordance between me and patients and the things that I think it makes a difference around. So I'll say for a long time I felt a little sheepish feeling like I ought to be different at all when taking care of patients with disabilities, I really tried so, so, so hard over at the beginning of my training to kind of measure up and sort of be a doctor like other doctors and, and be seen as sort of fitting into the mainstream of practice.

But the, the longer I have actually been out here working, the more I've really come to see that my experience as a patient and my experience of living in the world as a person with a disability is a real strength and it really, really informs my practice. Every patient I see, I think to myself, does this person have a disability? And you know, not everyone who I might think of does having a disability necessarily self identifies in that, that way which is fine. People don't need to have any particular identity, but I really firmly believe that there is a common experience across different types of impairments, across different groups, people with disabilities, whether or not that's healthy, identify that really is important and informs the way that I think about patients.
One thing that I do every time is that I kind of, I start setting what I think of as disability, cultural norms with people and doing cognitive reframing so that I talked to them about things like how there's ways of functioning in the world that are normative, and actually the medical profession and physicians often literally are the people that define what those norms are, which can be an uncomfortable position to be in. If you're trying to work with someone who is part of the spectrum of human diversity and does things in a non normative way. But I actually point out, you know, we have these norms, but they may not really make sense. We want to focus on the individual in front of us, what's their normal, what's their baseline. And really look at how do they function? What are their strengths? What are their needs? What are their limitations? And not try to just do everything the way everyone else does because that's how it's done.

I try to reframe as well around things like ‘overcoming’, which of course is a word that a lot of people with disabilities are really allergic to because we feel like, of course disability is this integral part of ourselves. We don't overcome it. We just are ourselves and continue to do all that. We do, be who we are with our disability really included as part of us. And I'll say that to patients sometimes. I try to change norms around things like durable, medical things, equipment, not too uncommonly. Someone will say to me like, Oh, you know, I'd never want to use a cane, you know? And I will say to them very directly, yeah, I want to, I want to present something for your consideration, when you look at me being in a wheelchair, I don't know exactly what you're seeing, but I'll tell you how I think about my wheelchair. It is the instrument of my liberation. Without it, I would be lying at home in bed and with it, I am so to do this job and see you and hopefully be useful to you. And I hope that you may consider it. I think a cane might give you the same opportunities to be safe and to be mobile and to move around in the road. And that you might just think of it as a tool. And then the question we have to ask ourself is, you know, since this is an available tool, is it going to make your life better or not? And if it is, let's do it, why wouldn’t we? And that kind of norm setting, I think is really important.

Lisa Meeks:
So interesting. You talk about the norms that are set by physicians and medicine. And I think importantly within that is this idea that something that doesn't measure up to the construct that is as set, the boundaries that are set within medicine then becomes abnormal or clinically relevant when in fact it may just be another way of approaching the world that may be absolutely normative to the individual and not actually impair pair them in the same way that it's perceived to cause impairment.

Bliss Temple:
Yeah, absolutely, and I think it's not that it's not that I, I sort of categorically feel that there's no loss involved in disability. And I think for some of the people, maybe many of the people, maybe much of the time, no, it's the fact that the disability may involve some loss. And I think that's perhaps particularly true for people that have an acquired disability later in life. But I do think part of taking care of patients with disabilities really is seeing their wholeness, seeing the unique ways in which they encounter the world and experience the world. And not reinforcing these kind of general norms that just don't serve people well, and don't acknowledge, you know, the really delightfulness and variety of human diversity and the ways that people with disabilities can creatively find ways to really live a life and have a life.

I also think one other thing that I often do when I have patients with disabilities is just print out and acknowledge structural barriers that people with disabilities face and bias views that people may face.  I actually had been an inpatient if you count the stints I've had in nursing homes also for longer than I had been a doctor until my second to last month of my three year long residency. And I came to medicine, fairly unapologetically identified with patients now. And sometimes, sometimes I think in medicine, um, really from both sides, the patient side and the doctors side, there can be this sort of tension where on the one hand, this is a healing profession and we're all in it to heal people. But on the other hand, there's a kind of a, an us versus them mentality sometimes where patients are trying hard to get what they want.

And especially if they've encountered systemic injustices or bias, or they're worried that they will, worry that they won't get what they need either be seen whole the way they need to be seen and listened to the way that need to be listened to, you know, and then I think for, from the physician side of things, um, sometimes patients that are not sort of normative and don't have needs that fit into a neat category can be daunting a little bit scary, feel worried that, Oh, this person may require some, something that I don't have time or resources to give. Um, you know, and so I often when I send someone off to a specialist or something like that, I'll just say to them, you know, I know that I've sometimes not had good experiences with specialists in the health system. I don't know if frame it in terms of myself, but I'll say to them, you know, the, for the big academic medical center, I still learn from one of my patients.

And they sometimes say it's a little bit Soviet post office over there. Um, just because I know that bureaucracy can be kind of dense to make one's way through. Um, and I actually just name, name what I believe to be true, which is that, you know, not everyone you encounter is necessarily gonna be able to take in your whole experience or know that they really need to listen to you. And they actually help people strategize about how to deal with that. And I may, for instance, send them off to the specialist with a one-page medical history, a few focused questions that they're going to ask him an agenda for the meeting so that I can help them kind of keep their power frame the discussion, talk about the things that they want to talk about and really prepare to be ready for this system and which they're not normative and they need to get their needs met.
 I also know deeply from my own life about the kind of barriers that people experience, even on the way in the door, you know, I can't drive cause I'm going to disability and I take the bus to work and you know, I am not taking a hard line on people showing up for their appointments. When I know that they have caregivers getting them ready to come in, that they have transportation difficulties, that they have communication difficulties, that it takes a lot of effort to just get in the door at the office. I also do a lot of things virtually for people over phone and over messaging that I might not for some other patients where I know that they're not facing those same kinds of barriers to getting care. You know, and I try to know that about all my patients, you know, how what's their context look like and how can I really meet them where they are and understand the barriers that they're facing to getting care and try as much as they can to submit those.

Sofia Schlozman:
In the next section, the conversation shifts to a discussion of Dr. Meeks’ and Dr. Temple’s collective commitment to increasing the number of physicians with disabilities in the healthcare workforce. Listen or read along as they discuss the value of individuals with disabilities coming into healthcare, how diverse communities can shape how people view the world, and concerns over placing an unfair burden on underrepresented voices to educate those around them. We begin with Dr. Temple’s recollections of how her disability affected not just her training experiences, but those of her peers as well.

Bliss Temple:
One thing that I've really been struck by is how important that's been actually for me as I've gone through my training and my work now to actually just be there in the space as a healthcare worker. Um, and as a trainee, I think of a couple of incidents that happened when I was training when I was in medical school. Um, there was this one time when, um, I was in medical school and we had a patient who came to do like the last 10 minutes of a lecture on a neurological issue. And the professor talked for an hour about this particular neurological disability. And then at the end, the patient came in and it was supposed to say a few words about living with it, which is awesome that the school did that. Um, and we sat in this kind of amphitheater-style seating where we had wood panels in front of our bodies. And really you could just see our heads. It was like the UN very formal looking. And then the speaker would be down in sort of a pit below.

So the patient in this case was a wheelchair user and was down in the pit talking to all of us above him. And I actually asked him a question about discrimination and bias and how he had experienced his healthcare providers, what he thought about that. And he looked at me and pause for a really long time and then said, “I am going to try to answer your question. It's really important, but I just don't think you all can really understand how hard it is to be a person that looks like me and go into a space like this”. And my class actually started to laugh. He couldn't tell I was in a wheelchair because he could only see my head. And I could see that he was getting upset by that so I actually just wheeled myself out from behind the barrier and stood in the middle of a stairwell so he could really see me. And he just broke into the smile of pure delight  and said in this old sort of Southern gentleman way, “Wow. Look at that.” And I think his delight in his kind of obvious feeling that like finally, someone could really understand this perspective and not  just being kind of, one of them was really obvious to my classmates who have brought up this story, you know, that happened 15 years ago. You know, I've probably heard 10 times from various people. Like, remember when that guy, you know, and I think those kinds of moments of sort of connection and recognition are really important for people to just witness.

I remember another time it was actually in my final year of med school when we had a geriatrics presentation and a physical therapist came in and was giving this presentation to my class and presented disability in this way that, where she had, uh, a pyramid shape graphic. And she said, you know, there's this hierarchy of functioning, you know, and at the base, people need to be able to do their activities of daily living things like, you know, walking and eating and sleeping and talking, you know, and then there's this next level, which is the instrumental activities of daily living, things like cooking and shopping that they need to do to live. And then she put at the top, um, can't remember what she called it, but basically it was like working and participation in the culture. And she said, “people need to be able to do the things at the bottom before they're going to be able to get to the top.” And I was horrified and sat there sort of thinking, ‘Oh, how am I gonna address this thing?’ And my class, you know, she presented the graphic and she was giving a lecture and people started interrupting her and they were saying things like, but if someone can't drive, which was on her list, that doesn't mean they can't work. You know? And they knew that because I, you know, med school is more high school than high school. Everyone knows each other's business was relatively small class and they knew that because I didn't drive, and I think, um, you know, and actually they kept using the example of me, but places in the hospital she's working, she gets people to help her with these things. So she's able to work. What about that? You know, and I was actually like near tears myself, honestly, sharing that to let go of my poker face because I was so amazed that my classmates had my back in this kind of looming landscape sometimes where I would feel like, Oh, I have this perspective. Is it safe to share it? I didn't say anything. But these people that had been on this journey with me, you know, driving me, giving me rides, watching me sometimes struggle with inaccessible stuff or bias from the people that were training me. You know, not all of them knew me really well personally, but as a group, they were able to see this experience that they were having with me in a way that was really powerful.

Lisa Meeks:
One of the things we, we kind of, I guess you could say bonded over or kind of shared some laughs is how our friends wind up being so invested in an access and they don't realize that it's happening. So for me, friends that have been friends for more than a decade, they see the world differently just from being around me and knowing the way that I see the world, right. Is know, kind of view the world through layers of access. And if something is markedly inaccessible, I'll notice it. And I'll probably talk about it because I'm very passionate about making sure that everyone can engage in an activity or an educational space.

And even friends within the last few years that are not in the profession at all. So they don't do disability work at all, but perhaps they're in medicine will, you know, tap me on the shoulder or send me a text message and say, did you see this? Can you believe this person has this attitude or that the way that they said this was so disrespectful or this space is so inaccessible. And I always say, you know, the majority of people are very good people and want to do the right thing. They just, they're just not aware. Right. There's just not this awareness of it at this level. And you had shared, you know, similar experiences like you just did.

Bliss Temple:
Yeah, absolutely. You know, and I think, I think there's really something about, you know, seeing people with disabilities in action, getting to know those struggles, being intimately involved with people with disabilities. That really, I would say in addition to providing people with some of the specific knowledge and also the passion about this issue, hopefully in a more general way, I think it really provides kind of a model for  just knowing people with disabilities can be in the world, can be agents in the world can achieve things in the world, you know, a sense of possibility among colleagues for what people with disabilities are really able to do. which of course is, I mean that all people with disabilities have to go into health professions, but just sort of a model of people with disabilities, living their life, doing their thing, but that breaking down some of that us versus them where the people with disabilities are always the patient and the doctor is not a person with a disability and, and kind of breaking down a little bit I think this vexed relationship that has there has been historically between healthcare providers and people with disabilities where, you know, there, there are these sort of stereotyped interactions and, and a real Gulf between the two now.

And I think that kind of learning is invaluable and only way that people can get it deeply is by having friends and colleagues and peers who have disabilities now. And because of that, I think there's a real value to just having people with disabilities present in training programs, present on faculty, out there in the world, working for healthcare organizations, bringing the perspective, but also modeling participation of people with disability and through the littlest things like how the chairs are set up in the lunchroom, it could be really just teaching people by being in that space, what accessibility really looks like and how people can treat people with disabilities, with respect and achieve equity. I think sometimes as a, as a trainee, it can be hard to know how to communicate about this role, really important asset that when brings having a disability, because obviously there still is bias and discrimination, and it's really important for us in these settings to be seen for our well-rounded accomplishment accomplishments. You know, no one who applies to med school is there because of their demographics, you know, they're there because of their passion and their achievements. But also to really communicate, “I bring this perspective and they bring this experience and they bring this way of being in the world that is going to help your program, your institution, my peers, everyone whose lives I touch really being better.” Over time, I've started talking about this in professional settings more and more, you know, and I, I almost never lead with it, because that doesn't feel right. And I think, again, doesn't, it doesn't help people so much put my disability identity into the totality of who I am, but, I often in an interview or something like that, it, uh, I'll kind of slip it into the last question or find a way to say it. And you know, it doesn't have to be something really elaborate, but, I'll say, you know, as a person with a disability, I feel like one of my superpowers is creative problem-solving. I know my strengths and my limitations really well and am able to analyze a situation, get in there, figure out how to make things work and I've also really honed my skills over time, working with my community, helping other people figure out how to solve problems. And I think that's a real strength that I bring. I also know a lot about life as a person with a disability. So I'm able to relate to those patients and make plans for their care in a way that has brought a lot of value to organizations I've been part of.  You know in saying things like that, I think sometimes it, it can help to flip the narrative so that you don't show up at an interview or something like that. And the question is like, “Oh, will you accommodate me?” Or, “you know, am I going to be okay?” Even though I have a disability, it's more like, you know, I have this perspective that you need and I have this way of being in the world, that's going to enrich you. And it wants you to notice that. So I'm going to name it for you.

Lisa Meeks:
I love it. And I absolutely feel like one of the things that we don't do well as we start to work towards better inclusion of people with disabilities, it's almost like, Oh, you have a disability. Okay. And we make all of these assumptions, and when I'm out in the world doing consulting or talking to a program or talking to a learner, it seems that the disability alone seems to be the threshold. And I want to move people from, you know, having a person with a disability in medicine to seeing that each person with a disability is different and brings different perspectives and different benefits and this is just one element of what makes this candidate a really well-rounded wonderful candidate who can inform medicine in a different way.

I want to backtrack just a little bit. So often, and this happens with lots of marginalized populations, especially those that are underrepresented in medicine. So often the person of color or the person that identifies as LGBTQ, or the person with the disability winds up being the sole source of information for the entire community of individuals and that can make that person feel very uncomfortable. And when I listened to you talking about the presenter and being in that space, I had two thoughts. One was,  through the course of your education, you will come into contact with potentially 800 peers M1-M4, and they will, to some extent, understand that a person with a disability can be in medical education and isn't that phenomenal because when they go out into the world, and I’ll talk about this in a little bit, they have a different construct of disability. At the same time as the only visibly disabled person in the room, did you feel like you were compelled or you had this almost burden on you to be the individual who informs kind of the conversation around disability?

Bliss Temple:
Absolutely. You know, and I think, you know, for me, particularly in medical school, but even later on, as, you know, the only at the time that I went to my medical school, you know, as far as I know, I was the only person who'd ever been through there with a visible, clearly identified disability. Um, and there, there was actually a level for me in medical school, particularly when I started on, started out or it was like, I was so singular that it almost, wasn't a category of different who would, is just like me who is different, but the, it definitely felt like a burden. And I felt like disability was actually so invisible that it wasn't like everyone in the room swiveled to look at me to tell them about disability. It was more like some lecture would say something awful and then I would be sitting there thinking, do I put my hand up or not?

Or like, you know, the very first thing that I was supposed to do at my orientation was whitewater rafting. And, you know, I can whitewater raft, maybe, I don't really know I haven't done it. Um, but, there was nothing on there about like, you know, “let's talk about how the accessibility will work for this”, you know, like it just wasn't anywhere in there. Um, and I did, I did feel that burden and they think, you know, many, many, many people from any kind of underrepresented group feel that burden.

One thing that I have tried to do is, although I've done a lot of academic work in disability and professional work in disability, I try to be constantly aware of and informing other people about when the time is right of the enormous diversity of disability, not just impairments, but also experience and this sort of, I only speak for myself and I also, although I've done a lot of work in disability, really resist being sort of the token person with disability, I won't speak for all people with disabilities ever. I will put a disclaimer out there before I say anything. And I asked her sort of consciously, particularly early on, would often sidestep and duck being the spokesperson and are trying to reinvent the curriculum. And instead, really kind of fall back more on these, this contact strategy for being a person with a disability.

So instead of coming in guns blazing, trying to change the narrative and the lecture, I would show up on the wards, in the clinical rotation, and say to people, “watch me work”, if they had concerns about my limitations or brought up questions about how it was going to perform or ask me stuff about my disability, I would often say, “can we hold off for a little bit on having that conversation? How about we set up a meeting in three or four days until then, but I'm hoping you'll do is watch me work. I think it's going to help us have a richer conversation”, you know, and in that way, I guess I have tried to be myself, bring my sensibilities, bring my way of being in the world as a person with a disability to the table, but also not kind of have to get out there, changing the narrative in ways that burden me extra all the time.

Lisa Meeks:
So you're educating through kind of modeling versus, coming in, as you described, kind of coming in guns, ablazing, which I think is a strategy that is used and even if it's effective in getting a policy changed or an accommodation approved in the end it doesn't elicit trust and education and a relationship and kind of growth in the individuals that are working with the learner or, with the physician. And so, I take the same approach you do, which is kind of this cautioned approach of teaching, educating, not assigning judgment, I rarely will assign a judgment to the way that somebody arrives at the conversation, because we're all just products of what we've been exposed to and our upbringing.

Bliss Temple:
I completely agree with that. I do want to say, I don't think it's either, or, you know, sometimes, you know, if a person has a willingness or they see the need, you know, by God, you've just gotta be like, “no, this other thing belongs in the curriculum or please don't say it like that.” And you do have to come in just sort of doing direct advocacy saying the thing, you know, I don't, but I think like for me, at least to avoid both being pigeonholed and also just kind of breaking under the burden of being this person from an underrepresented group who to date has nearly always been the only clearly identifiable person from my group in the room.
This strategy of sometimes just kind of being who I am and letting that make waves for me and bring about transformation and then sort of strategically picking up what are the projects I'm going to work on? What are the educational pieces of do? What are the committees I'll sit on? What are the battles that I'll pick to fight? I think for me, that's, that may prevent this balance where I care deeply and passionately about the cause of people with disabilities here and, and experienced in healthcare, as workers and as patients, but also, I am myself and as a clinician, I'm a well rounded person who does all kinds of things, not just disability.

Lisa Meeks:
Yeah. I think that's a great point that it's not all or nothing. There is, there is a balance to it. And I would even go a step further and say, it's situationally dependent and stakeholder dependent in that I will start out. One of the things I'll use, just a very specific example. One of the things that puts a bee in my bonnet is the use of language and the terms that people will use to describe disability, people with disabilities, kind of the lax use of language that is clinically relevant, but used in a non-clinically necessary description of something. And so those things really bother me. And the way that I will address those with someone I don't know is to say what they've said to me, I'll parrot it back, but use the correct term or a more respectful term. I don't want to say one thing is correct. I think that there's a spectrum of correct that different people would use depending on their preference for language, but I will model back what they have said to me as a way to try to educate. If they don't seem to be getting it, then I will respectfully say, “you probably want to be very careful about the language you use.”
Language is, is super impactful and can build bridges or burgeon them, and go into some sort of explanation about it that is really designed to be educational and nonjudgmental.

Bliss Temple:
I think when it comes to language, I also do them deal model things, and sometimes we'll call it out. I do try in general to talk to people about the difference between intent and impact. And I will sometimes say to them, you know, I know that your intent is to communicate clearly and name things properly. I just want you to know that the impact of the language you're using right now may not be what you intend. And so would it be okay if I tell you a little bit about how this community tends to use language, you know, and I sometimes will just make it really explicit for people in that way.

And also I think in addition to the sometimes overwhelming burden on the individual, that's another problem with having sort of this identified one person as the spokesperson for all people with disabilities is that, you know, we are an extraordinarily heterogeneous group and that kind of learning and that kind of modeling is always better when there are people with different kinds of disabilities and different kinds of perspectives. So, you know, that's another argument for improving the diversity of the healthcare workforce. You know, if we buy into this idea that contact and modeling is important.

Lisa Meeks:
Absolutely. And as someone who does not identify with a disability, I think it's at many times even more important that I provide some balance in a space where there are lots of people with disabilities who are being tasked with being kind of the representation of the community. I think that as allies, it's important that multiple people be kind of “woke” if you will, on the topic such that they can speak to it in an intelligent way without taking away that personal experience, but also kind of relieving some of, of that burden.

Sofia Schlozman:
In the next section, listen or read along a Dr. Meeks and Dr. Temple discuss strategies to better understand and measure the effects of individuals with disabilities on the medical field and patient outcomes.

Lisa Meeks:
My research almost exclusively involves either disabled individuals giving me the first person accounts of their experiences or programs and institutions giving me a firsthand account of the approaches that they take, why they take those, and usually it's in the course of trying to improve access.

So I've had the absolute pleasure of working with multiple institutions and programs throughout the country. And I will say West coast to East coast this does not change that when I meet with a program director, or I meet with a Dean of students, or a clinical or a director of clinical curriculum, that the one thing that everyone has in common is that when they have either in medical school or in training, been exposed to a peer with a disability, a faculty member with a disability, those individuals are leaps and bounds ahead in their openness to having a conversation about disability.

Sometimes we are limited by medicine's need for empirical data. And when you're trying to measure someone's impression of the impact that, that has been made by being in the same circle as an individual with a disability, there are methodological issues with trying to measure that and having it be valid. And so I wondered if you have any thoughts about both the way we measure this impact and, um, what we can take away from these more anecdotal stories about how disability has informed medicine.

Bliss Temple:
I love this question and I have been thinking about this about the last year or so pretty intensely. I haven't done anything formal with it yet, but I really think this is important. And a, I think measuring it is going to be really complicated because when you start to think about concordance between physicians with disabilities and patients with disabilities and the impact on peers across groups of different impairments for people with disabilities across specialties, across types of training settings, there are just so, so, so many variables. It's hard to think about how you standardize this at all and come up, come up with some kind of methodology that's gonna make your results meaningful. And yet I think this is so, so, so important. Something you need to really need to study understand, and then hopefully over time, they get out ways to use what we've learned to improve practice.

And my thoughts are that anecdotal anecdotes are not evidence, but qualitative data is evidence if it's collected in a relatively systematic way and then grouped in terms of themes. And I think that's probably the place to start with this topic just because, you know, we, we don't yet I think have mapped out, you know, what even are the, the big themes and categories of interest here, what are the ideas that need testing? What are the methods people are using? Just because we really haven't studied this at all. And it's so complex to study. Um, what I'm doing myself is for now trying as an individual clinician. And that's how I spend most of my professional time is as a clinician, just really trying to map out what I'm doing that I think is working well, think about the sort of deeper reasons behind the choices that I make in how I take care of people with disabilities and the types of interventions that I'm feeling are valuable that I'm seeing as valuable for my patients. And then really starting to think about, is there a way to start qualitatively collecting those types of themes, maybe starting by talking to healthcare providers with disabilities and doing some qualitative research in a high quality way to get at those things and then maybe that's going to suggest ways to test that are a little bit more quantitative or, you know, ways to set up experiments that are a little more quantitative. But I think the issue is there are just so many variables and there's not any well-established framework for how people deal with work.

Lisa Meeks:
I just think that's all the more reason to build a framework. And I'm confident that over the course of the next few years, that can be done.

Bliss Temple:
I totally agree. I really want to see it happen.

Lisa Meeks:
Yes. And we can make it happen. We're doing so many things in the last five years. Really. There's been so much done on this topic

And I, you know, with regard to research, the other thing that I, I would say, and I would put out to those that are doing this work is that when you are so passionate about this, and this is, this is truly like for me, it's my life's work, there are certain things, certain elements that are very important to you. One of them for me, is to always, always, always include people with disabilities in my research, and that way the results, the findings, the impact is all informed by people with disabilities. And I would encourage everyone out there who is doing work on this to make sure that you're including a learner or a student or a junior faculty member, as well as making sure that somebody with a disability is on your team. It makes for such a rich assessment of the material and the application of the findings.

You know, the whole premise of the podcast was really to provide mentorship and to serve as a teaching and educational tool for those in the pathway of medicine. But one of the other things that it has become that wasn't the original intent necessarily was this opportunity to educate not only the learner in the pathway, but physicians and peers and faculty members and the like about what they need to be thinking about what, what they should be doing to be more active in this, this goal of equal access and inclusion. And so I'll give you the choice, as we move into the end of this conversation to either speak to the learner in the pathway with some advice for entering medicine, as a person with a disability, or to speak to faculty and colleagues about advice to help facilitate that entry to medicine for the learner.

Bliss Temple:
I would love to speak to the faculty side of things, which I think, you know, often often gets a little less air time to the extent that this topic gets air time at all. What I would, I think to say is I really hope that people who want to do the right thing want to do well by people with disabilities and include us in every level of the healthcare workforce can start to expand their thinking. So we absolutely foundationally need accessibility. We need equitable and when need accessibility and equitable policies to be applied on an individual basis, taking each person's individual context into account, because people with disabilities vary so much and their life circumstances vary so much. So necessarily the appropriate accommodations and supports that let us do great work are going to be varied. Beyond that sort of foundational commitment to providing accessibility and equity, I hope that there can be this expansive vision that we've been talking about where people really seen some value of trainees with disabilities colleagues with disabilities, you know, not as tokens and not as people that have to speak for the whole, but as models of being in the world and in a way that can embody human diversity in a particular way that can bring life experiences that will lead to creative, new ways of providing care and connecting to patients and where the modeling can go in both directions where, you know, faculty and other trainees are learning from the people with disabilities that they're working with.

And I also hope that that a faculty can hold in their heads and expansive vision of the possibilities for their trainees, with disabilities, you know, once the kind of technical problems of how you do this or that in the course of training are solved. You know, I want there also to be this vision of, you know, this person can be the chair. This person could be an innovative researcher. This person could be a gifted administrator, you know, to see the possibilities for people with disability and really hold those achievements and future pathways in ways in which their way of being in the world is going to ripple throughout their careers, you know, top of mind, so that it's not just about accommodations on them, that's important, but also about this bigger picture vision.

Lisa Meeks:
Thank you so much that that is amazing. And certainly advice that is needed and I think will be well received by the medical education community. Bliss, it's been a pleasure to reconnect with you. I'm so excited for the future, for the pathway project, for the potential to do some research, basing it in the provider with a disability and getting the perspective of the provider. And I'm just so excited for all the things that you will do over the course of the next several years.

Bliss Temple:
Thank you so, so much for having me. This has been a great conversation and happy to continue at any time, because this is such an amazing area of passion for me. And I think this type of conversation is so important. So I want to keep it going.

Sofia Schlozman:
Thank you so, so much for joining us for this conversation, Dr. Temple. From your insights on how you practice medicine, to your reflections on your time as a trainee, to your valuable advice for faculty members and administrators, we are so thankful for all of the knowledge you shared and so lucky to have you in this space.

To our audience, thank you so much for listening or reading along to this episode. We hope you enjoyed this conversation, and we hope you tune in next time.

This podcast is a production of the University of Colorado Anschutz Medical Campus SUMMIT program, the Stanford Medicine-Stanford Medical Abilities Coalition, and the University of Michigan Medical School Department of Family Medicine - M-Disability initiative. The opinions on this podcast do not necessarily reflect those of the respective institutions. It is released under creative commons, attribution non-commercial, non-derivative license. This episode was produced by Dr. Lisa Meeks, Jacob Feeman, and Sofia Schlozman.

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