Episode 41: Dr. Dinesh Palipana

In this episode, Dr. Meeks and Poullos are joined by Dr. Dinesh Palipana. Dr. Palipana is a lawyer, doctor, researcher, disability advocate, and recipient of the 2021 Queensland Australia of the year award for his work advocating for doctors with disabilities. Dr. Palipana shares his personal experiences as a physician with a disability and how he works to create more inclusive medical spaces and attitudes, in Australia and the United States. 

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.

 

Sofia Schlozman: 

Hello and welcome back to the Docs with Disabilities podcast. This episode is the fifth installment in our ongoing series on BIPOC voices. If you have not yet listened to the other episodes in this series, we highly recommend that you check them out as well. 

In this episode, we are joined by Dr. Dinesh Palipana. Dr. Palipana is a lawyer, doctor, researcher, disability advocate, and recipient of the 2021 Queensland Australia of the year award for his work advocating for doctors with disabilities. We are so honored to have him on the show today to talk about his own experiences as a physician with a disability and to share his insight on how to create more inclusive medical spaces and attitudes in Australia and the United States. We begin with an introduction from Dr. Palipana.

Dinesh Palipana:

My name is Dinesh. I am a doctor working in the emergency department at the Gold Coast University Hospital in Australia. I am a lawyer and a researcher in spinal cord injury. I am a disability advocate and I work as a lecturer at the medical school at Griffith University.

Peter Poullos:

So, knowing what you do about the landscape for disability in Australia and in the United States and in other countries, what would you say the differences are and similarities between disability inclusion in those countries?

Dinesh Palipana:

I was born in Sri Lanka, actually, and I lived there till I was 10 years old, and I spent a little bit of time thereafter I had the spinal cord injury as well. So, I did a little bit of work in Sri Lanka around people with spinal cord injuries and a few other things. So, I had those two countries to directly make comparisons to, and I feel extremely lucky. Australia has a lot of support systems in place, like a national insurance scheme, to provide care, and equipment, and support to people with disabilities. Whereas, when I was in Sri Lanka, even the hospital environment for people with spinal cord injuries were very, very difficult, because even things like air conditioning to thermoregulate, having access to physiotherapy space, and simple equipment like catheters were all lacking and all these patients with spinal cord injuries were put in one room, which wasn't very big. A lot of them went home and passed away because, particularly in rural Sri Lanka, there just isn't the medical and social care to help them stay alive.

Dinesh Palipana:

So, having seen all that, I count my blessings every day to be living in a country where there's a necessary support to live, and to work, and to get around the community. Even to be having a conversation with you today is not an opportunity that most people will have. So, I feel very lucky to have done that and to have had this opportunity. And I think there are probably some strengths and challenges in comparing countries like Australia and the United States as well. From my brief time that I spent there, what I came to understand is that things, like the Americans with Disabilities Act, seem to have provided a really strong foundation to build on with protections. And again, that's with my very limited understanding of how the system works, in detail, in the United States, But in Australia, we've had some challenges in the past because until very recently there wasn't human rights registration and the constitutional rights were limited and the Anti-Discrimination Legislation, while it was there, I think the legal frameworks to protect the rights of people with disability weren't as strong and people struggled when they tried to fight for their rights.

Dinesh Palipana:

That's something that's developing over a period of time, to become stronger. So now there is human rights legislation. Now, the body of law is being developed in disability, but when I was struggling to find employment as an intern, when I graduated, there was really no legal protection, even though I earned my degree and spent time at the hospital. I think the strengths are the social structures built for people with disabilities. So, a couple of years ago, we had the National Disability Insurance Scheme and the National Injury Insurance Scheme that was rolled out across Australia. And these schemes, again, while they're developing and are still being shaped, they provide everything from funding for care, equipment, and access in the community that everyone needs to live and to, hopefully, live according to what their goals are. So, I think those kinds of schemes have been a great strength. And if anyone sustains a spinal cord injury or disability, they are generally eligible for cover under one of these schemes.

I think different countries have different challenges and different strengths. But I think developing nations, I feel for the people that live there, because while we're talking about challenges in education and employment and other things, I mean, these people were struggling to survive. 

Lisa Meeks:

Wow, it's interesting when you reframe it. Earlier today I was thinking we had not pushed the needle enough. I was actually doing another interview where we were talking about how we have to continue to persist and continue to try to hold people accountable to, not only the laws, but best practice here, and then to come on and talk to you and think, "Wow, how lucky are we that we even have these laws," is a totally different mind frame. I never lead with the law. To me, the law is kind of an ancillary device. I always lead with the human rights, social justice perspective. But it's nice to have the law there in the U.S. to bring in when it's necessary. But I'm, I'm wondering from your perspective, because you are a lawyer and were a lawyer prior to going into medical school, how you see that, almost like a dance or the balance of the legal protections and the legal stance, versus, the social justice kind of approach to inclusion. And because you've obviously probably utilized both and what is and is not effective in your work?

Dinesh Palipana:

I think the law should be a last resort because it's expensive, it's time-consuming, and it's complicated, and we shouldn't have to resort to that. And I think the more important thing that has really benefited me, is just having good people with a good culture that believe in the right thing that believe in the value of inclusion. I had this injury, spinal cord injury, halfway through medical school. And it was just about when I was starting my clinical rotations. So, I got to experience a wide range of different specialties. And I got to experience a wide range of different attitudes as well. And both as a student and as a resident, I can give you two different experiences. One was in the emergency department where I work in the busiest emergency department in Australia. It's a really dynamic environment, it’s full of people, it's full of different situations. And everything's completely unexpected.

The people in the department… when I first met my clinical supervisor there as a medical student, she took me out for coffee and she had a chat with me about what my life was like, what the injury was. She met my mom and talked to my mom because my mom was a big part of my life. And she's always going to be part of my life.

So, we had a coffee and I still remember it. And at the end of that chat, she just said, "Okay, great, we'll make it work." And " We can't wait to have you." And ever since that point, I've really felt at home and valued and respected and like a part of the team. And any day that I'm at work, the doctors and nurses, the radiographers, the physiotherapists, everyone, the environmental service people. Everyone just treats me like a normal person and a part of the team. I say hi to everyone. And it's just so nice wandering into work. So, I feel the culture is so inclusive. And I was talking to my girlfriend who also works in the same department, and we were just reflecting on the diversity of people, whether it be LGBTQ+ or, people with disabilities or whatever else, it's just not a thing. It never comes up. And everyone's a part of the family and we care about each other, we check in on each other. So that culture is so important. Whereas I worked, or I tried to get a spot in the radiology department and the attitude was completely different.

Dinesh Palipana:

And I was told that even though the emergency department has accepted me that they don't want someone with a spinal cord injury in that department. And so I wouldn't be able to work there. So, I think the reason I told that story is I think culture and attitude is way more important for inclusion than law, because even if you fight legally for inclusion, and even if you manage to get a court order to say that "Yes, you can work in this place." And then, "Yes, they have to take you." I think it still makes for a pretty tough environment to be in.

So, I think, while legal protection is very important, I think they just need to serve as a reminder and a message that this is our social structure. This is the framework that we need to exist in. But I think changing minds and attitudes to that which value inclusion is really important.

[music transition]

Peter Poullos:

When you were talking earlier about how you were the last incoming intern to be offered a job. I think you were offered your job two days before the start date, right? And, reading that made me really angry (laughs) for you, the fact that they separated your application out from everybody else's and then just kept on dragging it along and delaying. But the thing that was even more disturbing was that after you were allowed to enter into your job after graduation, that they went, and then they tried to make it harder for medical students with your type of disability to enroll and complete medical school. Is that right? And if so, how did they attempt to do that? And did they succeed?

Dinesh Palipana:

Yeah, well, Lisa would be very familiar with that piece of work that came out, around 2015 or 2016, and those medical deans of Australia and New Zealand, which released a set of inherited requirements that was designed to basically exclude people with disabilities from studying medicine. And it had a range of things like, your motor function should be this, and your sensory functions should be this. It had a really strict set of criteria. But I guess the most difficult part when that came out, is someone forwarded me an email from one of the committee members that helped draft that document. And I still have that email, but the email said something along the lines of, "This policy should allow us the legal protection, if we want to exclude someone with a disability from studying medicine, or if we need to exclude someone who's acquired a disability, who's already studying medicine."

And that just felt like, (laughs) when I just read the words, it feels like it's very directed at you, right? But it wasn't really legally challenged. And then this document filtered out through to the organization that administers the entrance exam for medical schools and some medical schools put it up on their websites. So, this was filtered through to a lot of places and it wasn't really challenged legally, but there was a lot of advocacy, which Lisa also supported. And this year I've been peripherally involved in the work that, with the community, has changed the documents, so there's a new one that's being developed, which is a really nice thing. And it's a lot closer to a more inclusive approach. So that's been really nice to see that transformation.

Peter Poullos:

Yeah, well, we still have a ton of work to do in the US on that front, but it sounds like you're describing technical standards, right? And they vary considerably from one place to the next.

Dinesh Palipana:

Yeah, but luckily we have some good people leading the way. And I have a set of technical standards that I can pull out at all these different events. “Look at this, this is how it should be."

Lisa Meeks:

You know, we're trying, and the AAMC is doing great education and outreach on this. And we have exemplar examples of technical standards. We have, certainly have, we have people like Pete Poullos, actively working in medicine, hundreds and thousands of physicians with disabilities actively and uneventfully practicing medicine. And so, it's just, it still surprises me when we happen upon the ignorance that is embedded in some of these standards and the writing and the kind of historical language that's used and it's disappointing.

 

Sofia Schlozman:

In the next section, Dr. Meeks, Dr. Poullos, and Dr. Palipana discuss the value of welcoming people with disabilities into medical professions. Listen or read along as they discuss how improving inclusivity can promote innovation and improve efficiency.

 

Lisa Meeks:

One of the things that we share is this idea of innovation and how it very organically emerges as part of living with a disability and working with a disability. And I know just in, you know, my interactions, I actually could pose this to both of you. I'd love to get both of your perspectives on it. This idea that, you know, necessity is the mother of invention and how innovation has, has been a part of your life since the accident. And in what ways have you innovated in medicine in your daily routine, I guess both personally and professionally to the advantage or increased efficiency, or some sort of work around that you've come up with that has been helpful.

Dinesh Palipana:

Yeah. You know, we were talking about the law and the social justice angle, if that's the right thing to do before. So, I think law, the law is probably the bottom of the rung, and you've got social justice and everything next up. But I think the highest level of what we're aiming for is that this is a really beneficial thing for us to do, because it will increase efficiency and innovation, and profits and whatever. And so, innovation has definitely been a part of practice for me because I had to figure out how to do things. And I wanted to figure out how to do things more efficiently than my counterparts. So, in my first year when I was an intern, I kept really detailed records of how many patients I was seeing and what was happening.

And I wanted to demonstrate efficiency, and I've found ways of examining the patients, typing up my notes and having a workflow using things like iPads and voice recognition and whatever else that would allow me to be more efficient, while delivering high quality care. So, in the emergency department where we are often seeing so many patients, one of the things that I kept track of is how many patients I would see. So, in my first year I was seeing 24% more patients than the average intern using whatever tools and workflows that I had.

Dinesh Palipana:

So, I was able to demonstrate that not only was inclusion a good thing, but it could be more efficient as well for me at the time. But since then, we have adopted so many different things, and I've been able to contribute to the rollout of technology now at other hospitals, including new electronic medical records and more voice-read voice recognition. I even fiddled around recently with one of the emergency physicians who helped me figure out how I might be able to intubate on a dummy using video assisted intubation. So, there's so much technology out there that can enable a person to practice and that can bridge physical gaps. We need that in medicine anyway. And I read this book by Dr. Eric Topol, which is a Creative Destruction of Medicine, and he talks about how medicine is so slow to adopt technology that would actually make it better. And we have so much, we have so much. And I think inclusion is one of the ways where we can improve and increase the uptake of technologies that will actually make us a better profession.

Lisa Meeks:

Yeah. I mean, thinking smarter, there are so many workarounds that we've created over the years for physicians and learners with disabilities that are then adopted as part of the protocol for the department, or if it's a procedural work around, that get adopted because it is more efficient with greater outcomes. So, I love that. 

 

Sofia Schlozman:

In the next section, the conversation transitions to a discussion of diversity and allyship. Listen or read along as our hosts and our guests explore how community involvement and allyship can help shift attitudes and force change in medical settings.

Peter Poullos:

What barriers of inclusion for doctors with disabilities who also identify as doctors of color do you still hope to dismantle through your advocacy?

Dinesh Palipana:

That's such an interesting question because I was at an event earlier this year and one of my friends, they were saying, "Man, do you realize that you not only have a disability, but you're a migrant, you tick all the boxes."  I was like, "Oh, well, I never actually thought about that." But yeah, the thing is I think the challenges for culturally and linguistically diverse people are widespread and real. But for me personally, I've never really been, I haven't been affected by it. And maybe it's because we moved to Australia when I was 10 years old and I grew up in a little seaside town. 

Dinesh Palipana:

It was just a, really, it was a tiny little town and you just feel, oh, I just always felt like part of it. So, my, I guess my identity as a person of color, I never really felt apart, if that makes any sense. So, I think that you can be two challenges stacked on top of each other. But the thing is there are so few doctors with disabilities in this country and there are even fewer doctors with disabilities that have visible disabilities. So I don't know if that challenge has really come to the forefront just yet. We have both of these issues going on, but in medicine broadly, I think there are challenges for doctors of different cultural and linguistically diverse backgrounds.

Dinesh Palipana:

There are also challenges for my female colleagues. The really interesting thing is again, when I was an intern, I did a term in internal medicine which had two interns, and my colleague was a female. And there were periods when other healthcare professionals would prefer to talk to me and they've said it to her on the phone by virtue of being a male doctor. And there were patients that preferred a male doctor, and they would be patients that would mistake her for not being a doctor. So, there were, there were challenges like that for my female colleagues. And what I realized was that they had sometimes, and I've observed this in a variety of different specialties, that they had more challenge getting tasks done because they were female, than me who was unable to use my hands, which was a pretty grieving realization sometimes to come to.

The other important question on the point of this topic is that recently I was talking to a group of medical students and we were having a conversation. And one of them asked, actually asked, a really interesting question, "Do you ever feel tired being an advocate for a minority group?" And my answer was "No," but I think the more interesting thing that comes out of that is that I think it's important to be an ally for people who are going through things or who are a minority group. I think allies are more important. And the reason I say that is because in my journey, with the spinal cord injury, when I was struggling to get a job and when I was faced with other challenges along the way, my allies, my mom obviously to be one, but a lot of the female, senior doctors were my allies. A group of them actually offered to give up their salaries to fund my internship. They said, "Let's take money off the table. So, why don't you, why don't you let this guy become an intern." So I had allies like that along the way and they didn't have the spinal cord injury. But they stood with me. And I think that's the more important part, it's important to have allies, and it's important to have people that just support you and support the cause. So, when we were talking about being a person of color or culturally and linguistically diverse, I think it's important to have allies.

Peter Poullos:

Is disability consistently included in diversity initiatives in Australia or at your institution? Because here, we are sometimes an afterthought or left out altogether, not necessarily even on purpose, but just because people forget that we're here.

Dinesh Palipana:

Yeah. Yes. I think the challenge is, again, touching on the internship issue, the broad organization or the state body that was employing interns had these, "We are an inclusive employer, and we welcome people with disability and diversity," and whatever else. All the hospitals have, “Yes, we value diversity, and we have a disability inclusion plan and action plan”. So, all these institutions have had it, but when it comes to the crunch, when it comes to employing someone with a disability, when it comes to supporting someone who's acquired a disability, this becomes a different thing. And I think while there are action plans and while there are messaging and policy, I think the challenge lies on the ground and in middle management, where it becomes a very difficult thing. And while the leadership are behind the broad message, I think there are opportunities for them to be allies more, and there are opportunities for them to fight more and give people more, which doesn't really happen.

Lisa Meeks:

I think that the whole idea of allyship being critical to raising awareness and pushing equity forward is absolute. I also, I think when you're trying to think about injustice, it is very hard to tease apart some of these things, right? The constructs that keep those injustices or discrimination active and weaved through all of these different marginalized populations. And sometimes too, it's the shifting of the power, who has the power in the situation, to fight. And so, in this, I love your story about the senior doctors that collectively were willing to give up part of their income to fund you because it forced a situation, right? It was all of a sudden if money is not the issue, it forces people to either say they're being discriminatory and they don't want someone who has a disability, or to come up with another reason.

I just, I think that's such a unique and incredible approach.  I've had students with disabilities where that person has been the recipient of some sort of discriminatory action or microaggression, or just flat out aggression, aggression. And when the community comes together to support the student and demands specific action be taken for the community, the power of that is so big, but it also diffuses the opportunities to make it an individual person issue, right? It, all of a sudden now, is a community issue. The community has decided that this is not in line with our morals or values or our goals. And so, it takes the pressure off of that person, the person with the disability, or the person who's the minority person in the room, or the person who has, well for any identity, you know, being the minority versus the majority representation. I think that is absolutely essential.

Dinesh Palipana:

Yeah. Particularly in medicine where there are such big power differentials that are very hard to navigate. So I think that that is really, that's really cool because when people then get behind someone that becomes a community issue, it's a lot easier for someone to navigate. I like that.

Lisa Meeks:

Some cultures are just more collective in their approach to things and community oriented. And in those cultures, people thrive regardless of their identity, whether it be because they're part of the queer community or because they have a disability or because they're a member of an ethnic or racial minority. And that brings it back to kind of your community to finding your people who are going to stand beside you and back you.

Dinesh Palipana:

Going back to culture too recently, there was a trauma, in our emergency department and this group of people and one of the junior team from a surgical specialty was putting in a chest tube. And there was a surgeon in the room, there was an emergency physician in the room, and the surgeon started berating the person putting in chest tube, and the emergency physician stopped him. And he said, "We don't tolerate that kind of attitude towards people in our emergency department. So please stop." 

It was, it was great. It was amazing and that was it. And I think we need that, right? We need people to speak up, we need people to really uphold that culture.

Lisa Meeks:

And the same thing for your example of women. Whether it's harassment or choosing to ask for, you know, a physician that's male, having a male walk into the room and say, "My colleague, Dr. So-and-so is extraordinarily competent, and you will treat her with respect. The idea of somebody with the power showing up for the other person who is being kind of attacked in that power differential.

 

[music transition]

 

Lisa Meeks: 

I will actually teach the researchers in my research lab that the learners, students, the residents, how to respectfully, but forcefully stand up for someone with a disability or show up for somebody with a disability and, and do advocacy in a way that's respectful that calls people in that, you know, invites conversation and teaches people in a way, in a way that's educational.

We're all products of our environment, but we were all taught something by the people who, who've raised us, whether that's parents or family, or the community and family of medicine and what they've taught us. Um, but sometimes that has to be untaught. And so, if we approach it in this educational way where a person can have, well, we help them have a little bit more self-reflection about their actions or their words. I think that can be really powerful. And then, you know, while we're teaching students to do that in our lab, as part of just, how do you be a good ally and advocate, I think it's also important to teach them about the power in numbers, right? Going back to that community approach as well.

Dinesh Palipana:

Totally. And I think two things from that is when we were going through this inherent requirement or, you know, the equivalent of technical standards in Australia, there were two medical students from Melbourne University that reached out to me at their own accord and didn't know them previously. And they said, "We've seen this document and we don't want our institution to be a part of that. How can we best the advocates to make sure that our institution remains inclusive?" And then they went and talked to their deans and staff and whatever else. And I thought that was amazing, but there was a talk, a SMACC talk, by an emergency physician named Cliff Reid. And he talks about heroes in it. He defines a hero as someone who does something for the benefit of another or other people, weathering personal risk, overcoming fear while having a very strong moral compass. And I think that's what this is about, right. I think you're teaching the medical students to be heroes and those little acts of heroism that really matter. Because it is about fear, and it is about overcoming personal risk because you think there's risk to your profession, or your career, or your education. But you are still guided by your moral compass to do something for the benefit of another, without expectation of personal gain. I think that's a really powerful concept.

Lisa Meeks:

Absolutely. And I think the personal risk is it's hard. I mean, these students are in, at the lowest order of all things. But I look at institutions like Stanford, and I think about what Pete's built in just a little over three years and all of the students that are now coming up through Stanford and some of the things that they've done that have been, I think, pretty risky.  But they did it for change. And they're doing it as, you know, at risk to themselves, but to force a change in the system.

Dinesh Palipana:

Yeah.

Lisa Meeks:

And yeah, I think it's honorable for sure.

Peter Poullos:

I know, I'm so proud of them for doing that. It's really spectacular. Yeah.

Dinesh Palipana:

But these are the people, these are the people that can shape the future and the future of the profession, and the future of the world. We need people to take the reins and stand up for something that's right. And I think that there've been so many movements of late that have had a powerful impact in society. But I think the voice of the people matters in creating change. The voices of the community matter, because I think we often forget that institutions and politicians are accountable to the people rather than the other way around.  I was actually talking to Grace Forrest, who is an anti-slavery activist. And she was saying that companies change direction if it's as little as 14% of their consumers are activists for a certain thing. So, it doesn't take much for an institution to change direction. So, if we have a small pocket of activists, you can really make an organization listen.

Lisa Meeks:

Well, some of the big ones, you know, Google, Facebook, Amazon, Nike is hiring a disability specialist. I feel like in the last two years, many of the major corporations in America have hired on disability specialists or someone to come in and help, not only with informing the creation of products or the accessibility of the website or ordering or delivery, or in some way, shape, or form are employing people to help the company understand how to cater to the consumer that has a disability and  I would say in the last year, I've seen it flip from not just catering to the consumer, but actually marketing to the disabled consumer. So, you know, we've seen the stories about the deodorant clothing, which is fantastic and you know, now sportswear. And so, I do think there is a big shift and companies are listening. It's, you know, when are the employers of major medical institutions going to hop onto that.

Dinesh Palipana:

Yeah. And actually, I think some of those more mainstream conversations are important to contribute to the inclusion conversation in medical institutions as well. So, when you see it around the world and around big corporations and groups like that, I think you are compelled to at least think about it.

 

Sofia Schlozman:

The conversation now shifts to consider how medical institutions can create and promote proactive strategies to support learners and colleagues with disabilities. Listen or read along as Dr. Meeks, Dr. Poullos, and Dr. Palipana discuss the value of open conversations, diverse spaces, and academic scholarship in not only supporting disabled learners but in showing that they are valuable and essential members of medical professions.

Peter Poullos:

How do you think that our medical institutions can shift the burden of change away from people like us with disabilities so that the institutions end up being more proactive than reactive?

Dinesh Palipana:

It's still gonna be attitudes, isn't it? I think the messaging that I've seen and some of the work that I've seen, most institutions are still driven by profits and efficiency in projects. And in fact, that's probably one of the broader challenges in medical care that we have is how do we deliver high quality care while dealing with these issues about budgets and whatever else that's coming from the high down. And I think inclusion is the same because I think that it's a costly thing, or they think that it might be a difficult thing in that it might be challenging. But I think if we can demonstrate that this is a beneficial thing and this has the potential to increase your efficiency and new profits and whatever else, then at least the top level of the institutions will start to buy into it a bit more.

Dinesh Palipana:

I just think we have to frame it as the benefit and then it has to just filter down from there. And I think from that level down, that probably has to be more stick than carrot. I think people just have to be, sadly, punished for not, not doing the right thing. I mean, I told you the story about radiology earlier. Our radiology department. When I took that to the director of human resources, that story, her response at the time was to move to a different hospital that might be more supportive. So, it just has to be something that the top level believes in. And then if there's anyone there below that's not willing to buy in, and that does things that are contrary to inclusion, then I think it has to be a little slap on the wrist.

Peter Poullos:

What you said earlier about, like, middle management is really true and it's just your story about radiology there versus emergency medicine and like, that's that one radiology department wasn't welcoming. It so happens that my radiology department is welcoming. But when you think about all the people with disabilities and all the hospitals throughout the world, you know, most people, nurses, therapists, CNAs, doctors, anybody who is taking care of patients, they're reporting to somebody and that supervisor, chances are, will not be well-trained in how to deal with employees with disabilities. And so, you might get lucky and your supervisor might be open-minded, might be familiar with the law, and might treat you well, but it's kind of like the luck of the draw.

These disability conversations are happening every day. Like everywhere all the time. Like, "Hey, can I get off at four instead of five today? I have to go to a doctor's appointment," or “Can you cover my shift for me tomorrow? I'm not feeling well," you know, what is the attitude of your colleagues and the supervisors and what sort of, not even accommodations in the formal sense, but adjustments are people willing to make to support one another. Unfortunately, it's just, it's very random.

Dinesh Palipana:

Yeah, I totally agree. But I also think that's why it's important that we shape the medical students of today, like you and Lisa are doing. You know, sometimes it's even, even when you have a group of juniors or people coming up, that to say "Wait, that's not okay. Why are you saying that?" Questioning these ancient attitudes that are getting around and sometimes that's enough for people to think about. So, I think having the next generation, I think that's important too, to kind of force the senior medical establishment to start thinking of it differently. But I also think the presence of more diverse people within hospitals and within different specialties is really valuable as well, because a lot of this is about the fear of the unknown, whether you're talking about people of color or people of different culture or people with disabilities, whatever else.

I remember you know, at a certain point in my career, I worked with a very, very senior surgeon who actually, I was terrified of because I often hear them yelling and whatever else. So, I was really, I was really nervous to start spending my term with them. And so, on my first day I turned up and I was like, just terrified. But it went really well. This whole term went by and then we got to the end of it and it came time to do my evaluations. So, we sat in their room and they started talking to me about what it was like having a person in a wheelchair coming through their service. And they told me that initially there was a great deal of hesitancy and concern. And then as the term went on, they said that their thoughts started shifting, and by the end of it, they said that they were ashamed that they thought that way at the start because their whole attitude about medicine had changed about what a doctor is, and who, who could be practicing medicine.

Dinesh Palipana:

And that was a really nice moment from someone who is very traditional and very senior to have the humility to explain that their attitude had shifted over that period of time when it happened. Also, yesterday in our spinal cord research lab, I was talking to two of my colleagues. So, they have a very diverse range of religious, political and social beliefs, and lifestyles and whatever else. And we were having a conversation openly talking about those beliefs, sharing things together. And as we understood each other there was a great deal of respect and openness. And it was a very good conversation, but I think that's one of the things, right, if we share experiences, and we share time together. And if we openly understand each other with respect, those attitudes shift. I think that that is really valuable.

 

[music transition]

Peter Poullos:

This sort of pattern, like people are scared or skeptical. They don't know what to do, and they make the adjustments because they have to, and then at the end of it, they look back and they say, "Wow, that wasn't easy, but it was so worth it." And their attitudes change. It's just like one person at a time through this contact.

Lisa Meeks:

Pete and I have written about this and kind of taking the premise of contact theory and applying it to the inclusion of people with disabilities and the implications for reducing stereotypes and stigma around disability. And I think that's one mechanism for doing this. And we were responding and kind of writing up what someone had done at the University of Washington in emergency medicine actually, Dinesh, but I think there's one step further.

The people at Washington not only did this and were innovative in their approach to including this learner, but then wrote it up for the academic medicine scholarship. I think people have these moments where they have learners with disabilities, whether they were forced to, because, you know, we have to follow the law or because they wanted to just for the social justice perspective, you know, this is a learner in our program and we're going to be inclusive either way. They have that “aha!” moment. And what I generally do when I hear about those things, I just did it for our department of surgery and we just submitted a piece, I come in as kind of the cheerleader and I'm like, "This is great. This is great. You have a great attitude."

The clerkship director is like, "This was no big deal." And I'm like, "I need you to put that in academic words, in a paper," because I think the thing that we failed to do in disability, where we do it with everything else is to see the potential for scholarship in this space and to write up these case studies or these theories, and to disseminate that to our peers, such that the next time a person is in a position where they're going to be including a learner with a disability, and they're fearful, if they were to look on PubMed or Google scholar, or what have you, there would be some guidance there. Somebody else that had gone through that would have been able to maybe squash those fears a bit. I think it's also a great resource for disability resource providers or other individuals that are in charge of determining reasonable adjustments or reasonable accommodations, to be able to go to a clerkship and say, "This was successfully done at Stanford, and at the University of Washington, and at UCSF, and at Rush University and at Northwestern."

Lisa Meeks:

And when we start talking about the inclusion of individuals with spinal cord injuries in medicine, I can give you coast to coast, examples of schools that have successfully done it. And you have this mounting evidence that it is not only not impossible at the end of the day, it's not a big deal. Then you have a really hard time justifying the exclusion of a learner and saying that it's not possible. And not only do you have a hard time doing that just as an ethical, moral, logistical issue. But also, if it were to become litigious and all of these other people have done it, and all of these other people have written about it, it becomes really difficult to legally defend your actions. So, I'm getting a two bird, one stone situation with the manuscripts, with the scholarship because it shifts the conversation, it changes the norms, and it gives people a defense if they need it.

Peter Poullos:

Oh, Lisa, you, every time you talk, it reminds me of why I am your protégé.

Lisa Meeks:

(laughs)

Dinesh Palipana:

I love, I love the grand plan. That's cool. Yeah.

 

Sofia Schlozman:

In this final section, listen or read along as Dr. Palipana shares his advice for learners with disabilities seeking to enter medical professions and his advice for the educators who work in medical institutions.

 

Lisa Meeks:

So, the podcast was developed out of this need to provide mentorship in a situation where there are hardly any mentors available for learners.

Dinesh Palipana:

Mm-hmm (affirmative).

Lisa Meeks:

And so it’s this kind of asynchronous mentorship. The learner can log on, can look at the podcast, can choose who they wanna listen to and get some golden nuggets, some advice to help them kind of navigate the (laughs), the sometimes landmines of academic medicine, or whatever profession.  

Dinesh Palipana:

To the learners, and this is a bit more of a philosophical piece of advice. I've been at points in my life where I've looked back, and I've thought about the future. And I decided that I don't want to live with any regrets when I look back at my life. So, when it comes to the end of the day, and when it comes to certain checkpoints in life, you are going to be the only person there, and you are going to be the only person that can be held responsible for your choices. All the people that might've provided barriers, or that might've challenged you along the way, that might've tried to stop you, they're not going to be there. And they're gonna be living their own lives, doing whatever else. So, it's going to be you holding the check.

Dinesh Palipana:

So, my advice is don't let them stop you from living the life that you want, and don't let them get you to a point where you have regrets, keep going and find places and find ways and challenge systems, and challenge people. Keep going so you can get to a point, look back and be happy that you've done everything you can to live the life that you want. And that is really, really important. To the faculty, educators, to senior doctors, and to whoever else, inclusion is really important for so many reasons. It's not just a legal requirement but it's beneficial. It increases efficiency. It benefits organizations and teams, and it's so valuable, but it's really up to you. It's up to you to be allies, it's up to you to be leaders, it's up to you to be thought leaders, and you have to be heroes to do it. So, please think about doing the right thing. Think about fighting for people and think about leading the way, because with you the change starts.

Lisa Meeks:

That was lovely. Well, it is a pleasure to have been in your company this evening. And I know I'm a huge fan, and I think we're all across the country, just watching you with amazement and everything you've done for Australia and New Zealand and educating people on the value of doctors with disabilities, and anything we can do to support you we're always here. But it was my pleasure, and I know Pete's pleasure, to speak with you this evening and thank you so much for coming on the show.

Dinesh Palipana:

Thank you, you've supported me in ways that you probably don't even know. And there's a mutual fan club going on here, so I'm a big Lisa Meeks fan.

Lisa Meeks:

(laughs)

Dinesh Palipana:

So thank you for everything that you've done for making the road easier for people like me, and people going through similar experiences. 

Sofia Schlozman:

To our guest, Dr. Palipana, thank you so much for joining us for this episode. I speak on behalf of the entire Docs with Disabilities team when I say that we are so grateful, not only for your willingness to share your thoughts and ideas in this interview, but for the work you do every day to advocate for people with disabilities across the world. 

To our audience, we hope you found this conversation impactful and meaningful. If you have not done so already, we highly encourage you to check out the other episodes in our BIPOC voices series. Thank you so much for listening to our podcast. We hope you'll join us next time.  

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

Music:

  • “Positive and Fun” by Blue Dot Sessions

  • “Donnalee” by Blue Dot Sessions

  • “Aspire” by Scott Holmes

  • “Gambrel” by Blue Dot Sessions