Dr. Meeks interviews Dr. Marley Doyle, a psychiatrist with a visual disability. Through a recounting of Dr. Doyle’s experiences, they touch on several items, including the ethical responsibility to disclose a disability, the difficulties surrounding disclosure, the choice of a specialty that will not impose concerns regarding patient safety, mentorship specific to disability, the critical need for role models and messaging around disability accommodation.
Dr. Marley Doyle, MD
Episode 4, Transcript
DocsWithDisabilities Podcast #4
Dr. Marley Doyle
Lisa Meeks, PhD, host
Marley Doyle, MD, interviewee
Introduction: 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 Docs with Disabilities 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 researchers and policy makers that ensure medicine remains an equal opportunity profession.
Welcome back to the Docs with Disabilities podcast. Today we chat with Dr. Marley Doyle, a psychiatrist. Dr. Doyle is an active social media user and is connecting users with resources and her perspectives on inclusion in medicine using the #DocsWithDisabilities hashtag. She’s been a great conversation starter on social media and, as a medical educator, is uniquely positioned to help create a more accessible and diverse environment for the education, training and practice of physicians with disabilities. Let’s listen or read along as Dr. Doyle introduces herself and reveals the trajectory and eventual diagnosis of her disability.
Hi, I am thrilled to be here. I'm Marley Doyle, and I am a psychiatrist practicing at the University of Nebraska Medical Center in Omaha, Nebraska. My story begins probably way earlier than I actually acknowledge that it did. So, I actually probably have had my vision condition since birth, but it really didn't get recognized until I was just about to go to college. For a while, the diagnosis was a little bit unclear, and it was just a different time. It was the 80s, and I don't think people thought about disabilities in the same way as they do now. But I remember playing softball and there were a couple incidents where I didn't see the ball and got hit and running through screen doors.
But when I was in school, we had those clear projector screens where you put the clear paper and then it got projected. I could never see those, ever. And that was even when I had glasses, but it still didn't really make a lot of sense, but went about things and didn't really think too much of it. And finally, when I was in high school, one of the optometrists that we saw said, “You know, this doesn't really make sense. I don't know why I can't correct your vision to 20, 20. It really doesn't fit. So, at that point, went to an ophthalmologist and had all these tests done and what they told us was that it kind of looked like retinitis pigmentosa, which is a degenerative eye disease, or it looks like Rod-Cone Dystrophy, which is similar, but nobody really knew. And they just knew that it was kind of strange.
Nobody knew also then what that meant as far as progression or course, and we didn't really get a lot of direction. It was just kind of like, okay, we did these tests, here's what we saw. And then that was it. It affected me somewhat but not too much because I didn't really feel like I had a clear answer or direction. I think part of it too was that I was an adolescent and I think, you know, adolescents’ sort of have this sense that that bad things won't happen. So, I think it was a little bit of being naive and then a little bit of having this belief that things were going to work out and be fine.
Then I went to college and just sort of did my thing. I didn't really change my life. I was still driving at the time. Things were still kind of difficult. I always was a little bit clumsy, but then I would laugh about it, kind of make jokes about it with my friends. Most of my friends didn't really know anything. And so, I went through college like that.
Moving into the fast-paced environment of medicine forced her to reflect on any ethical duty to disclose. Let’s listen or read along as Dr. Doyle describes her angst, her eventual decision to disclose, how she built compensatory skills that reduced the impact of her visual disability on performance and how failure of the medical school to confirm her disclosure sent mixed messages about whether or not she should talk about disability.
I remember when I made the decision to apply to medical school, I had this debate about whether I should disclose my vision condition or not. And it really was something I wasn't sure about because most people on a day to day basis had no idea because I kind of had mastered the art of playing it off. And even in the classroom, I still wasn't able to really read the board or PowerPoints, but you just adapt.
And I got good at learning things by listening and picking up on context and things like that. So, I remember thinking, well, I don't necessarily want to include something in my personal statement. I was afraid it was going to be seen as a card that I was pulling, you know, like, oh, here's my disability card and using that. And then when I would show up for this interview, they would look at me and say, well, you look fine. So, on one hand I was worried about that, but then on the other hand I was worried about if I didn't disclose. And then later if I asked for accommodations or even worse, what if something bad happened because I couldn't see would I be held liable for something?
So, all of these things were going through my head. I didn't know what to do. I didn't have anybody to mentor me on this. I don't come from a hugely medical family. My grandma is a nurse, but I didn't have any physicians that I knew. So that was tough. And that was, I think, the first time that I really had to sort of face my condition and think about how it might affect me long term.
When I think about why I went to medical school, it's kind of an interesting choice because I wasn't somebody that went to medical school and then had a disability happen. It was, I decided to go knowing that I had a disability but wasn't greatly affected at the time. So, I think, again, I didn't really understand or know how far it would go. And so, I think I was hoping for the best, that it would sort of just stay at the level that it was currently at. So again, this denial a little bit, which isn't exactly unhealthy at certain times in your life, but I think at that time that sort of was fueling a lot of my decisions. And also, just proving that I could do things. Because I think when you have a disability, you often feel that you're having to prove yourself and oftentimes be better than average because you're fearing that people might judge you or think of you in a certain way. And so, you feel like you need to be exceptional to prove yourself. So, I don't know if that was part of it too, but nevertheless I decided to disclose it in my personal statement.
People didn't read it to the depth that I assumed they would. It never came up in any of my interviews, so I didn't have to talk about it. And that was fine with me because at the time I was really kind of uncomfortable talking about it, but I was surprised at the same time that nobody really wanted to ask more questions. And I hope that things have changed now.
I hope that if I was going through this process now, somebody would've asked me, not just to catch me but just because they were interested in my story or interested in me as a person. And, I didn't get that. So that kind of left me feeling like, well, maybe it's not a big deal or maybe it is a big deal and nobody wants to directly talk about it so I shouldn't talk about it.
Students who are thinking about disclosing face fear, and sometimes partially disclose. In this phenomenon, students let out a little bit of information at a time, to test the water and see how people might respond.
I do think that there is discomfort about offending or saying the wrong thing. I now help out with interviews for our residency program and there's this list of questions you can never ask, right? You can't ask about pregnancy or all these things. And so, I think people put disability in that category and are just almost afraid that it's going to be some sort of interview violation if they ask about it. So, it is an interesting conundrum for people when you're talking to them because we just aren't very skilled at talking to people about challenging things, whether it's disability or whether it's another loss that they are going through. I think we just have a hard time with that.
It was surprising since it was such a big deal for me because it wasn't something that I was, in my personal life, really sharing a lot and talking about. And so, it felt like a big deal to me that I included it. I don't know what I was expecting, but it was just sort of like, wow, I just did this big thing on a personal level. And then it was kind of met with nothing. Right? So then, in some ways that was reassuring because the world didn't end when I disclosed. I still got into medical school. But then in other ways it was a little bit invalidating where it almost felt like, okay, I talked about this and now nobody is talking to me about it. So, I don't know what to make of that.
I talked with Dr. Doyle about whether her choice of specialty was heavily impacted by her disability. Let’s listen or read along as she discusses how her declining vision and lack of career counseling definitely played a role in her decision to become a psychiatrist, but how it’s a career that she loves.
I don't know if I would have chosen psychiatry if I was fully sighted, but I like to think that I would have. I really love my job. I really love psychiatry as a specialty. I would choose it a hundred times over. I do feel lucky that the stars aligned and that kind of matched up as well as it did. But it absolutely played a factor because I didn't get any career advice or career counseling about this from any medical providers. But I do remember kind of having this flash of insight of, well, if something does go really wrong, I need to be able to do my job, and that wasn't going to be anything procedural.
I really liked other specialties, so I really liked cardiology. I really liked neurology, but I didn't feel like they were going to be possible for me. And I think that's kind of another hard decision point for somebody with a disability because, on the one hand, you're told you can do anything. You don't want to let your disability limit you. But then on the other hand, that's not really the reality because there are certain things that you can't do. And so, you have to figure out a way to do it on your own terms so you still have control over it. But I think that was a little bit hard because even though I really liked psychiatry, there was a part of me that resented not being able to do something else. Choosing a specialty was difficult because of these competing, conflicting emotions.
Given her role in medical education and her status as a person with a disability, I asked Dr. Doyle to share her thoughts on how medical schools and training programs might improve practices, starting with how they communicate about disability inclusion.
You don't want to make people feel like they need special treatment because you want them to be included just like their peers. But at the same time there is consideration. I actually think that the best point of entry would have probably been from my ophthalmologist. Just even having the conversation about, “Hey, how are you coping with this? What have you been thinking about?” Or if they weren't going to have the conversation then directing me in some way to get the resources I need, whether that be through an occupational therapist or disability informed guidance counselor. The school has some role too. For example, when I disclosed in my personal statement about the vision condition, it does seem like some follow-up maybe should have happened when I started medical school.
Just, “Hey, here are the services we have,” and that really wasn't done. To be honest with you, I had no idea that I could get accommodations until I was in residency. I didn't know what an accommodation was. I didn't know any of that. And so, I do think that somewhere along the line somebody maybe should've reached out because I just didn't know what was available.
I think I was afraid that people would question whether I could be in medical school or whether I belonged or whether I could even do the job. And so, I think that that was part of it too, is that even if that statement would have been made, it also has to be followed up with a statement of, if you have an accommodation, that doesn't mean that it's going to be held against you in any way. Because I think that was a major fear of mine. And so, whether it was implicit or explicit, I did feel like asking for help would definitely be frowned upon. As a person with a disability, even just that acknowledgement that, yes, we know you're capable, is huge.
Next, we moved to the nuts and bolts of how Dr. Doyle traversed the medical school landscape and how simple changes to the presentation of materials would have improved the learning environment for her and for others.
The first two years in the classroom, our medical school was great in the sense that all of the lectures were podcasted. And so that was wonderful for me because I couldn't see the PowerPoint. But, knowing that the lectures were podcasted, I could go back and listen to the lecture, increase the speed, and get the information then go through the PowerPoint on my own if I needed to, on my computer where I could see better. And that was not anything that I needed accommodation for. That was just done for every single lecture. So, I didn't do any accommodations during that time.
I did have a really hard time in anatomy because you have to pick out pretty small things. And one of the troubles that I have is with color contrast. So, I remember that the strings and the tags that they used were not very differently colored than the things that we were trying to point out. I just remember it was really difficult to pick out the tag and then identify it. And the worst thing is with those tests is that they're timed. So, I think you have 30 seconds or a minute at each station. So, I felt like it would take me, you know, at least half the time to even find the tag. And sometimes I still couldn't even find it. Then to have to worry about what you were trying to identify. So that was really hard. I didn't ask for any accommodations for that. Now, at a very different point with my disability, I certainly would have. But at the time, again, I was afraid, with my first semester I didn't know how it would be received. But it was such an easy thing. A TA could have just pointed out where the tag was. Like it would have been so simple.
Sometimes the power differential in medicine keeps students from reaching out. Learning to talk about struggling, difficulties and disability in a positive manner would likely reduce some of the Stigma and encourage a more open discussion between the learner and the faculty, facilitating equal access.
It's hard to imagine that nobody noticed. Maybe people just didn't know what to say or were afraid of pointing something out. But, it's hard to imagine you wouldn't have noticed that I was struggling. As a teacher now of medical students and residents, I try to be really aware of that in remembering what it was like and how it felt to have nobody notice. And so, I do try to do better about that because sometimes you just need somebody in the position of authority to say, “Hey, I noticed this, what's going on?” And then that allows you to have permission to say something whereas maybe you don't feel like you can do that without kind of having somebody reach out like that.
All medical students struggle with the thought that something they do will harm a patient. For those with disabilities, there is often a hyperfocus on this concern, despite the lack of evidence suggesting any increased risk. Dr. Doyle addresses her feelings as a medical student with a disability and how her disclosure and open communication helped alleviate these fears.
I struggled with this fear that I was not going to be able to see well enough and I was going to mess something up and have some grand effect on somebody's health. That became very prominent on surgery, which actually led me to have to disclose it to my medical school for the first time because I was about to start on my surgery rotation. And I just remember being like, I don't feel good about this because if I'm in an OR and I'm asked to suture, I can't play it off. I can maybe pretend I can see a PowerPoint, but I cannot pretend that I can see somebody's blood vessels and feel good about that. So, it really forced me to disclose it in a way that I hadn't had to before.
Actually, everybody was pretty reasonable. They just said, “Okay, well what can you do?” And helped me be in the OR but not have to do anything that required really fine vision. That was nice because I felt like I could be part of the experience, though there wasn't any kind of accommodation in the OR itself.
The other rotations and procedures were hard too. If you looked at me, you probably wouldn't know. But then I didn't feel really great when an attending or a resident would ask me to do a procedure. I would get this like just really intense anxiety and be like, I think I have to say something cause, I don't feel good about just pretending. I just don't feel like that's responsible. It was that constant stress for that entire third year. And you know, in medical school you have to do all the rotations. That was challenging and I was so relieved when I finally started residency.
Dr. Doyle eventually used accommodations in residency and discusses how the positive experience and having a knowledgeable program director impacted her confidence in disclosure and requesting accommodations once she moved into fellowship and employment.
I was starting to have trouble with the electronic medical record. I would have all these workarounds and I could do the screen in a certain way, but it really was getting to the point where I felt like I was becoming less efficient. It took me longer to find things. And so, I was a second-year resident and I did the same thing. I disclosed in my personal statement, but again, nobody asked about it. It never came up again. Finally, I went to my program director and I said, “Look, this is what's going on.” And she was shocked, and she said, “Why did you never say anything?” And I said, “I thought I did. I thought I disclosed it in my personal statement. To me, I thought that was enough.” But, she was like, “Well, no, I mean, it would have been kind of good to know we would have helped you way sooner.”
Her name's Dr Joan Anzia, and this was at Northwestern. She's amazing. She was so supportive and helped me because her response was just, “Well, you know that you can get accommodations, right?” And I was like, “No, I don't know what you're talking about.” And so, she got me in touch with somebody from IT and we got the computer thing figured out. And they helped pay for it, which I was at the time just shocked about because I thought I was going to have to front the bill or something. And she was just like, “No, this is your right. You are able to request accommodations in as long as they are reasonable and allow you to do your job then that's our job.” And I had just never heard that message before. It really was so freeing because I really felt like I asked for help and then I got this very supportive response.
That was great. I learned a lot because I could use technology in a way that I had never been able to use it before. It was life changing because the technology was also improving. The iPhone had come out. There were all these different kinds of things that I could use in my day to day life to allow me to kind of continue to do and work at the same level that I was working at before, which was amazing. Cause I really was questioning how long am I going to be able to do this for? So, to get permission from somebody in authority to kind of allow you to succeed when you didn't know if it was possible was a game changer for me.
It shifted things for me because then when I went to apply for fellowship, after I was accepted, I said, thank you for accepting me, but here are the accommodations that I'll need. And just started the conversation from day one, which was helpful because then everybody truly did know because it wasn't like, oh, I kind of included this in the statement and I was sort of expecting that to be my disclosure. It was kind of like, here's what I need to allow me to do my job. And just so you know, this is something I have. I was so relieved that nobody questioned whether I could do the job. And I was able to do that with my first job and then every job thereafter too.
This journey has been hard. But I also think being a physician puts you in a place of privilege because I can walk into a job and say, I need this, this, this, and this, and people will do it. I don't think people that have other jobs necessarily feel that empowered to walk into a job and do that. I have a sister who's a nurse for example, and she did not feel like she could do that with her first job. And I have a brother who works outside of the medical field, and he did not feel like he could do that when he entered a job.
With a ton of experience and a passion for medical education, Dr. Doyle now advocates for the inclusion of qualified learners in medical education and is excited about the push to include disability in the greater scope of diversity.
The further I get in my training and the more leadership positions I take on, I have to be honest, the easier it is to disclose. I have felt a little bit freer to say what I need. And I think that just gets back to one of the things that I feel like I got in my medical training was this fear that it's a weakness. That if you disclose, people are going to think less of you or that you can't do your job. But in truth it's really not. I truly believe it’s a strength because I think it you to relate to patients in a lot of different ways. It has this wonderful life experience that it gives you. But that's not the way that I saw it going through my medical training and I had the fear that other people shared that same sentiment. I just want to let people know that are in training that that is not how it should be viewed. It should not be viewed as a weakness because it really gives you unique skills that allow you to be a wonderful physician.
What got me to start advocating was this realization that I was kind of trying to be a model. And what I realized is that I didn't really feel like I had anybody to model or advise me on this when I was going through. And I really wished that I did. I was thinking, well, if I didn't have that, chances are other people don't have that either. So, wouldn't it be great if I could be more vulnerable and talking about it because chances are I'm not the only one that experienced that. And so, I kind of got this sense that I wanted to be able to give back because I did have some really wonderful people along my journey that were really supportive. And that was truly life changing for me. And so, I thought, if I could kind of be even a fraction of that to somebody else, like that could have an impact for generations of medical trainees to come.
And also, I felt this desire to say, look, yeah, this is part of me, but it's not the whole part of who I am and I still can do all these other things. I think that by being a little bit more vocal as a group, it's going to decrease the stigma. What I found when I was going through training is I felt it was very stigmatized. I felt like I couldn't talk about it, but that was partly because people weren't talking about it. So, I think it's partly a desire to change the culture that we have around disabilities in medical education.
Dr. Doyle reflects back on her experiences with disability, her decision to disclose, life after disclosure, and the huge impact that transparency in the process for requesting accommodations made on these decisions. She also discusses the responsibility that institutions and organizations have in helping normalize disability and model inclusive behavior.
There's been these points in my life where I've had to make a decision. So, I talked about the personal statement and then disclosing or surgery. It really has gotten to a point where I really needed to start using a cane. I had had a couple injuries, and it just was getting to be unsafe. And I was going to this conference. I was traveling alone. I thought it was going to be really hard. And it was, but honestly it was great because I didn't feel like I had to play it off, because it was just out there, and people were so helpful.
There was a time at the conference where I was in the lunch line and somebody just without even being prompted was like, “Oh, okay, well we have Turkey sandwiches, ham sandwiches, and a veggie sandwich.” And I thought that was so helpful and so nice because usually what I do is I just grab whatever sandwich and hope that I like it. It was just so helpful to have people know and I was amazed at how helpful people can be without even being prompted when they just have the correct information.
And it kind of made me question all these other decisions I had made in my life about when I didn't disclose. But I do think a lot of it is, humans don't necessarily know what to do or what to say when is unknown. But with using a cane for example, then they kind of know and then they act accordingly. But it made me think about all the people that have these invisible disabilities because I feel like people are really good when they can see it. Oh, okay. I can see that you have a cane. So now I know what to do. But when I had the same vision condition before and wasn't using a cane, nobody knew what to do. And so, it made me think of all the people that have chronic pain or psychological disabilities or things like that and how that adds an extra challenge to the person in a way that isn't as apparent as somebody that has a more visible disability.
I will tell you what made all the difference. This recent conference I went to where I use my cane, when I was registering, they had a separate question that said, will you need any kind of accommodations and if so, what would you need? And I had never been asked that on a conference registration before. When you're in a position of authority or you're doing some kind of clerical application forms, you can make such a difference by just phrasing a question. That allowed me to feel like I could say, “Yes, I do need accommodations.” And then a couple days later I got an email saying, “Hey, we saw that you had a request for accommodations. What do you need?” And that was amazing.
I think that that kind of modeling normalizes it and allows the person with a disability to ask for what they need. Whereas when you're just filling out a normal conference registration, it's never asked. So, it would take quite a bit of effort, first of all, to find out who you even email, what you do, what is available. It's a lot of work. For a lot of people, it’s like, I don't even know where to start. So, I think that if the conference can just start the conversation and allow it to happen, that would make all the difference in the world.
We end our discussion with Dr. Doyle’s candid advice to those individuals with disabilities who may be considering medical education.
If you are considering medical education or medical training at all and you have a disability, it should absolutely be something that you should consider and just know what you have available to you, which is accommodations. But that being said, even if you have accommodations and the most supportive school in the world, it still is a hard road because medical school is hard for everybody. It's even harder when you have a disability, even with the best accommodations. You're going through two challenges at the same time. And yes, everybody does have challenges, whether it's in your personal life or medical conditions, but it's a little bit on a different level, I would say.
I found that it's challenging but then also a little bit isolating because you don't feel like there's a lot of people that can relate to you. So, one thing that I always think about and encourage people to do is really shore up your support system to allow that level of support to occur. So, when you are going through a hard time or you have a question, you kind of have a community of people that you can rely on. Social media has been wonderful for this because you might not have somebody at your institution, but there's really great communities on social media that you can access at any point. That might be a good avenue or it might be really supportive friends and family or a select cohort in your medical school. Or maybe it's a community organization. A lot of cities have low vision clinics and support services through the community. So, whatever it is, I think you should do some research beforehand. Focus on how you're going to get your circle because you're gonna need that to kind of get through some of the tough times.
I am so indebted to Dr. Doyle and all of the DocsWithDisabilities interviewees. By sharing their experiences and providing advice for the listeners, they are helping to make medicine a more inclusive profession and in doing so, positively impacting the care and health of our patients.
Join us next time when I interview my dear friend and colleague, Dr. Michael Argenyi.
This podcast is a production of the University of Michigan Medical School, Department of Family Medicine, MDisability initiative. The opinions expressed in this podcast do not necessarily reflect those of the University of Michigan Medical School. It is released under a creative common, attribution noncommercial, monoderivative license. This podcast was produced by Lisa Meeks and Kate Panzer.
*This podcast was created using excerpts from the actual interview and is representative of the entire conversation. Interviewees are given the transcript prior to airing. Some edits may reflect grammatical and syntax adjustments for transcription purposes only.