“I Can Understand Where They’re Coming From”: How Clinicians’ Disability Experiences Shape Their Interaction With Clients

Professional Identity in Health Education

Most of the existing research on clinicians with disabilities focuses on the barriers they face. In their reflection on the formation of medical students’ professional identities, Wong and Trollope-Kumar (2014) list multiple factors that play a role in the process of identity formation, including prior experiences, role models, curriculum, patient encounters, and societal expectations. During their training, clinicians with disabilities experience institutional pressure to conform to a professional identity (Coulehan, 2005; Fergus et al., 2018) detached from their preexisting identity that might be informed by their disability experience. As a result, they often experience a disconnect between their personal and professional identities—as they progress through their training, students often express anxiety about losing aspects of their preexisting identities in the process (Wong & Trollope-Kumar, 2014). In addition to dealing with issues of identity, the competing discourses of competence and caring privilege biomedical expertise (e.g., technical expertise and clinical skills) over soft skills in clinician–client relationships (Apker & Eggly, 2004; MacLeod, 2011).

Related to the process of a clinician’s professional socialization and identity formation is how professionalism is defined and perceived among clinicians. Research shows that stigmatization and marginalization of disabled clinicians when they are viewed as inferior relative to their able-bodied colleagues is a common experience of health professionals with disabilities (Bulk et al., 2017; Easterbrook et al., 2015). The societal and the institutional discourses about disability when the programs and structures themselves are not designed for someone with disability serve as mechanisms for such marginalization (Graham et al., 2015).

Cultural Factors in Clinician–Client Interaction

Communication between a clinician and a client is an important factor that leads to positive health outcomes (Levinson et al., 2010; Thompson & McCabe, 2012), including the effectiveness of the treatment (James, 2016). Race, ethnicity, religion, gender, sexual orientation, and age are recognized in medical education as domains in which various groups may have different care needs and values (Eddey & Robey, 2005). The clinician–client relationship is strengthened when clients identify with their physicians based on common personal beliefs and values (Street et al., 2008). Strategies that address racial, gender, and ethnic diversity, and inclusion strategies as well as shared ethnic, racial, linguistic characteristics between a clinician and a client (cultural concordance) have the potential to improve experiences in health care settings for people with disabilities (DeLisa, Thomas, 2005).

For cultural concordance to be meaningful, it needs to be based on lived experiences informed by an individual’s social location (i.e., how we are perceived by other people, how we are classified by societal institutions, and how we identify ourselves; Zerubavel & Wright, 2012). One of the examples of how cultural concordance manifests is the archetype of the “wounded healer” (Zerubavel & Wright, 2012, p. 482). It was developed in psychotherapy to demonstrate how a clinician’s own past or present wounds can sometimes facilitate an emphatic connection with clients (Zerubavel & Wright, 2012). The occupational therapy literature also illuminates the therapeutic potential of clinicians who can draw on their insights, perceptions, and judgments (Solman & Clouston, 2016; Taylor et al., 2009) and adapt to the clients’ needs and characteristics.

Both clinicians and clients bring many factors to bear when they enter a clinical encounter, including their personalities and cultural backgrounds (James, 2016). Misunderstanding underlying cultural factors can have an adverse effect on clinician–client communication, trust, and, ultimately, their treatment (James, 2016; Nivet & Fair, 2016). A client’s clinical experience can have considerable impact on their health outcomes, and shapes their perspective of the health care system (James, 2016; Shakespeare, 2018).

People with disabilities often experience poorer health outcomes because of the physical (i.e., inaccessible medical equipment, inaccessible location) and attitudinal barriers they encounter when accessing the health care system (Smith et al., 2011). One of the significant attitudinal barriers include poor communication between health care providers and clients with disabilities (Shakespeare, 2018). There are also reports of a significant discrepancy between how health professionals are trained to view disability and the lived experiences of many disabled people (Shakespeare et al., 2009).

One of the factors that contributes to this is the hidden curriculum (which refers to an important component of health professional education) that draws on organizational and institutional contexts and cultural subtexts (e.g., role modeling, informal conversations, interactions among faculty and students, the structure of power and privilege, and the architectural layout of work environments) to shape how and what students learn outside the formal and intended curriculum (Hafferty & O’Donnell, 2015). In fact, the consequences of the hidden curriculum can be far reaching, influencing outcomes at the individual, policy, and health system levels (Basnett, 2001). For instance, the difference in health outcomes for people with disabilities and without disabilities is substantial; yet, they are often dismissed because of beliefs that these differences are caused by the condition that led to the disability or that poor health was present first and subsequently led to an impairment (Krahn et al., 2015). Some of these experiences are rooted in the biomedical tradition that only appreciates diagnostic explanations (Frank, 2000) without also considering the social determinants of health (Raphael, 2016). Many clients with medically unexplained illnesses complain that they do not feel taken seriously by their doctor because of the ambiguity of their symptoms (Malterud & Solvang, 2005), and the task of navigating the biomedical expectations of being “a good patient”—someone who is obedient and positive (Sointu, 2017). Such attitudes along with the experiences of invalidation can result in clients disengaging from health services (Stone, 2014).

Disability Epistemology

Disability is both sociopolitically and materially constituted by the structural contexts and specific individual embodied experiences (Erevelles, 2011; Price, 2011). This concept reflects the multilayered complexity of the concept of disability, which can be either a mental or physical state (or both), as well as a societal construction that assumes “disabled” and “non-disabled” are self-evident categories. Epistemology has traditionally been associated with the scientific, value-free approach to knowledge production. Disability experiences are traditionally placed within a realm of medicalized categories of illness, health, and pathology. Disability studies scholars counter this approach by exploring “the social implications for bodies deemed excessively aberrant” (Snyder & Mitchell, 2001). In other words, disability studies have problematized the positivist approach by foregrounding disability epistemology, whereas knowledge/expertise is produced through an embodied, biographical experience often informed by the fact that disabled people are confronted with obstacles or problematic situations that can prompt enquiry and invoke a particular and reflexive insight (Nijs & Heylighen, 2015).

As a result of the deeply embedded epistemic asymmetries (i.e., privileging of one form of knowledge over another) between an expert health care provider and a client, an epistemic injustice, or the lack of appreciation for an experiential knowledge, occurs (Blease et al., 2016; Carel & Kidd, 2017). As such, the patient’s authority as a knower of their body and mind is questioned, discredited, or ignored in the context of a mainstream medicalized approach (Armentor, 2017), and further dismissed through “negative stereotyping associated with some of the [patient] speaker’s characteristics (e.g., race, accent, age, gender, disability)” (Blease et al., 2016, p. 551). In contrast, an approach that embeds epistemic humility recognizes the boundary of the health professional’s own expert domain and the potential contribution of clients with disabilities in knowledge production (Ho, 2011). Accordingly, a clinician’s own disability experiences can improve the quality of care and introduce disability cultural competence (Garland-Thomson, 2017; Robey et al., 2013) that can extend diagnostic and medicalized views of disability to include a social, cultural, and political understanding of what it means to live with disabilities and be counted as disabled. The idea that a clinician’s lived disability experience adds an epistemic value that will in turn result in better care does not suggest an automatic erasure of any differences between disabled clinicians and their clients. However, it emphasizes that a lived experience of disability is as important and valuable as the competencies reflected in the institutional practices, policies, and language that shape learners’ perceptions of their role and identity.

There is growing recognition that professionals with disabilities can help reduce discrimination and barriers to health care (Iezzoni, 2016; Wong, 2016). In a study of physicians who have become seriously ill, Klitzman (2008) explores how the experience of being a patient has led many physicians to treat their patients differently by demonstrating increased sensitivity and awareness of systemic and policy-level issues. Knowledge from studies such as this has inspired disability studies scholars (Erevelles, 2011; Garland-Thomson, 2005; Linton, 1998) to advocate for using the idea of disability culture—a framework through which people with disabilities can understand themselves, their environment, and their experiences—to advance a conversation about the importance of promoting the inclusion of clinicians with disabilities. Disability culture emphasizes the sharedness of a history of oppression, stigma, and isolation, and of being disabled by social attitudes, policies, and everyday practices (Chacala et al., 2014; Marks, 2007; Smith et al., 2011). At the heart of disability culture is an explicit rejection that being disabled is negative and that disability is a deficiency or abnormality (Marks & McCulloh, 2016). The value of disability experience is articulated by Linton (1998) who writes,

Although the dominant culture describes the atypical experience as deficit and loss, the disabled community’s narrative recounts it in more complex ways. The cultural stuff of the community is the creative response to atypical experience, the adaptive maneuvers through a world configured for nondisabled people. (p. 5)

Similarly, Garland-Thomson (2005) suggests a “sitpoint” (p. 1570) theory ² that particularizes the experience of living with a disability to counter the normative assumption that one perceives the world from a standing position.

Despite a significant research in health education around diversity, cultural concordance, professionalism, communication, and theoretically rigorous disability studies that work on epistemology and the lived experiences of disability, more research is needed on the benefits of bringing in disability perspectives in health care settings.

Study Context and Design

Noting the gap presented by the literature to bring a critical lens to understanding the role of disability epistemology in shaping an epistemic connection in a clinician–client relationship, we conducted a study to answer the following question:

The research for this study was part of a larger study that used a constructivist grounded theory methodology to understand the barriers people with disabilities encounter as they enter the health care field. Although the larger study relied on a grounded theory methodology, the secondary study drew on constant comparative methods by sorting through the data collection, comparing incidents applicable to each category, and developing elements of the theory (Thornberg & Charmaz, 2014). Through this framework, the research team documented the properties of such concepts as advocacy, identity, and disclosure as they relate to the practitioners’ interactions with clients.

The research team consisted of individuals with experience in qualitative research and with backgrounds in disability studies, occupational therapy, social work, psychology, medicine, nursing, and education. This diversity of representation ensured multiple perspectives emerged during team meetings. In line with the second generation of grounded theory, the research team recognized the constructivist nature of knowledge that is affected by the researchers’ social locations (Charmaz, 2016)—interrogating the self is more than just examining one’s social location and its impact on the field; rather, it is a reflexive process that involves negotiating one’s positionality and recognizing the shifting nature of power relations (Hesse-Biber & Piatelli, 2007). In keeping with this, the research team considered the topic personally important while recognizing that personal connections to this research are not linear and cannot be viewed from a dualistic insider–outsider perspective.

The research study was approved by the university’s research ethics board. The study is based on in-depth interviews with 55 health care practitioners and students in professional health care programs (medicine, nursing, occupational therapy, physical therapy, and social work) at three universities in Canada.

Recruitment and Selection Criteria

Both clinicians and students were included in the study. To recruit participants, we engaged in the following strategies. First, an introductory email invitation was sent from key program personnel to all students, clinical/practicum supervisors, and clinical practice leaders. In addition, key program personnel and the research project team recruited through their networks and posted flyers on campuses and at associated clinical sites, as well as through university social media.

The inclusion criteria (which applied to both the larger study and this specific study) required participants to (a) be students or health care practitioners who had experienced temporary or permanent physical disability, chronic illness, or mental disability for at least 2 years, and that their disability experience or a portion of it had occurred during their schooling or practice; (b) be practicing or studying in one of the targeted health professions; (c) have experienced both academic work and fieldwork in their program; and (d) have provided written and verbal consent to participate.

Data Collection

Participant interviews were conducted between July 2014 and December 2017. The interviews were designed to elicit information on the following domains: the process of requesting academic and workplace accommodations, disability disclosure in academic and clinical settings, identity, stigma, and social support. Each participant underwent three semistructured interviews each lasting between 45 and 90 minutes and taking place at approximately 6-month intervals. This longitudinal approach supported a deeper, multilevel analysis and ensured that changes in individual experiences (including the transition from being a student to becoming a clinician) were captured but remained outside the scope of this article. Each interview was audiotaped, transcribed verbatim, and reviewed by the interviewer for accuracy.

Analysis

For the purposes of analysis, the data were categorized using theoretical sampling, a commonly used method in grounded theory (Charmaz, 2006). Theoretical sampling involves a process of data collection directed by evolving theory rather than by predetermined population dimensions (Draucker et al., 2007). As theoretical constructs evolve, precise information is sought to refine emerging ideas. Several of the researchers involved in the larger project independently analyzed the transcripts using a constant comparative method to generate initial codes followed by focused coding to specify the properties and dimensions of a category. During the focused coding phase, we selected what seemed to be the most useful initial codes and compared data with codes (Charmaz, 2006). Building on the initial rich category understanding, the research team determined what aspects of the interviews were most likely to provide empirical indicators needed for category development. A representative sample and interviews were collected across three sites. A concern about a theoretical saturation was addressed through a representative sample and a large number of interviews collected across three sites.

The coding was completed using NVivo qualitative software. After all the interviews were coded, the transcripts were reread to ensure all the nodes that refer to the client interactions were captured. The examples of the nodes that were identified as relevant included interpersonal interactions and support systems, the social self, advocacy, disclosure, and professional experiences.

Research Participants

Of the 55 participants who were recruited, the distribution of students (26) and clinicians (29) in the sample was relatively even. Most of the participants were either advanced-level students (who had completed the mandatory fieldwork component of their studies) or recent graduates who had fieldwork experience. The majority of the student participants were studying nursing (10), whereas most of the clinician participants were involved in social work (nine). The least represented field among students was medicine (one), whereas medicine (four) and physical therapy (four) were least represented among the clinicians.

The work experience of the clinicians ranged from 2 to 30 years. Many of the student participants had spent 2 to 10 years in different fields before joining a health program, whereas some of them had limited prior work experience. Of the later, several had worked at disability-serving community organizations or in other workplaces that involved human services. Of the 55 participants, nine self-identified as having had a learning disability, 16 had a mental health–related disability, nine had a mobility disability, 10 had a sensory disability, and the remainder indicated having a combination of different disabilities.

Building Rapport Through Understanding

Throughout the interviews, participants talked about what they bring to their interactions with clients with disabilities that clinicians without disabilities might lack. Although such understanding might originate from the shared experience of stigmatization and oppression, participants reflected on the nature of this deeper connection by recognizing that concordance and understanding are not about sharing the same diagnosis. One participant who described the experience of working with a client whose disability was different from their own noted how their personal experience allowed them to build an emotional connection.

I’ve never experienced not being able to walk for example. So, it might be a little bit harder to relate in that respect. But just, I guess the emotional part around that feeling I can definitely relate to, or frustration or why did I have to get this, versus somebody else.

The rapport established with a client and the trusting attitude toward a clinician can come from the clinician drawing on their lived experiences to inform their work. As one participant described, sometimes simply providing clients with a glimpse of how the clinician adapts to their disability can be more effective than describing it based on the official curriculum. One clinician—a wheelchair user—described how she demonstrated driving a car to a client. The client was a young girl who also used a wheelchair, but had limited exposure to people with disabilities prior to her injury.

They asked to come watch how I got my wheelchair in and out of my car, ‘cause I have a car not a van which this eleven year old was really interested in, she’s like I don’t want a van, how’s that gonna work, I showed them my hand controls, was able to let her know that oh yeah I got my license when I was sixteen.

The nature of a shared experience is such that it brings a sense of familiarity and authenticity with the potential to shift client–clinician power imbalances by appealing to a common humanity. Situations that are conducive to epistemic connections are characterized either by the similarity of the experiences (such as experiencing a similar treatment or encountering similar barriers) or by the urgency of the situation a client is in (such as when a client seems distressed and the clinician understands the need to build an epistemic connection to alleviate that distress). One participant emphasized the importance of recognizing when such shifts need to happen in an organic way.

I said “well, hey, like you know, I’ve dealt with some things too, like, I’ve been you know, dealing with depression as well.” So I just felt that was an appropriate place to share that. So, and it kind of, right away she was like, “oh well thanks for sharing.” And it seemed to kind of defuse her anxiety a little bit. I kind of wanted to just say, like, “you know, like, I’m not the nurse with power in this position, like, we’re all just people.”

An epistemic connection that manifests in shared understanding of a disability experience builds a deeper connection, trust, and a sense of rapport (particularly when it emerges organically) that can benefit a client the most.

From Understanding to Advocacy and Creative Approaches

Related to the idea of understanding is the notion of connecting personal experiences to professional settings and translating them into tangible tools and solutions. Disability adds another aspect to the relationship between a clinician and a client that involves advocacy and development of an alliance that shifts the less tangible idea of understanding to the more tangible realm of quality of care. The issue then becomes one of discerning how the rapport and understanding that arise from the initial connection can result in better quality of care and a truly personalized approach to clients’ needs. Many of the study participants emphasized that advocacy for their clients start with advocating for their own needs. As one of the participants said,

Self-advocacy involves recognizing that you have needs, and then accepting that they’re justifiable, and then acting on them to ask somebody to make a change for you, um, that takes a little getting used to.

Many participants noted that becoming a better self-advocate made them better practitioners. Moreover, as persons with disabilities themselves, many felt that they were better equipped to identify relevant and useful tools. Furthermore, their experiences of self-advocacy increased their determination to advocate for their clients and make sure their needs were better met. As an example, one of the participants—a mother with a spinal cord injury—created a video to improve care for women with the same condition who want to become parents. In this way, she used her personal experience to improve her clinical practice while also addressing a need for more information on being a mother with a disability.

As well, to avoid a reductionist approach to viewing a client, clinicians with disabilities have a sense of the complexity of the individual experience entwined with the context that he or she lives in. Participants commented on their ability to translate their understanding of this complexity by avoiding one-size-fits-all approach in their practice.

I think those experiences were helpful for me . . . And when I’m recommending a strategy, I feel like I have more personal experience now, as well as my clinical experience, that, “this might work for you, why don’t you try it out.”

If understanding and advocacy facilitate the epistemic connection between a clinician with disability and a client, there are several factors that might prevent it from occurring, and that make clinicians juxtapose profession and disability. These factors include concerns about client-centered care, perceptions of professionalism, concerns about disclosure, and concerns about making oneself vulnerable. In the context of client-centered care, any instances that foreground a clinician’s experience appeared as counterintuitive and unethical to some clinicians with disabilities.

Between Profession and Disability

Clinicians emphasized that clients should not feel that their story and their experience matter less or become secondary. In other words, the epistemic connection needs to maintain a focus on clients, not clinicians. It becomes a balancing act between trying to share enough for it to have a therapeutic/healing effect, and not sharing too much to avoid it being seen as deflecting attention from a client. Despite an overall agreement about the value of disability experience in clinician–client relationships, participants reflected on the challenges of walking the line between being a medical professional and being a person with a disability.

Some participants are selective about when to share their personal story because it can make clinicians themselves more vulnerable by bringing back past and often painful experiences.

In order to relate to a client, you have to empathize with them and in order to empathize with them you have to be part of their story, this is the thing. You have to open up and be there with, with them in their story. Now to do that you’re opening yourself up to vulnerability. And so if you don’t open up and empathize with your client, then you’re not doing a good job.

For many participants, being perceived as vulnerable is strongly associated with being less professional and more emotional. Yet, there is a no doubt that vulnerability is what it takes to build a deeper connection with a client. This dichotomy between what is defined as professionalism in health care and the role of personal experiences in professional lives is what needs to be addressed in clinical education and clinical practice.

The narratives of the research participants demonstrate that their own view of professionalism is dominated by the normative prescriptions of the hidden curriculum and the culture of the health care field. Professionalism is viewed as distinct from the lived experience of disability. It raises the importance of unpacking the construction of narratives around professionalism in the health fields’ curricula. The ongoing challenge of how professionalism in health care settings can be redefined to recognize the value of knowledge that is otherwise not conventionally seen as part of the clinical practice leaves many clinicians with disabilities struggling to navigate different aspects of their identity, and thereby feeling reluctant to cross the said line.

And one of the things that you have to do is be very professional. So I feel like me not disclosing that personal information is a way to make sure that I don’t blur those professional lines so that’s primarily why I haven’t done that while I’ve been in school.

In addition, the issues of disclosure and power imbalance become ethical dilemmas that clinicians with disabilities grapple with. Clinicians with nonapparent disabilities might have more control over disclosure compared with clinicians whose disabilities are more apparent; however, disclosure is partial and never absolute. Disclosure holds multiple meanings depending on a participant, and it needs to be considered to avoid reductionist understanding of clinician–client interaction.

Some participants felt uncomfortable sharing anything about themselves because of confidentiality concerns. The discomfort and stigma associated with disability create a culture of silence and discourage clinicians with disabilities to change that culture by making it more accepting of difference.

One of the participants brought up the issue of clinician–client’s lack of concordance. Although clients with disabilities tend to view their clinicians’ disabilities as a positive aspect, clients who hardly see any professionals with disabilities and who do not have a disability might express discomfort about a clinician with a disability. One of the participants shared the challenges of having to prove herself to her able-bodied clients. It becomes onerous and emotionally draining to put an extra effort into being seen as a professional.

The visibility of disability can affect what additional information related to disability a clinician is willing to share with a client. Some participants shared their frustration over the ways in which their disability prompts curiosity that does not contribute to the quality of relationship. In fact, it distracts from the focus on a client and separates the professional identity of the clinician from their identity as a disabled person.

Summary

This study explored the role that clinicians’ ability to draw on their personal experiences of living with a disability have on their interactions with clients and patients. Based on our analysis, we identified three social processes that interact as epistemic connections are formed: understanding, advocacy, and the tensions between having a disability as a health care professional and health care settings. The results reveal that students and clinicians with disabilities consider their personal disability experiences as important factors in shaping their clinical practice. A shared experience of living with a same or similar disability facilitates a deep sense of understanding that lays a foundation for improved quality of clinician–client interaction. The concordance (same diagnosis/disability) is not the only component of understanding. The emotional connection of simply knowing what it means to navigate the world with a disability, even if specifics of the individual experiences are different is also a component of understanding.

Once understanding has been built, clinicians can translate it into their practice. Understanding is a precondition to moving to advocacy and creative approaches. People with disabilities often talk about having to be creative when navigating an environment that is not built for them. Such unintended creativity provides outside-the-box solutions that clients can benefit from. The experiences of clinicians with disabilities being a self-advocate in the context of human and health services make them better advocates for clients. Practitioners with disabilities see the focus of their work not only on helping their clients but also empowering them by making sure their experiences are valued. Through advocacy and creative approaches, clinicians demonstrate how their ability to share commonalities creates authenticity that has a potential for transforming the culture in the health care industry.

However, despite the concordance and positive sense of mutual connection, the theme between profession and disability emphasizes the complexity of navigating the contextual environment as a professional with a disability and presents a potential barrier to realize a full potential of epistemic connection. In conjunction with the process of facilitating epistemic connections, clinicians’ experiences of disability may hinder it. The meanings of professionalism that tend to overlook the importance of identity-based factors and provide narrow definitions of the client-centered practice (Phelan, 2011) make it difficult for clinicians with disabilities to bring forward the aspects of their personal experiences into their practice. Clinicians expressed concerns about not being perceived as professional if they make their personal experiences of disability part of their interaction with clients. The expectations embedded in the culture of clinical and medical fields provide some context of how the notions of “professionalism” can discourage clinicians from invoking anything that can be considered personal.

Furthermore, clinicians’ ambivalence around self-disclosure that can often result in stigma and a sense of vulnerability hinders the process of renegotiating the terms of the clinician–client relationship. Recent studies (Jain, 2019; Stergiopoulos et al., 2018) suggest that the two strongest deterrents to students’ disclosure are their understanding of stigma and its associated risks to one’s career as well as a lack of institutional support. In addition, the need to balance the institutional perceptions about professionalism and client-centered care with the knowledge and values informed by the lived experience of disability made it challenging for clinicians to find validation of the positive role of their experiences in the current health care system. Participants with more apparent disabilities did not have the privilege of choosing what can be left unsaid. Mostly clinicians with disabilities who can “pass” contemplated their dilemma with disclosure. Creating epistemic connection can also come at a cost for some clinicians who might not be willing to make themselves vulnerable by bringing up painful memories or emotions.

Limitations

This article is a part of a larger grounded theory study and, thus, it does not attempt to provide a comprehensive picture of the area under study. Some of the limitations identified include a lack of perspectives from individuals who are not fluent in spoken English. Clients’ accounts could have enriched the discussion about the value of clinicians’ disability experiences and could have provided a truly two-way perspective on the interaction process. However, some recent studies (e.g., Mogensen & Hu, 2019) demonstrate community support for inclusion of people with disability as medical students and practitioners and corroborate the findings of this study. The participants represent a wide range of health and human service fields, and no assumptions can be made about the contextual equivalency of these fields. The study has not delved into unique characteristics of each field or specific practicum settings. Further research is needed to foreground the nuance of each field for professionals with disabilities.

Recommendations

Recommendations pertain to a close consideration of disability studies’ approaches in advancing discussion about diversifying health care workforce. In reflecting on the disconnect between the commitment to diversity in health professions and the realities of health care culture, Tsai (2018) writes that

once they (students from diverse backgrounds) are in school, they are told to leave what they bring to the table at the threshold of the hospital . . . Women are taught to emulate men (but not too much) and leave gender politics out of the operating room . . . Trainees struggling with chronic illnesses or disability learn early on not to associate too closely with their diagnoses. (para. 10)

The importance of clinician–client interactions for health care outcomes has been recognized, but diversification of the health care workforce through inclusion of individuals with disabilities is often superficial and tokenistic. Unlike other spaces, health care settings have a significant impact on the conditions in which that interaction takes place. The issues around privacy, disclosure, ethics, client care, and life and death situations create a challenging context for negotiating any personal experience of disability as a health care provider.

The participants struggle with navigating the blurry lines of being someone who can relate to a client and someone who needs to keep their distance to ensure the client-centered principle is not violated. The underrepresentation of health care professionals with disabilities can be addressed by measures such as increased transparency in policies and processes in both academic institutions and workplaces (Meeks et al., 2019), revision of the curriculum (Smeltzer et al., 2015), and transformation of the health care culture.

This novel exploration of the clinicians’ perspective in the specific settings of delivering a service to client may enable the participation of disabled clinicians in health professions by shifting the ableist point of view about what constitutes professionalism, thereby contributing to reducing marginalization from these professions. Furthermore, the benefits and the unique competencies, which disabled clinicians bring to health professions, as expressed by participants, should be considered when professional competencies or recruitment strategies to the health professions are being reviewed (Jarus et al., 2019).

Conceptually, the discussion of diversifying the health care workforce can be enriched by the critical disability studies that recognize the importance of critical disability studies as a knowledge translation project for health sciences. By defining disability as a sociocultural perspective that encompasses the politicized, phenomenological, and constructivist understandings of identity, materiality, and being, Garland-Thomson (2017) argues that disability is a very characteristic of being human and that it can contribute to the disability competency that proposes a nonprejudicial and positive view of disability.

She writes,

What critical disability studies can do is enlarge our shared understanding of what it means to live with disabilities and be counted as disabled. To do this, the insights and knowledge of critical disability studies need to be applied—to be brought into—medical science as a knowledge base and to its practitioners. (p. 325)

By invoking disability cultural competence, Garland-Thomson (2017) suggests going beyond sensitivity training. We need a new understanding that recognizes the full and effective participation of people with disabilities in society. The concept of disability cultural competence can be expanded to explore how epistemology of disability experience can be applied in clinical and medical practice through the stories of students and practitioners with disabilities. The model can provide the health care field with an opportunity to operationalize diversity by translating the presence of a difference into meaningful conversations and practices. Such rethinking of what is constituted as “knowledge” has the potential to provide a more seamless experience of professional identity formation, not only for clinicians with disabilities but also for all clinicians who embody their own life stories and experiences.