Diversity Matters: Changing the way the medical profession thinks about doctors

September 25, 2018  //  FOUND IN: Strategy & Leadership,

This story first appeared in the Chicago Tribune on Sept. 18

Chris Connolly chats with a classmate outside the Taubman Health Sciences Library. Photo by E. Jason Wambsgans/Chicago Tribune.

Like any mother who suddenly finds herself in a hospital waiting room, Helen Connolly was uneasy.

It was Feb. 28, 2007, and her younger son, Chris, had been taken to the Northwestern Memorial Hospital emergency room in Chicago — there had been an accident during his water polo practice.

Chris, who had turned 15 three days earlier, was a freshman in high school. He and Helen were close — he was her later-in-life child, a sweet, gawky kid who shared her curiosity and a measure of her intense drive.

“The nurse came out,” Helen said, “and said, ‘I’m sorry to tell you, but your son is quadriplegic.’”

Events seemed to blur — the family, including Helen, her husband Dennis and Chris’ brother, also named Dennis, were taken to Chris, and found him lying on a hospital bed, unable to move.

“He was saying, ‘Mom, what’s happening to me? What’s happening to me?’”

Changing roles

Eleven years later, Chris is in an exam room at the U-M Medical School. A doctor, with a clipboard, watches from the corner as Chris approaches a patient on the table.

“Please lift your left arm,” Chris said, peering at the skin along her outstretched limb a little self-consciously. It’s a routine dermatological exam — or a reasonable facsimile of one — except there’s nothing routine about it.

Chris is still a quadriplegic, having regained limited motion in his arms and legs only through unrelenting physical therapy. He is also a successful M2 who navigated an undergraduate education and master’s program in biology at Stanford and the rigors of applying to medical school. And that’s just the academics. He eases his wheelchair back and smiles at the patient. “Everything looks good.”

The dramatic change in roles Chris Connolly has experienced, from critically-injured patient to budding doctor, represents the convergence of a wide array of details: the school that helped lift him to extraordinary academic heights; the physical therapist who told him to walk; the teacher who questioned whether he could keep up; the engineer father who taught him to tinker and invent; the brother who didn’t give him an inch; the mother whose determination never allowed them to fall back.

It also represents the growing movement to rethink rules that have long prevented most people with disabilities from entering the medical profession. Disability experts estimate that he is one of only four or five medical students in the nation with his level of physical disability. The societal shift he represents aims not only to reinvent medical school standards and correct a profession that has largely exempted itself from inclusion of the disabled, but to change the way everyone thinks about doctors.

Connolly participates in a clinical training session. Photo by E. Jason Wambsgans/Chicago Tribune.

Leveling the playing field

Once you meet Chris Connolly, the question quickly becomes not how could he be a doctor, but why wouldn’t he be a great one?

Life at medical school is never easy, but as with most things Chris does, he must navigate an additional degree of difficulty. He does this with the help of his family. After class, he zips down the sidewalk to a spot where his dad can easily pick him up in a wheelchair accessible van. Helen and Dennis are now retired, and living with Chris in graduate student housing at U-M.

“We’re here,” Dennis said, “just to level the playing field for him.”

Chris must be up at 4 a.m. to make it to an 8 a.m. class. “I can do most things myself,” he said. “It just takes me a lot longer.”

He’s relentless when it comes to studying, attending lectures, then re-watching them online twice to make sure he gets all he can from each one. Physical therapy is usually accomplished by using electronic stimulation to move his muscles while he’s busy working. The walls of the apartment are decorated with motivational quotes, words (“Grit,” “Believe”) and photographs, including one of Muhammad Ali. His mom makes sure medical supplies are ordered, appointments get made, laundry gets done.

She has been his caregiver since the accident, and they’ve been roommates since he started college at Stanford in 2011.

On that terrible day when Chris’ life was transformed, his family — perhaps his mother most of all — was transformed too. Dennis and Helen had pursued careers — his as an engineer in private practice and as acting commissioner of Chicago’s Department of Sewers, hers as a special education teacher who also taught herself computer programming and day trading.

“My mom and dad raised us,” Chris said, “with the idea that it never hurts to try to do a little more. And I think that’s ingrained in my brother and me.”

‘Just start walking’

Helen spent more than three months sleeping in a chair beside Chris’ hospital bed at the Rehabilitation Institute of Chicago.

For Chris, “there was not a lot of progress,” said his brother. “My mom was trying to keep us all moving forward. But we were all depressed, him especially. I remember looking at him, and he just looked right through you, it was the thousand-yard stare.”

Yet, even early on, there was a sense of the road back. While other patients watched TV in the hospital, Chris listened to motivational tapes.

Progress came in hard-fought increments. Gradually, some function was returning to his limbs.

“I was eating chicken nuggets,” he said, “because they taste great, and realized that they were really burning my fingers. So that’s how I realized I had some sensation returning to my hands. So I highly recommend that method, eating chicken nuggets.”

He also found a mentor and friend in physical therapist Walter Guminiak, who bonded with the Connolly family.

“One day,” said Helen, “Walter told Chris, ‘OK, Boss, just start walking.’” Amazingly, Chris’ legs started to move.

“I think one of the most valuable experiences I gained,” Chris said, “was that it’s really great if you offer the best care you can give, but there’s a lot to be said for making people feel normal, as well.”

College-bound

Chris is a disciplined optimist, both by nature and of necessity, a person focused on his life’s forward motion. Today he describes his accident by saying, “That was one day in my life. There have been a lot of days since then, some of them less interesting.”

When it came time to apply for college, Chris’ high school counselor looked at his work and test scores and suggested that he apply to schools such as Stanford.

“I did not think, at all, that I would get in there,” he said, “because a lot of really, really smart people apply and they don’t get in. So my idea was like if they want me, great; if they don’t want me, I didn’t really expect a whole lot different.”

He wrote his college essay about the intense struggle to move his legs again — comparing it to scenes from “Star Wars.” Chris, and Helen, were headed to college at Stanford.

Though there were setbacks — a scrape in physical therapy, for instance, resulted in a major infection, landing Chris in the hospital early in his freshman year — Chris flourished, working in a disabled-student group and nailing his academics, finishing with a bachelor’s and a master’s degree in 2016.

Taking the next step

Medical school seemed like a logical next step. “I think being exposed to people in medicine for such a long period of time,” he said, “made me realize they’re not infinitely smarter than me. They’ve had a lot of training, and they are obviously smart, but given the academic nature of a lot of their work, I thought I could do it.”

He sent in applications, realizing that the barriers to entry were higher than any he had faced before.

Specifically, Chris knew that he would need to be able to meet a set of physical criteria, called technical standards, which medical schools traditionally require of all applicants. Though the standards differ from school to school, they often include things such as the ability to lift a patient or perform CPR, and were designed around the notion that a medical education produces graduates who are able to pursue any medical specialty.

“A lot of them,” Chris said, “are things that doctors don’t really do. I think you could have somebody who’s an amazing psychiatrist who may not ever really put an IV in. Does that make him any less of a doctor? Not really. So it made me think that I had to figure out ways to make sure that I would be able to complete everything just like everyone else.”

Connolly is changing the way medical schools think about technical standards. Photo by E. Jason Wambsgans/Chicago Tribune.

“The standards haven’t changed, basically, since 1973,” said disability expert Lisa Meeks, who published a paper in March for the Association of American Medical Colleges, which assessed access for disabled medical students. “What we haven’t kept up with is technology. Now … for the most part we can problem solve and find solutions.”

In her study, Meeks detailed a widely varying set of conditions for disabled medical students around the country. They ranged from broad acceptance and access at a few schools, to schools where disabled students felt stigmatized or frustrated by lack of accommodations.

Her research came about at a time when the medical profession has been grappling with the reality that they had practically exempted themselves from including people who are physically disabled among their ranks. And failing to admit disabled students to medical schools has played a big part in the lack of doctors with disabilities.

“There has always been this big disparity between the percentage of the physician workforce with disabilities and the percentage of our patients with disabilities,” acknowledged Rajesh Mangrulkar, M.D., associate dean for medical student education at U-M.

Mangrulkar has led a team that worked to shift Michigan’s requirements for medical school to a model that is workable for students with a range of disabilities. “We have been talking about this for years and yearning to align where we come from with where our patients are coming from. I see this as part of our diversity and equity and inclusivity initiative, to really broaden the pool of who comes into our profession, so that we can better serve our patients.”

As leaders at U-M began assessing their own standards, they looked at the state of technical requirements nationwide. “A lot of schools were very narrow, very rigid in their standards,” said Mangrulkar, “not really aligned with the Americans With Disabilities Act. The problem was, we weren’t having the right conversations as a profession.”

Part of those conversations, he said, was admitting that the idea of a one-size-fits-all medical education that turned out doctors ready to practice any specialty never worked. “Do we really know that every student will have the manual dexterity to be an outstanding neurosurgeon? I don’t know that we know that. So I think we had this false narrative that we were promoting for a long time.”

Shifting the focus

Instead, Mangrulkar said, the focus is shifting to turning out students who will be the best doctors “in the specialty they are right for. That’s a very fundamental change. And I think we needed that sea change in our profession.”

Some of the resistance to change in the medical community, he said, stems from the concern that changing standards might have an impact on the standard of care patients receive.

“I think some people might be concerned about what I would be doing as a physician,” said Chris. “But I’m aware of those things, and I’m not going to be an emergency room physician who has to respond to something within a few seconds. And as for what I’m doing right now, I’m doing everything that the rest of my classmates are doing.”

Re-evaluating the standards, Meeks pointed out, doesn’t mean lowering them. “I mean, just because you have a disability doesn’t mean Harvard should say to you, ‘Here, come to our medical school.’ You still have to meet the academic requirements. You still have to have the cognitive abilities.”

One bias that students with disabilities have to face, she said, is the notion that exceptions have been made for them. In fact, such students must still find ways to satisfy the basic requirements set forth by medical schools — but new standards allow them latitude in how those goals are achieved.

“People may say, ‘I don’t want somebody who’s disabled to be my doctor. I want the best doctor,’” Meeks said. “Well, we’re talking about people who have the same sharp clinical skills and abilities; they just happen to have disabilities. These are the brightest people in the country. It goes back to this: What do you think of when you think of a person with a disability?”

You might think of someone like Chris Connolly, Stanford graduate, driven U-M med student, whose plan is to manage his education and his disability with as much stubborn independence as he can.

“I think that I have to do everything everyone else is doing and maybe a little bit more at times,” he said. “I think that I have to figure things out that a normal person just wouldn’t. Like how do I use a stethoscope? How do I look inside a person’s ear?”

To that end, he began practicing techniques for clinical tasks such as taking blood pressure or using a stethoscope as soon as he applied to medical schools. “I wanted to be able to show people that I was going to make sure technical standards wouldn’t be a problem.”

When he discovered that he consistently dropped his stethoscope, he took a lesson from a childhood spent tinkering in the garage with his dad, got a few basic parts from Home Depot and made a handle that helps him keep his grip. U-M has now patented a 3D-printed version of that handle as a solution that can help other doctors.

“There’s always different people,” Chris said, “who will not give you enough credit when you say you can do things. So that has always been a bit of a motivator for me all along, just that I can do these things, they might be hard, but they’re hard for everyone.”

Acknowledging that struggle, said Mangrulkar, will help make Chris a great doctor. “The concept of us as physicians being more vulnerable with our patients is one all physicians need to be cognizant of. Maybe what our patients are yearning for is to know their physicians as humans, not as the expert.”

Looking at inclusion of medical students with visible disabilities, Mangrulkar said, may one day change how all medical students are evaluated. “People with visible disabilities have to be both vulnerable and professional at the same time, so why just them? Why not everybody?”

“Chris is special as a person, special inside as well, with his ability to connect and relate,” Mangrulkar said. “It’s hard to imagine a person like that wanting to go into medicine and our profession saying no. How could we do that? The thousands of people who are going to benefit from being able to work with Chris over the course of his career, it’s astounding to think of, and so I’m just so glad that he’s on this journey.”

Chris, meanwhile, is exploring fields like medical genetics and envisioning the life he might one day have. The family’s plan is that Chris will be prepared for a successful professional life that will allow him to manage on his own or hire an assistant when needed.

“I think I can do most things now,” he said. “I probably won’t be much worse off than any other clueless 30-year-old. My parents have done a lot for me, and so I want to be able to take care of them one day.”

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