Listening actively is the final portion—and arguably one of the most meaningful portions of patient care. When a patient can communicate with you in a way that you can understand, give them the time and space to communicate. Be patient and give them your attention. If they are part of the Deaf community, ensure that they have an American Sign Language interpreter present, as well as an in-person interpreter to best communicate the emotion behind their speech. Body language is especially important here and reinforces why maintaining good eye contact, using appropriate language that includes the patient in the dialogue, and asking permission to speak with family or care partners are pivotal factors in their care.

Using the EQUAL model will hopefully improve our care of patients living with disabilities, as well as their experience in the ED and accessing healthcare. Historically, they have multiple comorbidities, making them sicker at baseline. One study highlighted that those with a disability have higher adverse outcomes and incidence of cardiovascular disease and diabetes across the board, and that disabled women receive less health maintenance screening.² This means that their presentation is likely higher-risk and requires more diligent examination. With this model, there will hopefully be improved patient satisfaction and better outcomes.

Dr. Earle is a third-year emergency medicine resident at Baystate Medical Center in Springfield, Mass.

References

1. Disability and health overview. Centers for Disease Control and Prevention website. https://www.cdc.gov/ncbddd/disabilityandhealth/disability.html. Published September 16, 2020. Accessed October 10, 2023.
2. Krahn GL, Walker DK, Correa-De-Araujo R. Persons with disabilities as an unrecognized health disparity population. Am J Public Health. 2015;105(Suppl 2):S198–S206.
3. Rotoli J, Backster A, Sapp RW, et al. Emergency medicine resident education on caring for patients with disabilities: A call to action. AEM Education Train. 2020;4(4):450–462.
4. York J, Wechuli Y, Karbach U. Emergency medical care of people with intellectual disabilities: A scoping review. Open Access Emerg Med. 2022; 14: 441–456.
5. Poffenberger C, Backster A, Rotoli J. Emergency physicians’ perspective: caring for persons with disabilities. EM Resident. 2023;50(1):58–59.
6. Yocum AD, Simon EL, Dennison JL. Esophageal obstruction and death in a nonverbal patient. J Emerg Med. 2021;60(5):e109-e113.