Docs with Disabilities: Rethinking Inclusion in Medical Education – with Dr. Lisa Meeks

What happens when medical school is built around an ideal body and brain, who gets pushed out and what does that cost patients? Today, we're taking this beneath the surface and into what works on disability deep dive. Hello listeners, we're really glad you're here. I'm Keith. And I'm Jodie. Welcome back to Disability Deep Dive. Today's episode is docs with disabilities, rethinking inclusion in medical education, and rejoined by Dr. Lisa Meeks of the Docs with Disabilities Initiative. You'll hear how the initiative began and what it does. The barriers learners face in training and the practical steps, schools, and hospitals can take now. We also get into why this matters for patients and what accountability looks like across admissions, classrooms, and clinics. Yeah, and after the interviews took around for our deep cut, this week's deep cut is the TV series The Pit. Told through the day-to-day of a modern Pittsburgh hospital, The Pit raises the exact questions we will explore today, who gets heard, who gets sidelined, and how training culture shapes care. So let's get into it. Hello and welcome to Disability Deep Dive, Dr. Meeks. Let's start at the beginning. Can you introduce yourself and tell us about the docs with disabilities initiative, how it started, and what its mission is? Sure. So my name is Lisa Meeks. I am a professor of medical education at the University of Illinois College of Medicine and Chicago, Illinois, and I still retain an appointment at the University of Michigan in the Department of Family Medicine. But mostly in why we're here today, I'm the founder of the docs with disabilities, initiative, and currently I co-direct that initiative alongside Dr. Justin Bullock. And the docs with disabilities initiative is interesting because it began really as this very, very small grassroots effort to tell stories. I remember thinking so clearly that what I knew to be true, it felt like the world didn't know about. And so I just kept thinking about ways that we could tell stories about disability that didn't have to lean into a deficit model or an overly inspirational model, which is what I saw when I read about the one or two physicians with disabilities. So I wanted to change that and position disability really is this normal, valuable part of someone's identity that would lend its experience and expertise to medicine and health professions broadly in a really lovely way. So that's really kind of how it started and at the same time that it started, I had gone to the University of Michigan and started my academic career. Now just for contextualization, I'm this is my third career, a little bit older. I was in private practice doing diagnostics for children and adolescents. And so I would see and evaluate those children for ADHD, learning disabilities, autism, spectrum disorders, things of that nature. And on the heels of that, I was also teaching at the same time. I wound up going and working in a counseling center in higher education. And that's where I really started to see the inequity because in my private practice, I had the luxury of saying, yes, we see something here. So statistically, there's this difference. But I got to really lean into the strengths-based model and say, your child has so many wonderful abilities. Let's discuss how we maximize these. Where in the higher education setting, I was serving first as a counselor and then very quickly on the heels of that became a disability resource professional because I knew the psychometrics and because I had written letters on the other side for a combination. And I saw a lot more limitation once I was seeing it from the perspective of the school, the way that faculty were interpreting even the letters that went out to say, John has an accommodation. And the way that they would really see that is an affront or a challenge to a course and the integrity of their course. So I had those two careers prior about a decade in each. And then all of a sudden became a researcher at the invitation of the University of Michigan, which I will never- I could never be more grateful for the opportunity that I was given because it allowed me and the individuals that I work with to ask bigger questions and to make more impact. So at the same time, so that's a little context. At the same time, I was building my academic career for the first time and doing research and publishing research papers. And I thought, gosh, telling stories, AKA the podcast and doing research, AKA publication, it's too disconnected, right? And then I would build these little educational models because I knew people needed the information. And I was willing to, my children are grown, I was willing to do this work, labor of love type of work. We all, if you're in disability work at all, you know the labor of love at work. And I just thought there's no cohesion. We need something that brings all of this together so that collectively it can start to impact and actually move the needle, right? This one off here, one up there is helpful, but not as helpful as I felt like it could be if it were brought together and formalized hence the docs of disabilities initiative. And so our mission remains fairly simple. I always say I unapologetically want to increase the number of disabled people in healthcare professions, but it really is to drive change and perception and policies in the way people practice disability inclusion in their healthcare program. And we do this by that kind of synergy of the high quality research, the storytelling. And then one thing we've been able to add once we got off the ground, so to say, was the strategic partnerships with core organizations, so people like the double AMC, for example, or the AACM, so the medicine and the nursing associations that provide a home for all those nursing schools and medical schools. Wow. That's incredible. There's so much behind that. So you mentioned research, and we know you've obviously don't want to research in this space. Can you tell us a little more about what inspired you personally to focus your work and advocacy on disability inclusion in medical education? Well, I think that's a two-part question really. If you break it down, it's what inspired you to focus on disability and then what inspired you to focus on disability and medical education? Because the disability part actually and obviously came first, right? So for me, it's a mix. It's a mixture of having had that experience in private practice and seeing the ways in which parents would deflate if they received a diagnosis about their child or the way that the whole system was set up, right? You needed this diagnosis to access resources, but then the minute you did that, you were placing your child essentially in a structure that now viewed them very differently. And perhaps not always, but perhaps would cap what the expectations were of that child's achievement. And that always really bothered me. And I had it really dug too much into why disability just never seemed to be this huge thing for me until recently I was writing an essay on it. And it really goes back to the way that I was raised. My grandmother was born on the south side of Chicago and raised in a fairly poor household. And my grandparents, who we struggled a bit and I spent a lot of time living in and out with my grandparents and my grandparents were amazing people. My grandfather was a mechanic and worked on buses for the school system, but my grandmother was an aid on those buses. So if you think back, you know, I don't know how it works today, but there used to be different buses for disabled children and she so doesn't aid. My grandparents were the best people in the world. And they would very quickly be adopted into families. And vice versa, my grandparents would adopt families and children into our family. So for me, being around individuals that were wheelchair users or that were scooter or walker users or that were deaf, this was not abnormal to me ever. It was just part of the human experience. And in my house, we didn't pity people, right, and we didn't make them super heroes either because of their disability. It was If something was inaccessible, you figured it out. We would my dad was a bit of a carpenter and he would make rams So the people could get into our house. And I think growing up and having that modeled behavior of Really valuing people for all of who they are, right? Their full identity was something that was just ingrained in me so early on and Then my dad became disabled earlier in my teenage years and I bore witness to kind of the change in the way society perceived him. My father was a Dashingly good-looking man and I'm very gregarious and very big personality and was a fireman and had an accident fell off of roof and very quickly kind of went down hill on to having after one of his surgeries had a stroke and became a wheelchair user and The way that he was treated not only by the health care system, but by society Was shocking to me to be honest. And so there were all of those things that kind of personally Informed my desire to change health care for the better and to also change the perspectives of Individuals with disabilities, but I think the medical education part came from my desire to be a physician early on and I was diagnosed with cancer at 20 and Actually had to take a leave of absence out of school and then was unable to move forward and and complete medicine But I always volunteered in community-free clinics having been a patient in those clinics I felt that this was my way to give back and so I was constantly surrounded by medicine and kind of spoke that language and so when I was at This institution where I was seeing faculty really push back if they received a letter or question like I said the Ability of people to be in their courses. That was very difficult for me personally But also I felt that I knew better. I knew what disabled people could do I knew that behind the scenes perspective of Ability and felt very strongly that individuals with disabilities could make a big difference in health care by Challenging and combating those stereotypes. So My first interaction with the health professions program was nursing and it was not positive It was extraordinarily challenging and I thought somebody no one's doing this work You know, we've we had done a lot of work with The law and with practice for K through 12 We had done a lot of work with undergraduate education, but no one had tackled This kind of put up on a pedestal health care professioned space and I thought I speak the language. I know The way that health care providers talk. I'm not have never been afraid So I wasn't afraid. I think sometimes we can be intimidated by Titles, right? Yeah, sure and because we make such a Big deal out of individuals that are physicians or that are nurses and give them so much power It is difficult for the average disability resource professional or advocate to Hold their space and their knowledge with someone of that stature, but Again being raised by the individuals I was raised by was taught no one is better because of a degree, right my grandparents in Finnish high school and So I just didn't have that fear and I think it was that combination of not fearing it having a little bit of that language seeing a space that had been untapped and knowing What the possibilities were yeah for disabled people want to go into a career where One of two things was happening right either they had poor care and they wanted to change that for others that came after them Or they'd been the recipient of excellent care that had changed the trajectory of their life Maybe they're functioning or the way they viewed themselves and they wanted to equally give back So I think that it was just this very unique space and time and set of Qualities and life experiences on my part that kind of all came together To lead me to the work. I'm doing none of it was planned. Oh my gosh If I follow through my career plan, I don't even I can't even imagine where I would be right now I'm so gray always say I'm so grateful to the people That were part of the process up for the jobs that I did not receive. Yeah, I'm so grateful to those people, right? Because I love where I am and I am so blessed To be able to do the work that I do and it's meaningful to me But when I hear the stories Yeah of people who are now successfully navigating that is a nursing OTPT dentistry And the fact that they feel like they now have a community it just fills my bucket in such a big way Thanks for sharing that story. That's just such a beautiful story. Just start to finish I you write all the pieces just fill in the plates. I think it's amazing It's fantastic. So what do you think are some of the biggest barriers that students and professionals with disabilities face in medical training today? That's a great question and of course it's multi-factorio, but I would say that The biggest is they're not doing what we are doing here today, right? The three of us are connecting we're having a conversation. We're getting to A shared understanding of this construct and the people involved in the system the institution or institutional representative Which is often a disability resource professional and the faculty They teach the courses the clinical faculty that are precepting on the words are not having those important conversations that they need to be having so There's a lot of assumptions in the part of the faculty and those assumptions aren't being challenged. Yeah And there's also a lot of assumptions on the part of the DRP about what the faculty would say if they Entered this conversation right or a lack of trust or a fear as I had talked about earlier because oh my gosh I can't talk to a dean of the XYZ or a clerkship director for this program that person is Viewed as being so smart and so above all the knowledge that Someone else would have and so I think sometimes people get a little in their head And are afraid to have those conversations, but you know, it's so interesting. I'm doing a study right now with clerkship directors from a very prestigious medical school and Their study was on clerkship directors. So the faculty members and it the findings are that faculty members want to have these conversations They're eagerly awaiting these conversations. They don't feel like they're being made part of the equation And then of course, there's always the learner the student That is getting varied levels of engagement from either the institution or the faculty But it and everybody's scared, you know, I keep coming back to that everybody's scared But faculty know that there's a legal Education for what happens. Sure. So they're worried on just that level, right? I don't want to get sued I don't want to do anything wrong I believe most faculty are also very kind People who really want to help people get you don't go into medicine Most people are going to medicine for the procedure or the money. That's not there anymore Look at our health system. Most people go into medicine really and when I say medicine I mean broadly this could be any specialty really want to help people and they feel that way about their students Two and so they really want to help but they don't know what to do and then you have disability resource professionals who Are struggling to just see the students because their caseloads are so high or they don't have The knowledge of medicine or nursing or PT that they need to make good decisions And I know it sounds simple and it sounds a little polyanna-ish But I do feel like if you could get all parties at the table and have a conversation There would be such a renewed level of understanding that we could get past The hesitation and do some real good. I think that When we operate with this disconnect Students are the ones that have the biggest loss, right? Yeah, but we also aren't able to Move forward and be innovative and have it be fun. Oh my gosh. My job is so fun I get to think about how to innovate every day and how to build solutions so that people can have more access and not just the disabled learner But if I do something for a disabled learner 99% of the time it's going to help someone else So we're talking really about improving education optimizing Education improving the healthcare workforce There's just no bad for me. But some other things that are known barriers, technical standards, although I think we're really in a good place. I know most of the medical schools are starting to change these. And a new paper just came out in academic medicine that highlights some of the remaining deficits. And so I think that sometimes when papers come out, they're a little bit of a fire lit under programs to address something when it shows that there's so many barriers. So, technical standards. And I just really think ableism in general, so the kind of generalization about disabled people, the assumptions, the stereotypes, that's really still remains the biggest issue. And part of that could be broken down with addressing that first issue, the communication. Yeah. Yeah. Absolutely. I mean, this has been a theme in some past episodes too, but like the idea that those people don't want to be ableist. They just don't, they don't know. They don't have the information. So that communication is critical, I think. We see that theme over and over again with different guests in different world, different jobs, different, et cetera, and sort of what it comes down to is people just don't know. And if they knew, yeah, they would do better. Yeah. Well, you mentioned solutions and how that's so exciting is that you get to find solutions. So let's talk a little bit about that solutions. So how can medical schools and residency programs better support learners with disabilities? What are the solutions? Yeah. That's a great question. So I don't have all the answers, right? But I have a few. I like to give low hanging fruit answers because some answers are more complex. For this audience, I would say, listen, I, the learners are afraid. They know that ableism exists, but it's very deeply ingrained in healthcare professions writ large. And they are looking for signals. They are looking for signals that let them know that you are safe and that it's okay to disclose similar to what we see with the LGBTQI population and wearing your rainbow pin on your lapel or having a sign in your office that says this is a safe space or for whichever population you are trying to connect with. And so the students are coming in and they're fearful. To them, if you are an institution or your program or you're a faculty member that believes in disability inclusion and that wants to serve as an institutional agent or an advocate or you want to make sure that people know that your medical school or nursing school is inclusive, signal that publicly. You can do that by saying disability is a part of diversity. If I know that especially in Florida, diversity is under attack. If you want to instead signal just by saying we aim to create a disability inclusive environment, anything that you can do to let people know we know that disabled people are going to be here and they'll be there no matter what you say, right? You could be the most inaccessible environment in the world. People are still going to be there because it went up for you. This is a huge population. It's just, are they going to tell you that they're disabled and ask for the resources they need? So, signaling is really important. Having transparent policies help people find the information they need quickly and efficiently. I should not have to go dumpster diving in your website and go through 25 keywords to find the information I need and what I say to programs is go into incognito mode, go to your website and find information as if you were a disabled student. See how easy it is or how hard it is. Look at the words you used to describe the services you have. Would you, if you were a disabled learner, want to engage your program? Yeah. So, let's say you signal that you're inclusive, you have policies and procedures up and you have a process for requesting and it's all transparent, but your language starts with the Americans with Disabilities Act requires blah, blah, blah, blah. Yeah. Think about the message that's being sent with the words you are using. So, I think that is the first one. The second one is faculty need to be educated and they don't need to be educated in ADA 101, right? They don't need to know how wide a doorway needs to be. They need to have their assumptions directly challenged with a counter narrative that shows disabled people thriving. Yeah. And that needs to lead the conversation because until that happens, they're going to be defensive and they're going to want to talk about, well, what is a unreasonable accommodation or what about patient safety? I can show you the regs that tell you how to make a decision about patient safety. But let's talk about the possibility of disabled people being in your program first and get you to not be as reactive as we're talking about that by showing you that it's not only possible, but that people thrive and that they contribute to patient care, to innovation, to all of these things in a way that is so meaningful, so that when we start having our conversations about patient safety and by the way, people with disabilities are far more diligent about patient safety. It is really interesting. You know, we have fail saves in place in any profession that involves patient care to minimize the risk of a medical error. Medical errors happen to everyone in every situation or every scenario rather, but to minimize it. And what I have seen with disabled learners is that am disabled providers is that they create an even bigger fail safe for themselves, knowing what their strengths are, knowing areas that they need to be cognizant of, they are being hyper-vigilant. And that kind of, maybe hubris, the confidence without humility that we might see in some people, I don't see that in disabled providers. I see interactions with patients that are full of humility and grace and a lot more active listening. And so I don't worry about those things, but before you can get to all those discussions, I think we need to directly combat people's assumptions about disability. So I think that would be my second thing that I would say. And those are two of the most important things to be honest with you. The rest of this stuff is so much easier to figure out than you think it is. The things that people worry themselves about are the things that would take me five minutes to solve. And in fact, the majority of the time when I get a phone call, I already know the answer, because it's been done in two or three other institutions. What I focus on before I give that answer is let's think about the assumptions that are in the question you're asking or let me tell you about how this can be successful. So I get you to come down off of that almost kind of angst, this anxiety driven concern about people with disabilities. And I understand that's, I mean, society constantly reinforces a negative stereotype of disability. So I don't think back to what you were saying earlier, I think it's understandable why ableism would be a threat throughout. I never blame people for ableism up until the point where it's been defined. They understand it. And they've had several opportunities to check their ableism as they're operating, right? I always try to meet people where they're at and say, I know you don't understand what's happening. And quite frankly, for most people, they didn't have my upbringing, right? They have the upbringing with the parents in the grocery store where the first time they saw a disabled person, the mother said, what? Don't stare. Don't stare. Don't do that. And so what did we learn from a young, young age? There's something wrong there. It's bad. I'm not supposed to be engaging with it. Yeah. So I understand. I get that. That was not my experience. And I feel so blessed to have not had that experience. But yeah. But that is the normative experience. And then we get bombarded by my gosh, if you're in healthcare professions, you give them bombarded by your textbooks that you wait. Disability is the deficit. You watch movies where people with disabilities are either of these super heroes or they're these fragile beings, right? So society is. constantly feeding us the narrative. >> We had talked, you mentioned patient care. Why do you think it's critical for patients to see themselves reflected in their health care provide? >> That's a great question. I think because representation matters. But in health care, it can be almost transformative. If you are someone and I go back to thinking about how my dad was treated by the health care system, he was dismissed a lot, there were limitations put on him and he actually carried, and I wish I had talked to him more before he passed away about this, because I think it could have been really insightful for my work. But I got the sense that he carried a lot of shame about his disability and felt like he was a bother if he were to go to these appointments or if he had to go, would he often have to go to the emergency room. And I think that when you know that somebody has been through something and they understand you, there's this hope, this connection, this trust, I think that connection is really powerful. And we see that in studies that look at race and gender and other dimensions of diversity, how having that connection can improve communication, reduce feelings of isolation, improve outcomes, usually because someone has listened more or because someone is following the recommendations because again, it's a trusted source. So I think being cared for by somebody that understands disability is powerful in that way, but also it shifts the dynamic. We talked about how the DRP's view people that are physicians or nurses or healthcare providers in this elevated class, and they're afraid to talk to them, are afraid to challenge them. But when you share an identity with someone, when you share an experience with somebody, can also shift the power differential in ways that are really important, because if I trust you and and this is not or I'm not afraid of you, I know that you've had this experience and I feel like we're in some ways equal. I know that you know that my experience and what I'm going to report to is a disabled person is the most valuable data you're going to get today because you is a disabled person, know that you are the expert in your disability. So you see how that shifts the dynamic. Yes. And I think that changes the way healthcare is received. I've never, you know, one of the fears of faculty is, well, the patients won't like it. I think complete opposite. The patients will like it. They will feel even better. They'll pull and brace it. Yeah. Yeah. Yeah. Yeah. I think it's human nature to just feel more comfortable with someone that you feel is like you, like similar to you. It's such a simple thing, but yeah, that's amazing. You know, it's interesting. As an aside, I was diagnosed with a disability at 41. And I, it was a horrible experience. It was a very degrading experience. There was a lot of gas lighting, which you hear people talk about gas lighting and I thought, oh, I just don't, I don't, it can't be that bad. It is that bad. It really is. And I'm an educated woman in health professions with all the privilege that one could possibly have and was, was part of the healthcare system at a healthcare institution. And I was treated like, but I was treated very poorly. And I was questioned and I wasn't listened to. And it took a year and a half to get to a diagnosis that I think could have come a lot sooner and had a lot less implications and destruction on my body. Yeah. Had I been listened to and believed. And I think that's, it's problematic for women anyway, right? Around that age, who are often not listened to women in general, not listened to, other minoritized populations are not listened to by healthcare providers. But it really, when I had that experience, I had already been working for 20 years. And I thought, oh, I'm tripling down. Now, like, I thought it, I hypothesized it. My work was focused on it. I had not planned to get fit. There was no indication when I started this work that I would ever be disabled. And I was shocked. I got very ill very quickly. And it was shocking. And the way that I went through the healthcare system was shocking. And I thought, no, this is now, now this is it. This has got to be what we work on. Yeah. It's powerful. Yeah, it is. I'm sorry that happened. Well, on the flip side of that, are there any success stories, um, signs of progress and the like that you've seen in recent years that give you hope? Yes. Actually, it's funny because in preparation for this, I was going over the questions again and all weekend, this weekend, I've been, I've been home and I've been producing podcast episodes and their podcast episodes that are focused on a disability resource hub that is being launched next week through the ACGME. And the podcast episodes are program directors from residency programs and their disabled residents in a joint interview. Nice. And all weekend, I couldn't help but think, oh my gosh, this is going to be so impactful because getting back to the very first thing they started talking about, right? The power of storytelling to change perceptions. And I, as I listened to these amazing leaders and medicine talking about how much they've learned, how they would take this learner back in a heartbeat, and they would take 10 more like them. I thought, this is really going to help change the game. It's going to spark some interesting conversations. And those are the moments, like I said, in addition to learners, I have learners that will private message me on Twitter or Instagram and say, I never thought I could be a doctor. I just got my acceptance letter. I would have four years ago when I started listening to docs with disabilities podcast. It would, I would never have thought this was possible. And people that would have never gone into the profession. And then of course, I have a lab, a research lab, and I have about 12 disabled learners and faculty in the lab. And seeing their success is, it's my success, right? It's my success in that I am cheerleading for them. I am so excited for them. So I feel like just any time they do anything, whether I had anything to do with it or not, that the system has changed enough that they can do this. And I get to celebrate with them. And I'm so proud of our research lab and our learners and so proud of the faculty who have done so much work in the space. So I think every day, there's something I can find every single day to put just even if it's just a drop. It goes from ounces and liters to to a drop, but every day there's something that's going in my bucket and keeping me motivated to do the work. That's wonderful. So what can our listeners, whether they're in healthcare or not, what can they do to push for more inclusive practices in medicine? Start by look up to the term ableism. What is it look like? Is it manifest? Challenge your own ableism. Nobody, it's going to a course, right? Completing a certificate program on anti-ableism. It's a step, but honestly, it's like anything else that comes or is derived from our own thoughts. We have to challenge it. It's not something that can constantly be challenged by other people. So think about your language, think about your assumptions, think about your everyday practices. I would be interested to say when you see disabled people on the street in the airport in a restaurant, what is your reaction? What is your body language? What do you do? Are you still that kid in the grocery store that's looking the other way? Are you telling your children not to look the other way, right? The second thing, support organizations that do the work, money is being stripped away from anyone who's trying to do any diversity work right now. So support those people. If you can't support them financially, support them emotionally. Send them a letter. I cannot tell you every once in a while, I'll get a letter through our organization from a learner, a faculty, and it makes my day. Send a letter, tell people the impact you've had on their lives, share stories, amplify the stories of disabled people, and give them credit for it. Yeah. If you are in healthcare, if you are an advocate or in a position to have an impact on institutional policies that [BLANK_AUDIO] remote disability inclusion, start sharing information. Everything on our website is free. Everything that I create is free. All of my articles are open access, share them. Just share one. Share a podcast episode. And I think the most important thing is when disabled people are speaking with you, listen. Listen to them. Don't placate people. Don't give the whole can speech about what you can do and can't do. Sit and listen to the person in front of you and what they're telling you. I so often the change that is needed doesn't cost hundreds of thousands of dollars. It's attitudinal change. It's climate change. It's culture change. Sitting and listening to someone's stories of first step in and creating a culture where people feel safe. And I think disability inclusion, I'm doing the work in the healthcare space, but ableism is a societal problem. So it is gonna take everybody. It's gonna take everybody thinking about why they think certain things about people. There's a lot of cognition going on, right? But that's that same for any minoritized or marginalized population and our belief system about them. Why do we think that? And what can we do to challenge ourselves about that? Brilliant. Before we wrap up, kind of a fun question we like to ask at the end of each interview. Is there a book, a film, a TV show, piece of music, any kind of media that you would say reflects your work or even just has been on your mind lately? - This is such a great question and it's such a fun question, but I always get so much anxiety from the fun questions 'cause I'm like, "Oh, am I red enough, am I red enough?" What do I do? What do I say? So this question actually had me thinking and I read a lot of Buddhist philosophy and that has really shaped the way I think about things. - Oh, that's awesome. - But honestly, what I came back to was the song, this is me from the greatest showmen. - Yeah. - And thinking about one of the lyrics, one of the lines in there that I think captures this feeling that most of the learners that we have would want to have as they're going into a healthcare profession program, which is I'm not scared to be seen and I make no apologies. And while not every learner is there and just like I meet faculty where they're at, I meet learners where they're at. Not everyone's ready to disclose. Not everyone has been brought up with a sense of disability pride. But my hope for everyone is that they can be in a place where they're not scared to be seen and where they don't feel like they have to apologize. - Nice. - Yes. - That's great answer. - Yes. - Good answer, you did great. - Well, this has been an eye opening interview and such a pleasant conversation. - Thanks so much for being our guest today, Dr. Meeks, that we really appreciate your time and everything that you've worked for in this regard. Yeah, thank you so much. - It was wonderful, thank you. (upbeat music) - Before we get started, a quick heads up. The pit is a medical drama for mature audiences. It includes emergency care scenes, injury and trauma, flashing lights and alarms and storylines involving mental health and sensory overload. If you choose to watch, please use your discretion and do what feels safe for you. - This week's Deep Cut takes us to the pit, a series set in a modern Pittsburgh teaching hospital. Resuming in on Dr. Melissa King, and known as Mel on the show, a second year resident who many viewers read as neurodivergent. - The show never names a diagnosis, but Mel uses strategies that people with autism or ADHD might recognize in a perspective shapes how she cares for patients. It connects directly to our conversation with Dr. Lisa Meeks and how we train and support future physicians. - So let's stood out to you about how Mel manages sensory overload on shift, like adjusting lights, stepping outside or using lyrics to self-soothe. - I think we see her right away showing her limits and how she does something about it, that they jump right in with that. She lowers the lights, like you said. She steps outside, she recites lyrics and those simple acts become the tools that she uses to help regulate and study herself in this chaotic environment that she's found herself in. And I like how they treat it as, these are just facts for her, these are just steps that she takes. It's not overly dramatic. It's not, we don't necessarily zone in on it. It's just kind of there and part of who she is. - Yeah, no for sure. - So going with that, there's a scene where Mel connects with a patient that has autism after another doctor seems to have missed the key cues on that. What did you notice about her communication choices and pacing in that scene? - Yeah, I thought that was a really interesting set of the whole episode, I guess a few scenes, honestly, with that, and it was really great to see how, so first she's not the initial doctor that meets with the patient. The doctor that first sees this patient with autism, he's one of the attendings. So of course that means he's got a lot more experience and should be the, I don't wanna say the better doctor, the one that's just a little more experience with dealing with a variety of patients, that sort of thing. But he has a lot of trouble communicating with this patient and they're just getting, the patient's getting restless and angry, not being able to, I don't think the patient feels really heard, and Mel steps in because she notices that there's something about the patient that she recognizes, and the way she communicates is completely different. She calms him down, the patient calms him down, and just uses an entirely different tone, a different pace, kind of a reset, really. And the patient then does a much better job of being able to communicate what he needs and they build a rapport quickly. And just seeing that difference in how this "less experienced" doctor comes in and changes everything, just changes everything, and it's really incredible. - Yeah, the whole temperature of the room just completely drops. It's escalating and she's able to just bring it down to a low simmer again and start fresh. - Yeah, yeah, for sure. - So interestingly, the show keeps her diagnosis off screen. It's never mentioned. So what are the upsides and downsides of a character being coded as neurodivergent without actually saying it? - You know, I was thinking about this when we first discussed covering the show on the podcast. It's kind of keeping the diagnosis off screen is a mixed bag for me. On one hand, it invites people to notice what she does well and how she works and her diagnosis isn't a label, but for me, there's a trade off because if you're not naming it, there is the possibility that some viewers can miss what's going on and miss the context clues and miss why support matters. And also in turn, then I feel like the show can lose out on a chance to model this good language and behavior and disability rights that happen in the workplace. So I kind of go back and forth on my opinion on whether it's good or not. And hopefully, in future seasons, they'll start talking about it because the fans of the show have been talking about it off screen, maybe they'll take that into account. - Yeah, yeah, I'll be interesting to see what they do with that. And I tend to agree with that. Your way of looking at that, it's, yeah, it's a mixed bag for sure. - Well, we also learn that her sister Becca is a person with autism and in a care facility. How do you think that family context informs Mel's bedside manner and her advocacy in the emergency room? - Yeah, I think that context is incredibly important. It's how she knows what to do in that situation that we talked about earlier with the patient with autism. It's how she recognizes the patterns and knows that you need to do the sensory reset. I mean, I think one of the first things she does, when she goes in the room, is she dims the lights a little bit. - Yeah. - So it's those little touches that you may not think about as something that can help that she's obviously seeing a number of times, maybe just knowing her sister and the things that work with her and help her, they call and focused. She's able to then translate into working with others. And so I think that context is really huge. And I think it might even additionally hint kind of went back to the previous question and answer we were talking about. I think that might actually be a hint toward the fact that Mel also is neurodivergent, that my sister is autistic. That doesn't, of course, mean automatically that any of a family member is or isn't. But I think that set up as a way to make you say, well, that's interesting because I felt like Mel is showing interesting signs of being a little bit like that. That's what makes you. I think that maybe makes you think about is Mel also autistic or have ADHD or what's going on there. So I think the whole dynamic is important to the show and Mel's character development. Yeah, her actions are almost like muscle memory for her. She keeps the doctor portion going forward with the diagnosing what's going on as she's slowly doing these other things to change the environment and it just very, you know, just comes naturally. It appears to her. Yeah, yeah, I agree. So where do you think the pit gets representation right with Mel and where would you like to see more depth? Well, we talked about showing how she deals with patience, showing how she regulates herself, building that trust of the patient, noticing details what others miss and making sure she sets boundaries for herself. What I'd like to see is a little bit of more acknowledgement of those supports that she has in the dialogue, maybe showing how the team backs her up or doesn't back her up. I think it's important to show both sides and maybe gives a little bit of background on how the program is set up to either help her or hinder her realistically. In future seasons, I'd love to know more about her relationship with her sister. You know, did that cause her to go into the medical field and just other personal details. I know they like to stay within the hospital so far. There's only one season you don't know if they ever go out of the hospital, but just trying to bring as much of her family experiences into what makes her I think would be important. Yeah, that makes a lot of sense for sure. So if the writers choose in the next seasons to explicitly name her diagnosis, what would you like to see handled carefully so that it supports the character as well as supporting the audience? That's a really good question because there's a lot of ways you can go wrong and maybe only a few where it comes out looking good. So I think one of the one of the first things you want to do I think is avoid the whole savant trap and show that she's she's a team player. She's not like into doing things so low and showing off. I don't know just being separated from the group. Which I think the first season she is. She's definitely a team player. Like they that's all handled great. You want to also make sure that Mel stays as a whole person and it doesn't become like a focus that oh, this is the disabled character. You know, you don't want to see that happen. And again, like you mentioned, we don't go too much out of the hospital, but making sure that you can see that growth and that she has a life inside of her job. So oh, and another thing too, I would mention is that we don't want this to become some ridiculous thing where like, you know, a doctor gets mad at her or I say a doctor could be any fellow staff person gets mad or chooses her of something or I don't know. I just I think there is so many trite ways of doing it that I get a little nervous and maybe in the end it's best that they still never say it. I don't know. It's like I said, it's a mixed bag. We have to wait and see what happens, but if they do it, I just hope they do it well and just I don't know, just not make it as trite as sometimes things show up and then again, lose that focus on who she is as a person. Their best bet is to talk to some people who have these diagnosis and find out how they would deal with it. Hopefully, that's what they do. Well, and I think it's important to note that the actress that plays Mel has ADHD and so is herself neurodivergent and I think that helps and hopefully maybe when it comes to that development of the character, you mentioned talking to other people. I hope they also work with her herself. Yeah. And maybe you get some insight on, you know, what makes sense and what doesn't. Absolutely. The pit gives us a useful lens, a resident using practical supports and delivering strong care. It's a reminder that access isn't extra. It's part of safe, effective medicine. If you watch, notice where Mel adjusts the environment, sets boundaries, and builds trust with patients, other struggle to reach. Then ask, what would it take for every training program to make those supports standard? And that's this week's Deep Cut. Thanks for going deeper with us. That's it for this episode of Disability Deep Dive. A huge thank you to Dr. Lisa Meeks for joining us and helping us unpack how medical education can better support learners and clinicians with disabilities. Dr. Meeks brought clarity and concrete ideas to a topic that's often complex and overlooked. She reminded us how important it is to keep the voices of people with disabilities at the center when we talk about training and care. If you enjoy this conversation, make sure to subscribe, leave us a review, and share it with someone who will benefit from hearing it. You can learn more about the docs with disabilities initiative at www.docswithdisabilities.org. So this is our last episode for a little while as Disability Deep Dive. That's right. But we'll be back on November 6th. And we have a few surprises we think you'll be excited about. So stay tuned. Thanks for listening. Disability Deep Dive is produced by Jody Beckstein, Keith Casabon, and Disability Rights Florida, Florida's Protection and Advocacy Agency. You can learn more about the services we provide, explore a vast array of resources on a variety of disability-related topics, and complete an online intake at www.disabilityrightsflora.org. Any comments about the podcast can be sent to [email protected]. Thank you for listening to Disability Deep Dive.