The Freakonomics blog reports:
Dr. Gretchen Berland, an assistant professor at the Yale University School of Medicine and former documentary filmmaker, writes in the New England Journal of Medicine
of an extraordinary experiment she has conducted over the past 10
years. It involved giving videocameras to people in wheelchairs, and
asking them to document their daily lives (samples of the videos can be
The footage provides insight into the struggles faced by the disabled
in conducting daily activities; it also provides a penetrating view of
what happens during visits to the doctor, replete with considerable
potential for communication breakdowns. At best, a common result is
that doctors don’t get the full story of a patient’s condition; at
worst, the patient can wind up receiving inadequate or improper care.
I am not sure whether you would expect better or worse quality of empathy and interaction in dealing with other parts of the social support system as a disabled person, but I doubt that the underlying barriers to communication are very different. Since rational medical and welfare systems – both rule-based, albeit in very different ways – rely on the assumption that people can accurately and completely describe themselves in the ways the system expects and requires and that agents of the system can accurately and completely understand those self-descriptions, this is of fundamental importance. If the assumption about the completeness of communication is wrong, everything built on that assumption is at risk of being wrong.
That has clear implications for service outcomes. Those implications are at least recognised in principle, if not always addressed in practice. But there are also implications for service processes and experiences: a process which assumes that people can fairly readily move from place to place or be at a specified place at a specified time may be one which is radically more difficult for some people to comply with than for others – and even the recognition of those issues is much less well developed.