Making space for disability studies within a structurally competent medical curriculum: reflections on long Covid, 2022, Hunt

Abstract

While critically informed approaches to medical education are increasingly advocated in literature, discussion of the potential role of disability studies in informing pedagogy and practice is largely lacking. The emergence of long Covid, alongside the strong possibility of a wave of covid-related disability, underlines an urgent need for medicine to develop more contextualised, nuanced and structurally competent understandings of chronic illness and disability.

This article argues that the integration of thinking from disability studies into medical curricula offers a pathway to such understanding, informing a more equitable, holistic and patient-centred approach to practice. Further, a structurally competent, antiableist approach positions clinicians and patients as allies, working together within a structural context that constrains both parties. Such positioning may mitigate tensions within the clinical encounter, tensions that are well documented in the realm of marginalised chronic illness and disability. While the possibilities arising from a partnership between disability studies and medicine are numerous, the foci here are the social relational model of disability and the concept of psycho-emotional disablism, within a broader framework of critical disability studies.

It is argued that inadequate healthcare provision and policy in the realm of long Covid can be understood as a form of structural and psycho-emotional disablism, arising from and reinforcing an ableist psychosocial imaginary permeated with neoliberal assumptions, and carrying a risk of furthering both disability and impairment. After considering long Covid through these particular lenses, the article concludes with a discussion of how a partnership between disability studies and a structurally competent approach to medical education might translate into practice.

Open access, https://mh.bmj.com/content/early/2022/07/19/medhum-2022-012415

 

"An important structural issue of relevance to the above discussion is the historical tendency in healthcare settings, notably in the UK, to recommend cognitive behavioural therapy (CBT) and/or graded exercise therapy (GET) for particular conditions that have been positioned as ‘medically unexplained’ and thus assumed to be largely psychosocial in origin. Most notable here is the case of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), where such an approach has been heavily critiqued as lacking in evidence base, ignoring a burgeoning body of biomedical research, and being associated with patient harms (Geraghty and Blease 2019; Geraghty, Hann, and Kurtev 2019). It has been argued that such harms have ensued not only through inadequate explanatory frameworks, but also through failure to accept patient testimony as a form of evidence (Blease, Carel, and Geraghty 2017); these harms could thus equally be understood as arising from a lack of co-production and patient-centredness at all levels of the health system."

Also has other mentions of ME.