Mel Houser, M.D., Executive Director, All Brains Belong VT (6/9/2023)
“One size fits all” healthcare
Neurodivergent people often struggle to access healthcare. Healthcare tends to be delivered in a “one size fits all” way. This interferes with many people being able to access care.
Here are just a few examples:
- You must fill out the 20 page packet to become a new patient.
- You must wait in the overstimulating waiting room.
- You must communicate in a certain way.
- You must “fit” within the bounds of a 15 minute visit.
- You must navigate a patient portal (and its password) in order to access information from the appointment
When something is only offered in a “one size fits all” way, these types of defaults get in the way of access.
Let’s double-click on the executive functioning “defaults” that interfere with many neurodivergent people being able to access medical care.
The amount of executive functioning, motor planning and sequencing required before, during, and after a healthcare encounter cannot be overstated. And yet, when a patient misses an appointment, professionals often judge the patient. When a patient “no-shows” (what a judgmental term!), there are often assumptions made about the patient’s motivation. They must not care. Their health isn’t important to them.
In reality, missed appointments are often the consequence of disability. When a person has executive functioning differences that have gone unsupported, they are more likely to miss appointments. They were set up to fail.
Supporting executive functioning in healthcare
At All Brains Belong, we support patients whose needs were not met by the traditional healthcare system. 90% of our patients identify as neurodivergent. 97% of our neurodivergent adults suffer from chronic complex medical conditions. And while we’re reasonably good at treating these chronic medical conditions, what’s even more important is supporting our patients to actually be able to access their medical care here.
How we support our patients’ executive functioning evolves over time (based on patients’ needs and what the community requests). Here are some examples of what we do here that we think can be adapted to a wide range of traditional healthcare settings.
Between appointments
- Self-scheduling online or via text or email
- Frequent reminders by email and text
- A “recall” system when patients are due for appointments
- Pre-visit planning to allow patients to organize their thoughts and priorities ahead of time
During appointments
- Co-creating a written agenda
- Supporting time management
- Concrete action steps sent via the method of the patient’s choosing
- Making calls, doing research, creating visual supports –> all of this can be doing DURING appointments (it’s not “extra”)
Is this extra work for our small team? Sure. But we do it because we legitimately want our patients to come to their appointments. We legitimately want our patients to be able to access medical care. Supporting our patients’ executive functioning is about meeting their access needs. This stuff that is REQUIRED for access. Access needs are not optional.
Want to learn more?
Attend our webinar Tues 6/11/2024 6pm ET (and recorded for on-demand viewing): Practical Strategies for Neuroinclusive Healthcare.