As we get more information about Representative Giffords' recovery, it is not surprising to learn that she has weakness of the right side of her body and difficulty speaking. However, the tragedy in Tucson creates a "teaching moment" on many fronts and disability etiquette is one of those. If you had the privilege of working with or meeting one of the injured people, would you know how to react and greet them? Here are some things to consider.
Rewind backwards to the Presidential debates of 1996 between the candidates Bill Clinton and Bob Dole. During presidential debates, the candidates practice their responses to specific questions and how best to interact with their television audience. Do you think Bill Clinton rehearsed how he would walk across the stage and shake Senator Bob Dole's "left" hand, avoiding an awkward moment of reaching for Senator Dole's disabled right hand? You bet he did! Clinton even avoided talking about the age difference between the two candidates, sticking to the issues. What we witnessed was an exercise in "disability etiquette."
The Americans with Disabilities Act was signed into law in July 1990 and with it came a mandate to end discrimination against individuals with disabilities. While the law protects people with disabilities, it does not automatically educate the public on the correct way to interact with people with disabilities. For many people, meeting someone in a wheelchair or with a significant disability creates an awkward moment when they are unsure how to behave.
• What would you do when faced with someone with a paralyzed or missing right arm? Most people, even those with a prosthetic arm or hand, can shake hands. Follow Bill Clinton's lead -- it's appropriate to use your left hand if the person cannot respond with their right hand. The disabled person will usually give you a cue by extending an arm or hand as best they can. It is best not to just go ahead and grab an arm that may turn out to be a painful experience for the person. The "good old buddy" pat on the back or shoulder is never appropriate behavior.
• Have you ever noticed that when you speak to someone who doesn't understand English that you tend to raise your voice, thinking that somehow shouting the words will rattle their brain into understanding? We do the same thing when we address people with disabilities. There is usually no need to raise your voice. However, when someone has a cognitive impairment it can help to slow down and speak clearly. Use their first name only if everyone else is being referred to by their first name. Better yet, ask for their preference. This is a common mistake amongst physicians who refer to their patients informally but, then want the patient to call them "Doctor".
• Treat the person as an adult. Don't patronize the individual because they have a physical or mental disability. Don't pat people in wheelchairs on the head or shoulder in place of a proper greeting. Sit down and make eye contact. This is critical! When you are seated in your office and someone enters, don't you usually stand up to greet them? When speaking to someone in a wheelchair or lying in bed, look around, pull up a chair, sit down and get at eye level. I remember being a patient in the hospital and how uncomfortable I felt lying in the bed and trying to have a conversation with my physician as he towered over me. Don't sit on the patient's bed unless invited to do so. How would you like someone sitting on your clean linens?
• Some people want help, others do not. It is acceptable to ask if you can get the door, pick up their canes or push their wheelchair. But don't feel hurt if your offer is declined and the person wishes to be independent.
You made it through the greeting and introductions. Now what?
• Always speak to the disabled individual directly and not through someone else. As physicians, we make this mistake all the time. We will speak to family members and friends instead of addressing the person directly. Even if the person has a cognitive disability, their presence must be recognized and respected. People are individuals who happen to have disabilities and should not be addressed as "the T4 paraplegic in the corner" or the "stroke in room 603."
• When having a conversation with a person with a physical disability, use normal everyday language and relax. We can slip into an unpleasant and demeaning habit of speaking to the disabled person as if they were a child. You may have to make a physical accommodation, such as sitting down. Remember, the individual is otherwise no different than you.
• Most of us are poor listeners. When someone has a speech impairment, take your time and listen. Don't try to always finish their sentence. That can be difficult when you are in a hurry, but never to pretend to understand if you do not -- it is acceptable to say so. If the person has a visual impairment, identify yourself and let them know where you are what you intend to do.
FDR and Working With the Disabled
It is assumed by many that the disabled do not want to work or that they would not be qualified for certain jobs. Look at the individual's skills first and then at what accommodations can be made in the work place. Don't assume that the cost of these modifications will be expensive or that the disabled individual will be at an increased risk for injury. Likewise, don't hire an unqualified person just because they have a disability.
Had the extent of FDR's disabilities been generally know to the public, many say, he wouldn't have been elected. On the other hand, we might be further along in our attitudes toward working with the disabled if the public understood and accepted FDRs physical disabilities while recognizing his unparalleled leadership skills.
The tragic event in Tucson provides much to grieve about, but we can hope that we have raised not only the level of awareness about brain injury, but also the issue of disability etiquette.
You can find additional information and tips on this topic in my book, "Beyond Please and Thank You: The Disability Awareness Handbook for Families, Co-workers and Friends."