Disabilities In the E.R.

Why, if it's illegal to discriminate against medical students who are slow readers, is it not illegal to discriminate against the ones who are slow learners?

Forbes , October 30, 2004

When Mark Breimhorst took the Graduate Management Admission Test a few years ago, he got extra time to accommodate his disability. The Educational Testing Service noted the "nonstandard administration" when it reported his scores to business schools.

Protesting the stigma of flagged scores, Breimhorst sued under the Americans With Disabilities Act. ETS settled and agreed to stop reporting special accommodations. Now professional schools can't tell the difference between high scores earned by students under normal deadlines and high scores earned by students who get extra time.

In Breimhorst's case, that's justice. He was born without hands and needs extra time to fill out test forms. Neither business school classes nor management jobs demand significant manual dexterity.

But what about mental dexterity? There, the same principles of disability law behind Breimhorst's suit are clashing with the demands of professional life and the schools that prepare students for it.

Over the past decade students with learning disabilities have gotten used to having extra time on tests and, in some cases, separate rooms to reduce distraction. In many cases that makes sense. Giving a dyslexic third grader extra time on a standardized test makes it more likely that his answers will show what he knows rather than how fast he reads.

But a sensible accommodation for little kids can create a misleading double standard for adults. How much you know isn't the only thing that matters in school--especially when you're training for a demanding professional job. What patient wants a genius doctor who can't focus in a distracting environment, reads so slowly that she can't keep up with medical journals or tends to misspell drug names on prescriptions?

There are, of course, excellent physicians with learning disabilities. But they succeeded the hard way, without special accommodations. They demonstrated that they could work around their problems.

That's not fair, argue disability activists, and it's not legal.

"You're disabled or you're not," says Stephen Tollafield, an attorney with Disability Rights Advocates in Oakland, Calif. "A person can have a substantial disability in reading even though their intelligence and hard work have helped them to compensate for their disability. But the law requires that if you have a substantial disability, you're entitled to accommodation."

In a class action filed in California state court in July, he and other attorneys argue that medical school admissions tests unfairly discriminate against applicants with disabilities like dyslexia. The Association of American Medical Colleges, argues the suit, is too stingy about giving learning-disabled students the accommodations they've depended on throughout their academic careers.

The plaintiffs, says the suit, "have earned high school and college diplomas, often with high grades and other significant achievements. Plaintiffs were able to reach their potential and succeed, in part, because they received reasonable accommodations at school and on previous standardized admissions tests such as the SAT."

The lawsuit ignores the nature of medical training, which is notoriously grueling for a reason. Patients' lives depend on physicians' ability to perform under pressure. If learning-disabled students can't do well on a timed test, maybe they aren't suited to be doctors.

Irrelevant, says Tollafield. "The MCAT is not a test that's designed to predict how you would do as a doctor. It's designed to predict how you'll do on other tests in medical school and the grades that you'll earn."

That argument denies the fundamental reality of professional schools. No matter how theoretical their classes, these programs aren't about learning for learning's sake. They're trade schools that prepare and certify people for demanding jobs. In those jobs, performance--not intelligence or knowledge--is what matters.

Besides, the disability rights people have no objection to the most blatant form of educational discrimination: the prejudice against people who, thanks to the genetic lottery, aren't exceptionally bright.

For an aspiring doctor, average intelligence is a far greater handicap than dyslexia or attention deficit/hyperactivity disorder. Why do some brain attributes matter more than others? Why, to use the trendy jargon, should we "privilege" intelligence?

"Wow," says Tollafield. "That's a big policy question. I don't know that I'm capable of answering it."