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Dyslexic Doctor
By Gail Heriot

God bless the National Board of Medical Examiners. Citing the need to maintain standards and protect patients, they are refusing to allow Heidi Baer, who has now flunked the medical boards three times, extra time on her fourth attempt. Of course, Ms. Baer is suing under the Americans with Disabilities Act.

Ms. Baer claims to be dyslexic (and has several experts who back her claim). But what difference should it make if she is or isn't? Does anyone doubt that the ability to read and digest complex written material is crucial to a doctor's success? Indeed, given the astonishing speed at which medical science is changing these days, the ability to keep up with the medical literature is more important now than it's ever been. A doctor who can't do it is a hazard to patients, whether you call the problem "dyslexia," "poor reading skills," or "Fred."

The ADA requires that institutions like the NBME make reasonable accommodations for students' disabilities. But it is patently unreasonable to require the NBME to accommodate a reading disability when excellent reading comprehension skills are among the abilities that are necessary to success in the medical field and there will be no opportunity to accommodate the lack of those skills once the doctor is actually practicing. It would be different if the NBME were refusing to allow her to sit for the exam because she can't throw a baseball. Such skills bear no relation to the ability to practice medicine. Or it would be different if she needed a special light in order to read well. Although the ability to see what one is reading is important, once she got into the practice of medicine she could carry around her own flashlight. It would therefore be unreasonable to refuse her an accommodation during the exam. Her actual problem, however, is far more serious. Doctors are among the most time-pressed professionals out there. (How long did your doctor spend on you last time you went to see her?) Emergencies are routine. Ms. Baer isn't going to be able to slow everything down just because she's a slow reader.

I know, I know, it isn't her fault if she is dyslexic. But it wouldn't be her fault if she had been born with a low IQ either. Or a quadriplegic. Fate deals us all certain cards. The issue isn't whether fate has been fair, but rather the exam is a fair evaluation of her likelihood of success as a doctor. Nor does it matter that she has certain other qualities that would make her a good candidate for the medical profession if only she hadn't been dealt the dyslexic card. We're all package deals. And there are lots of professions out there where reading skills are less important.

Alas, the ADA has not always been interpreted sensibly. Instead of arguing that even if Ms. Baer is dyslexic, the NBME should not accommodate the problem because it would compromise standards, the NBME is arguing that Ms. Baer isn't really dyslexic, because she has average reading skills rather than below average ones. It's a funny argument. Do they really mean that if Ms. Baer had been a terrible reader, then they would have been under an obligation to give her extra time on the exam? I hope not. But the ADA frequently gets folks tied up in knots.

We'll see what happens. Unfortunately for the NMME, this issue has already been decided in favor of accommodations in the closely related legal context. See Bartlett v. New York State Board of Law Examiners. There a dyslexic aspiring lawyer (whose overall reading skills were average) who had made a career out of special accommodations in law school (and nevertheless did poorly there) was given extra time by the Second Circuit. As I've said many times before, it's a crazy old world.
posted by Gail at 5/03/2005 11:07:00 AM