“Think of it this way,” the school’s pediatrician said to me, his voice flat in my headphones. “Back in college, would you want a lab partner who needed these accommodations? When I read a letter like this, I picture a student who may not even graduate high school. I have to prepare the family for that reality.”

I took a slow breath, calming myself. This wasn’t how I had hoped the call would go, but here we were.

“Well, Dr. Zeal,” I said, keeping my voice level, “I was the pre-med student with those accommodations. I chose this specialty so my patients wouldn’t face the barriers I did. But more importantly, denying accommodations based on assumed future ability is discrimination. Now let’s address the content of her letter.”

I exclusively care for patients with hypermobile Ehlers-Danlos syndrome and related conditions. There are only a handful of specialists nationwide who comprehensively manage both the core syndrome and all the complex comorbidities – including POTS, MALS, spinal instability, and more. Among them, I may be the only pediatrician. Many of my patients travel from across the country, and some from abroad, to our specialized clinic. Families often admit they feel safe here because I’m not just their doctor; I’m also one of them. As a patient with hEDS myself, I bring almost 40 years of lived experience into the exam room. It’s a privilege to use this insight to help others.

One of my favorite roles is helping young patients reach their educational goals. Like me, many of them dream of joining the medical field to give back to our shared community. So it is particularly inspiring to support them in their academic journey.

On this particular call, I was speaking with a school’s consulting pediatrician about a high school freshman named Ashley (name changed for privacy). I’d submitted my usual school letter with what I call “the starter pack”: A description of her diagnosis, its functional impacts, and a list of recommended accommodations as a starting point. But as the call progressed, it became clear collaboration wasn’t on his agenda. Instead, he seemed to be searching for a justification to label her a failure before she’d even gotten started.

I see this all the time.

Despite the protections of Section 504 of the Rehabilitation Act and the Americans with Disabilities Act, accommodations are still viewed with skepticism and suspicion. Often, they’re dismissed as excuses, special treatment, or even a threat to academic standards. I’ve collaborated with school staff from kindergarten through graduate programs, in both public and private institutions, and the questions echo the same worn-out assumptions I faced 20 years ago:

• “If they don’t write the notes by hand, are they really learning?”
• “If they need this much support, do they belong in advanced classes?”
• “If we allow this, we’ll have to allow it for everyone.”
• “Is that fair to the other students?”

These attitudes not only misinterpret the legal mandate for accommodations, but they also completely miss the point of education itself. If the goal is to foster learning and assess mastery, does every student need to demonstrate that mastery identically? Is a multiple-choice exam more legitimate than a thoughtful essay? Does turning in homework at 11:59 p.m. matter more than understanding the material?

I’m not suggesting schools abandon structure or become infinitely flexible. The law states that accommodations must be “reasonable,” a subjective standard. But far too often, our pedagogy prioritizes artificial uniformity over actual learning. Instead of fostering creativity and resilience, our systems reward rote compliance.

From the start, public education in the U.S. has been shaped by exclusion. Students with disabilities, students of color, students from marginalized backgrounds were, and still are, systemically denied access to equal education. The IDEA (Individuals with Disabilities Education Act), passed in 1975, was supposed to ensure a free and appropriate public education (FAPE) for students with disabilities. But 50 years later, families still must fight tooth and nail to get basic accommodations, and teachers and administrators still view those requests as burdens rather than rights. And while school accommodations may not be our legal responsibility as doctors, they often start with us. A strong physician letter can make or break a student’s chance at equitable education.

Unfortunately, this outdated thinking doesn’t end in school. We carry it into the workforce, into medicine, into leadership, where the problem becomes a poison.

This cultural rigidity extends into medicine in a way that’s particularly ironic. I was recently on a call with a group of physicians with disabilities, and the shared frustration was palpable. Over and over, we described encountering the same phenomenon: Our own physician colleagues refused to think creatively when it came to disability. Many clung to outdated practices because “that’s how they were taught.” When presented with disabled trainees, their response wasn’t curiosity or innovation; it was resistance.

One physician on the call put it perfectly:

“There’s this intellectual quagmire that everyone in medicine kind of gets into… Not knowing the difference between law and policy, and not knowing the difference between tradition and science.”

Yet each of us on that call had countless stories of how we’d faced “unmovable” obstacles and created new systems to work around them. We learned, out of necessity, how to be our own best problem-solvers – and how to hold the door open behind us.

So while we bend over backwards to find solutions, a 2021 survey found that nearly half of physicians are uncomfortable treating patients with a disability, either because of stigma, lack of training, or outdated perceptions. The results were validating for the disabled community, who have long felt “othered” in the medical sphere – in exam rooms with tables we can’t reach, hospitals without accessible bathrooms, and with physicians who make us feel invisible.

To underscore this representation gap, a study in 2022 reported only 4.6 percent of students in United States medical schools self-report a disability, compared to 25 percent nationwide. It further revealed that 52 percent of these students were denied accommodations for their Step-1 exam; of those, 51 percent were subsequently delayed in their academic progress, and 32 percent of students who took the exam without accommodations failed. This is stunning when compared to the national failure rate of 4–5 percent. Meanwhile, multiple studies have confirmed that exam scores have no correlation with success in clinical practice, yet we persist in using these exams as the benchmark. This disproportionately keeps disabled students from entering the field.

I have never been more concerned than after our universities were banned from research involving “DEI.” When the people in power have never faced systemic barriers or needed to be resourceful, we’re left with leaders who lack the imagination and motivation to make meaningful change. And if we, as health care professionals, don’t understand the landscape, how can we effectively advocate for our patients?

Because too often, as in Ashley’s case, the primary barrier isn’t the school or the system – it’s another physician.

We can do better. We must do better. Accommodations are not handouts. They’re not about lowering standards. They’re about meeting the needs of the individual, removing barriers so people with diverse–yes, diverse–experiences and perspectives can build a better world.

So no, I won’t apologize for writing a letter that empowers a young girl to chase her dreams. I won’t entertain arguments rooted in ableism and discrimination. And I won’t stop asking the question that launched my career: What if we built systems intended for everyone to succeed?

And to answer that doctor’s question: Yes. I absolutely want a lab partner who knows how to think through a problem, not just repeat what they were taught. I want someone who sees obstacles and searches for better outcomes.

And above all, I want more thinkers.

Sarah Cohen Solomon is a pediatrician.