Polite Persistence

Lydia Smeltz, BA

Fam Med. 2022;54(8):645-646.

DOI: 10.22454/FamMed.2022.924429

I started my undergraduate medical education journey on a Monday at 8:00 am and by 9:30 am, my glossy-eyed, overly-excited first-year medical student persona was shed. The pervasiveness of ableism in medicine struck me a mere 90 minutes into my first day.

We began with a problem-based learning session focused on fragile X syndrome, the most common inherited cause of intellectual disability. As we read the case, my eyes fixated on the phrase “mentally slow.” The nonchalant use of the microaggression left me frozen. I kept my head down, but my eyes darted around the classroom and scanned the surrounding faces. I looked to see who cringed the way I did and who remained unphased, unaware of the offensive word use. The guise of disability inclusion within medicine began to crumble.

I drafted an articulate email to the course directors explaining why the language in the case made me uncomfortable and shared resources for respectfully talking about disability. I hoped that the email would come off as caring, thoughtful, and knowledgeable and not bossy, aggressive, or demanding. Before sending, I recalled the presumed risk. I was just a newly-minted medical student and I had a long 4 years to go. Finding confidence in the work I had done to educate myself on this topic for years prior, and before talking myself out of it, I hit send.

The course directors responded promptly. Relief rushed over me as they vowed to change the case for next year and talk about appropriate language during the facilitators’ week-in-review session. I felt lucky. This advocacy felt simple and effortless.

During the Wednesday lecture, the course director made a point to explicitly note the difference between using the R word in the proper name of the gene affected in fragile X syndrome and inappropriately using the R word as a slur to substitute for “mental disability.” While I still winced knowing that intellectual disability would be preferred to “mental disability,” I was happy for a minor win, until the next lecture where the slur was used multiple times. I couldn’t believe this was happening.

While my decision to send the first email was nearly automatic, now I hesitated. In sending the first email, I leaned on my naivety. But now, the course directors would recognize my name. I worried what they would think of me and what label I was creating for myself. I felt forced to place an exuberant amount of trust in new relationships with faculty I hadn’t even met face-to-face due to the pandemic. My anxiety teetered on a metaphorical tightrope created by the hierarchy between students and faculty, stretched by the tension between being a troublemaker and an advocate, and further fortified by threads positioning ableism as a critical, intersectional diversity, equity, and inclusion topic without competing with other social justice advocates.

My hesitation led me to text a friend at another medical school, who lives with a disability, and she responded, “yeah, ableism is a problem everywhere.” Although I still feared being seen as the “word police,” she helped me realize that my fear of doing nothing was greater. Language matters. Advocating for appropriate and respectful language is not word policing. Internalizing both the words others use to describe us and the ways we define ourselves, directly affects our thoughts, feelings, and actions. Fueling my efforts required viewing them as valuable and unremitting, and not insignificant or fleeting. Again, I hit send.

As a first-year medical student, my clinical toolbox appears largely empty yet holds an invaluable tool: the power of language. As an aspiring physician advocate, I cannot build a safe space that equitably values the lives of disabled people, nor can I effectively advocate without it.

I know one email will not eliminate the malady of ableism from medicine. At times I wonder if I will continue to meet these inevitable situations throughout the rest of my budding medical career with the same vigor I possess now. I hope each microaggression and inequity continues to light a fire in my soul. The language I advocate for and the language with which I describe myself and my efforts matter. Dismantling ableism will require polite persistence. I am only getting started.


The author acknowledges Wendy Furst and Dr Katherine Dalke for their help in ensuring she articulately translated her feelings into words.

Lead Author

Lydia Smeltz, BA

Affiliations: Penn State College of Medicine, Hershey

Corresponding Author

Lydia Smeltz, BA

Correspondence: 700 HMC Cres Rd, Hershey, PA 17033. 717-531-8521


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