Disability Studies Quarterly
Fall 2004, Volume 24, No. 4
<www.dsq-sds.org>
Copyright 2004 by the Society
for Disability Studies


BOOK & FILM REVIEWS

Lisa I. Iezzoni. When Walking Fails: Mobility Problems of Adults with Chronic Conditions. University of California Press, 2003. $19.95 paper. 355 pp.

Reviewed by Marsha Saxton, Ph.D., World Institute on Disability, University of California, Berkeley.


This book about people with mobility impairments helps both doctors and patients navigate the healthcare system. Physician-health services researcher, Dr. Lisa Iezzoni writes from her own experience of mobility impairment due to multiple sclerosis. Her self-disclosure of disability, which opens the book, is a refreshing departure from the classic medical literature, which has tended to hide the personal life experience of the physician behind the veil of professionalism. This has maintained the illusion that doctors never become ill or acquire disabilities or ever have to grapple with biased attitudes about disability directed at themselves. While she is a relative newcomer to the disability community perspective, Dr. Iezzoni's advocacy for people with mobility disabilities is solid.

A central point in the book is that medicine, because of discriminatory attitudes and policy about disability, as well as the rigid diagnose-and-treat approach to medical care, has ignored the real needs of mobility-impaired people. What is needed is for providers to pay attention to the life experience of their patients, take the time to accurately assess, and then enhance, the individual's functionality in their daily lives, whatever their diagnosis, even if "cure" is not an option.

The intended audience of this readable book includes medical and service professionals, social scientists and the community of people with mobility disabilities. This again is a refreshing departure from the classic medical texts, which assume that patients do not benefit from reading medical research. While the Internet has dramatically changed our access to medical information, there is still a lack of good, clear writing that simultaneously addresses the information needs of those on both sides of the doctor's desk. This book does that well. Using qualitative research methods, Iezzoni interviewed people from both these perspectives. Her extensive use of quotes from interviews brings the issues alive. I was particularly impressed with the candor of some of the providers about their dilemmas in addressing the needs of disabled people within the current medical system. One physician said:

If we don't pay attention to people's function[ality] in the face of their illnesses, then we have really cut ourselves off from the biggest opportunity we have to help as doctors. . . . . We all went into medicine, despite fantasies of cure, wanting to be helpful. Doctors feel frustrated when they don't know how to be helpful. They feel inadequate, overwhelmed, befuddled and not sure what to do. (p.152.)

Iezzoni addresses a range of social and personal issues which often arise in relation to mobility-related disability: poverty, stigma regarding sexuality, dilemmas of aging with disability, incontinence, architectural access barriers, and family care-giving struggles. I would have wished for a stronger focus on the difficulties of obtaining adequate Personal Assistance Services, often a huge barrier for significantly mobility-impaired people. However, the book's focus on assistive technologies is very clear and practical. The chapters, "Who Will Pay?", and "What Will Be Paid For?" contain a strong analysis of the barriers inherent in the Medicaid/ Medicare and private insurance reimbursement systems in paying for wheelchairs and other essential durable medical equipment.

The book includes humor as well, some of it ironic. Among the several cartoons Iezzoni reprinted is a New Yorker cartoon showing a Boy Scout helping an older lady with a cane, cross the street (p.58.) The Boy Scout says to the lady, "I also do suicides." Of course, this reveals the potential for malevolence in our society's notion of "help" for people with disabilities. Iezzoni offers instead a course of policy change and education that challenges disability discrimination and expands resources to meet the real needs of people. I prescribe two copies of this book, one for you and one for your doctor.