





































 V37 N4 / 2022 

©2022 American Medical Writers Association. All rights reserved.  
ISSN 2163-5315

AMWAJournal.org     29

ABSTRACT 
I am a firm believer that things happen for a reason, but also 

that good comes from talking about how things came to be 

the way they are.

 The first part of this article describes my personal jour-

ney navigating the complexities of having a disability con-

currently with those of being a medical writer and from that 

standpoint can be considered subjective compared with the 

data-driven information we are used to seeing in our daily 

work. It is not meant to be a history on disability law or a 

comprehensive treatise on why people with disabilities are 

underemployed—other authors have covered those topics 

in great detail in other milieus, to incremental avail—but, 

rather, to raise awareness of potential challenges within the 

medical writing context and how navigating stakeholders’ 

assumptions about health circumstances can be as ardu-

ous as managing the health condition itself. The second part 

of this article provides practical suggestions on things the 

medical writing community can do to make sure their own 

can keep being strong contributors no matter what their cir-

cumstances are in life. It is the author’s hope that this article 

will represent the start of a dialogue within our community 

and that by sharing one story others feel comfortable shar-

ing their own.

Growing up, both of my parents were disabled. So, from 

a young age, I always had many responsibilities and fre-

quently found myself teaming up with my brother to get 

through chores—more chores than my friends ever had. The 

silver lining is that this circumstance gave me the work ethic 

and sense of teamwork I have today, but I was also witness 

to the struggles my parents faced in the health care system, 

including a lack of access to therapies and stigma.

 I often think of how I am just about the same age now 

as my mother had been when she was forced to leave the 

workplace because of her health condition. About 7 years 

ago, I started to encounter my own health issues. At the 

time, I was an undisputed strong scientific contributor, 

and my managers stated as much in reviews. I had pro-

gressed on a steady path from writing to upper manage-

ment. Eventually, however, I could not follow the pattern of 

a normal workday and simultaneously address my health 

concerns. Many of the challenges I faced involved someone 

in a decision-making capacity making assumptions about 

my intentions, my needs, or my work—assumptions that 

were fundamentally false.

 Here is an example: I was 5 minutes late to a meeting 

because I had to run to the bathroom to take a medication 

I need at a certain time of day. A company leader assumed 

I was not being respectful of her time and confronted me 

upon my arrival.

 Here is another example: I hurt my back overexerting 

myself during a regulatory submission (too many consecu-

tive hours at my desk), and I had to go to physical therapy. 

Because I could not make late-day submission meetings, I 

was told I was failing at my job.

 It seemed that overnight, despite having declared my 

disability and asked for accommodations from day 1, I 

would not be permitted to maintain a seat at the table, so to 

speak—one that I had worked so hard to earn. So, I had to 

create a new table. Now, I put into my business all the time 

and energy I used to dedicate to someone else’s vision.

 I often think back to what it would have been like for my 

mother had a work-from-home option been more common-

place, and had she not been forced to leave the workforce at 

such a young age. I was lucky that I found another avenue 

to be able to continue contributing, although I would be 

remiss if I implied this was an easy path.

 As a hiring manager, I also hear all the time other exam-

ples of the type of issues I ran into, including women who 

either were told they would not want to come back to work 

after they had their babies or were told they outright had no 

job to come back to once they went out on maternity leave.

 This is the ladder of assumptions rearing its ugly head; 

in these cases, the person on the receiving end of data has 

translated an observation through a series of filters (the 

Reflections on Working as a Medical Writer with a Disability 
and How Medical Writers Can Be Disability Allies
Jeanette M. Towles, MA, RAC-Drugs / Synterex, Inc, Dedham, MA

TOPICAL FEATURE

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AMWAJournal.org     30How Medical Writers Can Be Disability Allies

rungs on the ladder) into a conclusion (Figure 1). The con-

clusion might seem right because it is based on what the 

observer comes to believe is true, but that truth has no cor-

relation with the reality of the intentions or actual circum-

stances of the person being observed.

 The stress of coping with a health concern compounded 

with that of managing the aspersion of others’ inferences 

amount to a recipe for failure for anyone who cares deeply 

about what they do for a living. Add to that the stress of 

deadlines, strict regulations, and other quirks inherent in 

our industry—perhaps not even knowing who to trust to talk 

to about any conflicts that have come up or accommoda-

tions needed, or embarrassment over how these things have 

been actioned to date—and one could quickly end up with a 

work environment that contributes further to health decline 

and precludes continued work.

 I cannot go back in time and change others’ reactions 

or my health, or convince my younger self to have courage 

because it does get better, but I can advocate so that no one 

else in our community unwittingly finds himself or her-

self in the same situation without help. Toward those goals, 

here are some tips on how not to fall victim to the ladder of 

assumptions and to support those with disabilities working 

in our medical writing community.

1. Avoid making assumptions about capabilities.
When employers think about hiring those with disabilities, 

the desire may be there in theory, but the procedures and 

infrastructure to do so may seem prohibitively daunting. 

There is often confusion over even the etiquette of how to 

interact with prospective employees with disabilities and 

fear over saying too much or too little.2 This hesitation is 

reflected by the rate of unemployment by those with dis-

abilities historically being nearly twice that of those who 

do not have disabilities.3 To overcome this barrier, avoid 

making assumptions that a resource or vendor is not qual-

ified enough or will need too much help to be effective; 

individuals with disabilities or disability-owned business 

enterprises bring expertise and very often have a commit-

ment to hiring others who have also experienced or been a 

victim of the ladder of assumptions. Keep in mind: these are 

individuals who, due to something intrinsic that they had no 

control over, are used to overcoming as barriers things that 

are quotidian to everyone else. A recent disability-related 

article circulating on social media about the return to the 

office after COVID-19-related closures details barriers such 

as “inaccessible commutes, painful chairs, binding cloth-

ing,” and “social cues in break rooms,” but also, in the expe-

rience of one worker with cerebral palsy, “even the inherent 

focus needed to move through a building,” as she navigated 

the fear of falling while moving between multiple meeting 

rooms daily.4 According to a leading organization that helps 

promote corporate inclusion efforts, Disability:IN, workers 

with disabilities are “regularly forced to adapt to an inac-

cessible world, and these experiences have sharpened their 

problem-solving skills and their capacity for innovation.”5 

These skills would make for an ideal medical writer in any 

circumstance.

 To address the question about what you can or should say 

(or cannot and should not say) to an employee who has a dis-

ability, there are some guidelines from the Equal Opportunity 

and Employment Commission, which are slightly different 

prior to hire and after hire (Figure 2 on next page).6

 Prior to a job offer, you cannot ask questions about an 

applicant's disability or questions that are likely to reveal 

whether an applicant has a disability, even if the disability 

is visually apparent. Employers can ask an applicant to vol-

untarily report a disability for affirmative action purposes.6 

Following hire but before start of work, an employer may ask 

disability-related questions and conduct medical examina-

tions as long as it does so for all employees in the same job 

category. After employment begins, an employer may make 

disability-related inquiries and require medical examina-

tions only if they are “job-related and consistent with busi-

ness necessity.”

Figure 1. The ladder of assumptions (also known as the ladder of 
inference). Adapted from: Senge 1994.1

DATA

ACTIONS

BELIEFS

CONCLUSIONS

ASSUMPTIONS

MEANING

DATA SELECTION

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AMWAJournal.org     31How Medical Writers Can Be Disability Allies

 Beyond the regulations, however, the key thing is to 

remember that what an employee who has a disability gen-

erally wants in the workplace is not to feel like his or her role 

or talents are diminished, even if he or she gets to the same 

goals a little differently (Figure 2). Avoid terminology like 

“handicapped” that causes the individual behind the dis-

ability to be minimized and words that pity the person with 

the disability.2 Essentially, operate just as you would with 

anyone else.

 Lastly, to quote my mentor and disability advocate Joyce 

Bender (2021), “sign the contract!”

 To truly have an inclusive workplace is to not only inter-

view those with disabilities—either those who self-iden-

tify or by intentionally seeking out any number of available 

databases of prescreened individuals or vendors with dis-

abilities who are seeking work—but also to follow through 

to onboarding that disabled employee 

or vendor. That person cannot maintain 

their economic freedom7 or contrib-

ute just by a company providing them 

lip service. The people who work on 

medicines in the life sciences, and thus 

the people who manage documents 

to help those medicines get to the 

clinic and market, should be reflective 

of the people in the community who 

will receive those medicines, which 

includes the over 1 billion people living 

with disabilities worldwide.3,8

 Even if no formal employee resource groups have been 

formed, make sure that any support resources are created 

and posted in an accessible way. According to a web acces-

sibility company’s assessment, up to 98% of US-based web-

sites are not fully accessible, and other research by the Pew 

Research Center showed that people with disabilities are 

approximately 3 times as likely to never go online and are 

around 20% less likely to subscribe to home broadband 

and own a computer, smartphone, or tablet. So, change can 

happen from the level of content creation.10

 It is equally important to leverage your influence to 

promote a culture that does not cause your employees to 

defend themselves or their needs repeatedly. As an exam-

ple, I once had to fill out a form justifying equipment 

accommodations that had to be approved by 3 different 

Figure 2. Communication guidelines for interacting with an employee or prospective employee 
who has a disability.2,6

2. Have a support system in place.
It is fundamental to point out: Not every 

disability is the same. Do your home-

work. These are potential corporate 

resources for integrating employees with 

disabilities into your team: 

1) Formal training programs for those 

without disabilities to learn about 

the tools and accommodations 

available for better integration 

across teams; 

2) Formal tailored onboarding pro-

grams, including disability-specific 

information such as reasonable 

accommodation procedures and 

orientation materials that are in 

accessible formats; 

3) Mentoring and career develop-

ment programs; and

4) Employee resource groups.3,9 

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AMWAJournal.org     32How Medical Writers Can Be Disability Allies

managers, which seemed like an unnecessary process caus-

ing me to have to disclose my needs repeatedly across the 

company, which may make some people uncomfortable. 

Once an employee states their requested accommodations 

to Human Resources, they should not have to repeat them or 

remind anyone; it is the company’s job (and in the compa-

ny’s best interest) to know what that person needs to do their 

job successfully. Also, if someone in the disabled community 

is brave enough to come to you with suggestions on how to 

make a policy more inclusive or a resource more accessible, 

any instinct toward defensiveness should be resisted—or, 

worse, gaslighting and telling the person it does not impact 

them; they are not pointing out an issue to you because they 

think whoever put the policy or resource in place is a bad 

person but, rather, because their unique viewpoint may not 

have been known when it was put in place.

3. After you listen, be vocal about your support.
The Americans with Disabilities Act of 1990 (ADA) makes 

it unlawful to discriminate in employment against a quali-

fied individual with a disability.11 Under the ADA, employ-

ers are required to offer reasonable accommodation, which 

is defined as “any change or adjustment to a job or work 

environment that permits a qualified applicant or employee 

with a disability to participate in the job application process, 

to perform the essential functions of a job, or to enjoy bene-

fits and privileges of employment equal to those enjoyed by 

employees without disabilities.”

 Let your colleagues know, both within and outside of 

medical writing, that including those with disabilities in 

your resourcing pool, as well as offering economically fea-

sible accommodations per the ADA, is not just a require-

ment to be dealt with—it is a winning strategy. In fact, the 

majority of requested accommodations cost nothing to 

implement, with the rest costing only $500 per employee 

on average.3 Common accommodations in the medical 

writing field may include more obvious ones like equip-

ment requests (adjustable height desks, headsets), soft-

ware (speech recognition, closed captioning), or flexible 

schedule, but there may be other less obvious ones such as 

need for accompanying service animals, a quiet or lighted 

workspace, a space with certain temperature parameters, 

or need for a color-coded filing system.12 Given that dis-

ability inclusion is also gaining ground as an important 

topic for corporate responsibility and investors, with more 

CEOs every day signing onto pledges like “Investors are 

‘IN’” and “CEOs are ‘IN’” and using tools like the Disability 

Equality Index, a benchmarking tool that helps companies 

build a roadmap of measurable actions that they can take 

to achieve disability inclusion and equality it is likely that 

most Boards of Directors would be supportive of and tout 

any successes you have had making your medical writing 

team more inclusive.5,13,14 This index is scored on a scale of 

0 to 100 points, with 80 and above achieving a title of “Best 

Places to Work for Disability Inclusion,” and measures based 

on answers and supporting documentation for the current 

year (or, for some questions, a recall of 1 year) the weighted 

domains of culture and leadership, enterprise-wide access, 

employment practices, accommodations, and supplier 

diversity, as well as the nonweighted domain of non-US 

operations. In fact, the Board of Directors will be so sup-

portive because data have shown that those who champi-

oned or improved upon their corporate disability inclusion 

practices were more likely to have shareholder returns  

outperforming those who did not champion or improve 

their practices.3

4. Celebrate disability.
During the COVID-19 pandemic, the author heard from 

many medical writing managers that they were trying to cut 

their employees slack for extenuating circumstances (includ-

ing caring for children or sick family members), in particular 

when it came to performance evaluations, and to ensure the 

protection of their time off and work-life balance (2021). 

 This was a breath of fresh air and should absolutely con-

tinue. As we envision what a return to the office or living 

with the pandemic looks like, it will be critical to bear in 

mind that there will be a large segment of the population 

who will still face the same day-to-day struggles of trying 

to fit in with a typical pattern of the workplace or workday, 

and that their intrinsic features create hurdles for them 

every day in the workplace, in addition to any extrinsic hur-

dles (like COVID-19). Now that we have proven that people 

can innovate (including producing life-saving vaccines for 

a novel virus) without being in the office face-to-face, and 

that it is not prohibitive to have a budget for technologies 

to enable accessible work, will we maintain that position so 

that those with mobility issues, for example, can innovate 

with us? I, for one, am hopeful that we can do this within 

medical writing and serve as a paragon of how to do it right.

It should also be pointed out that medical writers with dis-

abilities make for fierce leaders, as they already are used 

to advocating and negotiating to get what is needed. As 

Disability:IN points out, “The very experiences that have 

resulted in exclusion from all levels of corporate America 

are what make them such important assets to corpora-

tions…they are a large untapped labor force market due  

to inaccurate assumptions about their abilities; they  

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AMWAJournal.org     33How Medical Writers Can Be Disability Allies

represent a significant consumer population; and they bring 

different perspectives.”13 It has further been acknowledged 

by Disability:IN that “Companies that are disability-in-

clusive are thus better positioned to execute responsi-

ble governance, effective risk management, and optimal 

decision-making, as well as enhanced customer align-

ment, employee engagement, and transparency, as com-

pared with those without.”13 Thus, it is important not only 

to include people with disabilities on your medical writing 

team but also to give them the support and resources they 

need to get where they want to go in their careers, including 

positions of leadership. Your department will shine within 

the organization as a result of these efforts, and good lead-

ers will create other leaders.

CONCLUSIONS
As hard as it is to tell a story that may evoke feelings of 

exclusion or pain, the more we tell our stories in the medical 

writing community about how it is to work with a disabil-

ity in the health care field, or about any other times we may 

have been affected by the ladder of assumptions, the better 

chance we have of colleagues understanding our needs and 

how to help us in the workplace.

 By following the tips in this article, and by engaging with 

your employees to find out what else they need to feel sup-

ported for their specific situation, you can start your journey 

to making your medical writing team successful in disability 

inclusion and not accidentally rule out your best employees 

with preconceived notions.

 Coming together in our community around this topic 

through more regular and open dialogue hopefully will lead 

us to a universal position: we are not going to allow our col-

leagues with disabilities to lose the opportunity to contrib-

ute, and we are not going to lose strong leaders from the 

workplace due to lack of accessibility. Not on our watch.

Acknowledgment
Editorial and artwork support was provided by Carrie 

Patrick, Synterex, Inc, Dedham, MA.

Author declaration and disclosures: The author notes no  
commercial associations that may pose a conflict of interest in 
relation to this article. The opinions expressed in this article are 
the authors’ own and are not necessarily shared by their employ-
ers or AMWA.

Author contact: jtowles@synterex.com

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https://www.eeoc.gov/employers/small-business/4-what-cant-i-ask-when-hiring#:~:text=You%20can%20ask%20the%20applicant,medications%20are%20you%20currently%20taking%3F
https://www.eeoc.gov/employers/small-business/4-what-cant-i-ask-when-hiring#:~:text=You%20can%20ask%20the%20applicant,medications%20are%20you%20currently%20taking%3F
https://www.eeoc.gov/employers/small-business/4-what-cant-i-ask-when-hiring#:~:text=You%20can%20ask%20the%20applicant,medications%20are%20you%20currently%20taking%3F
https://www.youtube.com/watch?v=Vvnqd3on2u0
https://www.youtube.com/watch?v=Vvnqd3on2u0
https://disabilityin.org/resource/business-case/
https://www.shrm.org/ResourcesAndTools/hr-topics/talent-acquisition/Documents/employing_people_with_disabilities_toolkit_february_3_2015_v4.pdf
https://www.shrm.org/ResourcesAndTools/hr-topics/talent-acquisition/Documents/employing_people_with_disabilities_toolkit_february_3_2015_v4.pdf
https://www.shrm.org/ResourcesAndTools/hr-topics/talent-acquisition/Documents/employing_people_with_disabilities_toolkit_february_3_2015_v4.pdf
https://www.shrm.org/ResourcesAndTools/hr-topics/talent-acquisition/Documents/employing_people_with_disabilities_toolkit_february_3_2015_v4.pdf
https://www.cnet.com/tech/mobile/the-original-voice-of-siri-is-now-advocating-for-a-more-accessible-web/
https://www.cnet.com/tech/mobile/the-original-voice-of-siri-is-now-advocating-for-a-more-accessible-web/
https://www.cnet.com/tech/mobile/the-original-voice-of-siri-is-now-advocating-for-a-more-accessible-web/
https://www.eeoc.gov/laws/guidance/ada-your-responsibilities-employer
https://www.eeoc.gov/laws/guidance/ada-your-responsibilities-employer
https://odr.dc.gov/book/manual-accommodating-employees-disabilities/types-reasonable-accommodation
https://odr.dc.gov/book/manual-accommodating-employees-disabilities/types-reasonable-accommodation
https://odr.dc.gov/book/manual-accommodating-employees-disabilities/types-reasonable-accommodation
https://disabilityin.org/investors-are-in/
https://disabilityin.org/investors-are-in/
https://disabilityin.org/what-we-do/disability-equality-index/
https://disabilityin.org/what-we-do/disability-equality-index/



