Vernellia Randall, I Thought I Was Asking for Accommodations: When Communication Becomes the Disability, racism.org/articles/basic-needs/54-health-and-health-care/230-health-care-generally/13488-i-thought-i-was-asking-for-accommodations (June 25, 2026).

My primary care physician of four years and the practice he works in discharged me after a single appointment with an on-call physician.

I have been thinking a great deal about how that happened.

Over the previous several months, I had developed increasing cognitive fatigue and brain fog. As I became mentally fatigued, it became more difficult to process information, answer questions, and communicate clearly. Fluorescent lighting also aggravated my symptoms.

I realized these symptoms were beginning to interfere with my medical appointments. I wanted my physicians to understand that the way I communicated was changing because of my illness, not because I was unwilling to participate in my care.

I notified my primary care physician and my specialists that I was experiencing cognitive fatigue and that I would be relying more heavily on written communication. I prepared a detailed written summary describing my symptoms, how they affected my ability to communicate, and the accommodations I was requesting.

I thought the written summary would make the appointment easier—for both of us. It would allow me to communicate accurately without repeatedly restating the same information as I became mentally fatigued.

I brought the summary to my appointment at the Orlando Health Internal Medicine and Family Medicine practice and asked the nursing staff to give it to the on-call physician before she entered the examination room.

When she came into the room, she told me she had read it.

As the appointment continued, she asked a number of questions that I believed were already answered in the summary. I answered new questions, but when she asked questions that had already been answered, I responded, "It's in the paper."

I said that intentionally.

One of the accommodations I was requesting was to reduce the need to repeatedly answer the same questions because repeated questioning increased my cognitive fatigue. I had explained that in the written summary, and I explained it again during the appointment. I was not refusing to participate. I was trying to communicate in the way my disability allowed me to communicate most effectively.

During the appointment, the physician left the examination room without telling me where she was going, why she was leaving, or whether she intended to return. She did not tell me the appointment was over or explain what would happen next.

I remained in the examination room for approximately fifteen minutes. When no one returned and no one checked on me, I concluded that the appointment had ended and left.

When I left the office, I thought the appointment had been frustrating, but I had no idea my behavior had been interpreted so differently. No one told me there were concerns about my responses. No one suggested that my relationship with the practice was at risk. No one asked whether there had been a misunderstanding or whether another way of communicating might work better.

Two days later, I received a telephone call informing me that my July appointment with my primary care physician had been canceled and that I had been discharged from the Orlando Health Internal Medicine and Family Medicine practice.

I had been a patient of my primary care physician for approximately four years. That physician-patient relationship ended following a single visit with an on-call physician.

The reasons given for the discharge were that I had been uncooperative, had refused to answer follow-up questions, and had displayed an irritable attitude.

I have thought about those words many times.

Looking back, I think we left that appointment with entirely different understandings of what had happened. I thought I was explaining a disability and asking for accommodations. The practice apparently concluded that they were dealing with an uncooperative patient.

That possibility troubles me because I doubt I am the only patient whose illness has changed the way they communicate.

Many illnesses affect far more than the body. They affect memory, concentration, processing speed, language, and the mental endurance needed to participate in what appears to be an ordinary conversation. Those changes may not be visible, but they are real.

There is one thing I would do differently.

For years, I have encouraged family members, friends, and my students to take someone with them to important medical appointments, especially when they were seriously ill or when communication might be difficult. This time, I did not follow my own advice.

If I had it to do over again, I would have asked my son to accompany me.

I don't think I would have been discharged if another person had been in the room. A second person would have heard the entire conversation, observed the interaction, and understood that I was trying to manage the effects of cognitive fatigue rather than refusing to participate in my care.

That is the lesson I learned from this experience. If my story encourages one patient to bring another person to an important medical appointment, or one healthcare professional to recognize that communication itself can be affected by disability, then sharing it will have been worthwhile.

 Vernellia R. Randall, Professor Emerita of Law, University of Dayton School of Law. This article was drafted with the assistance of ChatGPT, an AI language model.