If you’re disabled and in a wheelchair, gaining full access to basic medical care can still be elusive, a new report finds.
The study, published online in the journal Annals of Internal Medicine, focuses on speciality care and concludes that even in our high-tech environment, something that seems fairly low-tech — getting a patient on to an exam table — doesn’t happen in many doctor’s offices. “Many sub-specialists could not accommodate a patient with mobility impairment because they could not transfer the patient to an examination table,” the report states.
It’s widely known — and a huge problem — that adults who use wheelchairs often face difficulties getting a complete physical examination because they have trouble getting on the exam table, says Dr. Lisa I. Iezzoni, director of the Mongan Institute for Health Policy at Massachusetts General Hospital. (Iezzoni, who has used a wheelchair for nearly 25 years because of multiple sclerosis, recently authored a report that found people with disabilities face major obstacles accessing a range of health services, from cancer screening to various medical treatments.) As a result, the study authors note, this patient population receives “less preventive care than their able-bodied counterparts.”
Dr. Tara Lagu, an internist at Baystate Medical Center
To investigate the problem further, researchers led by Dr. Tara Lagu, an internist at Baystate Medical Center in Springfield, enlisted medical students and residents to make appointments for a fictional obese (219 pounds), wheelchair-using patient with a recent stroke. They called doctors in four states (Massachusetts, Georgia, Oregon and Texas) and included a range of specialists — endocrinologists, gynecologists, orthopedic surgeons, ophthalmologists and psychiatrists, among others.
“We wanted a real-life snapshot of accessibility,” Lagu said. The callers would say: “I’m an internal medical resident trying to make an appointment for my patient — they had a specific script they had to adhere to.”
Shockingly, many of the office staff flat out refused to make an appointment, the researchers report. When asked why, some of these office staffers were quite direct and said it was not possible to get the disabled person on to the exam table.
You can listen to Lagu discuss the research here. But the bottom line (from the abstract) is this:
Of 256 practices, 56 (22%) reported that they could not accommodate the patient, 9 (4%) reported that the building was inaccessible, 47 (18%) reported inability to transfer a patient from a wheelchair to an examination table, and 22 (9%) reported use of height-adjustable tables or a lift for transfer. Gynecology was the subspecialty with the highest rate of inaccessible practices (44%).
Lagu said the study tracks with her “real life experience,” after 10 years as a doctor. “Pretty much everywhere I’ve been in my career, I’ve encountered this or a similar problem,” she said. Continue reading