Wheelchair Patients Find Obstacles at Doctor’s Offices

Almost one-fourth of doctors are unable to accommodate and treat patients who use wheelchairs more than 20 years after the passing of the Americans with Disabilities Act, a study found.

About 22 percent of 256 doctor’s offices surveyed said they couldn’t assist people in wheelchairs, with most of those saying it was because they weren’t able to safely transfer the patient to an exam table, according to research published today in the Annals of Internal Medicine. Lack of access to the building was a secondary reason, the researchers said.

The Americans with Disabilities Act, passed by the U.S. Congress in 1990, is aimed at ending discrimination for people with disabilities in everyday activities including access to medical care facilities and the services provided there. Today’s findings are one of the first to show where barriers to medical services remain for wheelchair-bound patients, said Tara Lagu, the study’s lead author.

“This is affecting a large number of patients, certainly the 3 million who use a wheelchair, but many more than that who have difficulty getting up to an exam table,” said Lagu, an academic hospitalist at Baystate Medical Center in Springfield, Massachusetts, and an assistant professor at Tufts University School of Medicine, in a March 15 telephone interview. “The point of the study is to help doctors realize what the problems are and to help them become more aware of the Americans with Disabilities Act and to identify what the difficulties patients who use wheelchairs are having in accessing health care.”

Fictional Patient

Researchers in the study called the doctor’s offices in four U.S. cities to make an appointment for a fictional patient who was female, obese and had suffered a stroke and couldn’t use half of her body. They also said the patient was unable to transfer herself to an exam table.

They found that 56 practices said they couldn’t accommodate the patient. Of those, 47 said it was because they weren’t able to help the patient onto a table and nine said it was because of their building.

Of the 200 practices that said they could accommodate the patient, 103 said they would manually transfer the patient from the wheelchair to a standard exam table that didn’t adjust its height without the use of a lift. Only 22 said they had accessible tables that lowered to the height of the wheelchair or a lift to transfer the patient. Manually transferring a patient to a table that’s unable to adjust its height is considered unsafe, Lagu said.

Unsafe Practices

“It was troubling to us that many surveyed practices were inaccessible, but it was equally problematic that few accessible practices possessed equipment that would facilitate the safe transfer, from chair to table, of our fictional patient,” Lagu said in a statement. “A majority of accessible practices reported that they planned to have practice staff manually lift the patient from a wheelchair to an unadjustable, standard- height exam table, a method that disability experts consider to be unsafe for both the patient and those lifting her.”

An adjustable table costs about $5,500 while a standard table costs $1,500, Lagu said. Tax credits are available for doctors to purchase the adjustable tables. Also, doctors that refuse to make appointments for patients in wheelchairs could face lawsuits, she said.

“Approximately 16 percent of civilian, non- institutionalized Americans aged 18 years or older have physical functional limitations and these numbers will rise sharply in the coming decades. Thus, all physicians can expect to see numerous patients with impaired mobility,” wrote Lisa Iezzoni, a professor of medicine at Harvard Medical School and director of the Mongan Institute for Health Policy at Massachusetts General Hospital in Boston, in an accompanying editorial.

“That practices would decline to see patients with disabilities raises troubling questions about their commitment to the core tenet of professionalism: increasing access and reducing barriers to equitable health care,” she said. “Height-adjustable examination tables can improve physical comfort, safety and access for many patients in addition to persons with disabilities. These tables also offer important benefits to physicians and practice staff.”

To contact the reporter on this story: Nicole Ostrow in New York at nostrow1@bloomberg.net

To contact the editor responsible for this story: Reg Gale at rgale5@bloomberg.net

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