July 2019, Volume XXXIII, No 4
Patient Perspective
Treating people with disabilities
Facilities and communications
hat’s the worst part about a routine trip to the doctor’s office—the long wait, the old magazines, the fear of needles? Add a disability, and you’ve got a recipe for a very stressful event, instead of a routine medical visit.
According to the Centers for Disease Control and Prevention (CDC), 26% of the adults in the U.S. have some type of disability. The majority of disabilities fall in the category of physical (mobility, hearing impairment, vision loss). Intellectual and cognitive issues may also create challenges when accessing medical care. However, medical professionals should be concerned less about the type of disability, and more about whether or not their clinics are accessible to all of their patients.
Connect with patients
If your medical staff is going to treat people with disabilities successfully, diagnosis is only part of what you need to know about your patient. The patient’s diagnosis will not tell you what that person needs to be able to collaborate with health care professionals and follow treatment protocols.
Ask your patient with disabilities these questions:
- What is their home and work life like?
- What are their abilities?
- How do they get to places? Transportation can be a huge problem, no matter what part of the state you live in.
- Do they use technology to make their world better and more accessible?
- Do they use a personal care attendant (PCA)? Should they consider using a PCA? There is currently there is a shortage of PCAs, which has made it a challenge for some people with disabilities to remain independent.
All of these questions are vital if you are going to be successful in treating people with disabilities. Your patients’ answers will give you a more accurate picture of how they manage to live independently.
Assess your facilities
Accessibility in health care clinics, doctors’ offices, and other health care provider facilities is essential for people with disabilities seeking medical care. Some people with mobility issues actually avoid going to the doctor because of their experiences on the dreaded exam table! It’s a serious matter involving access, safety, and dignity, all of which should be basic rights for patients with disabilities.
The primary function of the exam table is to support the patient in prone or supine side-laying positions. In most doctor’s offices, exam tables are typically designed for use at a fixed height of 32 inches. This height makes independent transfers difficult to almost impossible for many people with disabilities, especially those who use mobility aids such as walkers, wheelchairs, and scooters—devices also used by many seniors. The same problem applies to exam chairs that are meant to support a person in a seated or semi-supine position. Frequently these chairs do not allow for independent transfers by patients with mobility disabilities.
My experience, when visiting a provider’s office, is that the exam tables are the standard 32-inch height, making it literally impossible for me to self-transfer independently. Newer types of exam tables, which look like a seated table, are still a challenge because of their fixed positions. Hydraulic designs are better, although sometimes they still don’t go down far enough for a safe transfer. Support staff are always eager to help, but I decline every time. I use a scooter, and my experience is that the majority of medical providers do not know how to transfer patients with disabilities appropriately and safely on and off exam tables.
Medical staff should first ask the patient with a disability if he or she is able to get on the exam table without assistance. If the patient says “no,” medical staff should not try to talk them into using the exam table by saying “oh, we will help you.” Persons assisting a patient should be trained in safe transfer techniques for people with disabilities. When transferring the individual with a disability, they should always listen to the patient’s directions and suggestions as well. The patient with the disability knows what works best for a safe and respectful transfer.
Understand your legal obligations
In 2009, the state Legislature passed the Minnesota Safe Patient Handling in Clinical Settings Act (MN Statute 182.6554), which applies to physicians, dentists, and outpatient care facilities where services require movement of patients from point A to point B as part of the scope of service. Every clinical setting in the state was required to develop a written safe patient handling plan by Jan. 1, 2012, with the goal of ensuring the safe handling of a patient by minimizing manual lifting of a patient by direct patient care workers and utilizing safe patient handling equipment.
Under the law, these plans required an assessment of hazards, acquisition of safe patient handling equipment, initial and ongoing training of direct patient care workers, procedures to ensure that modifications are consistent with plan goals, and periodic evaluations. Health care organizations with more than one covered clinical setting may establish a plan at each clinical setting, or develop one plan that serves this function for all clinical settings.
The bottom line is that a clinic should have either an automated exam table that moves up and down and/or a mechanical lift that clinic staff have been trained to use to assist people safely on and off an exam table.
Part of what we are dealing with is the fact that the medical community has not kept up with the 1990 federal Americans with Disabilities Act (ADA). Health care providers—along with many businesses in America—have not met the intent of the law and eliminated barriers to allow people with disabilities to access their services. The medical community is obligated to follow the ADA and provide access to health care and give people the equal opportunity to be a patient at the clinic of their choice. People with disabilities are not alone in this issue of accessibility. The aging community mirrors the disability community’s issues in many ways.
Assess your patient communications
Some common patient concerns and suggestions that physicians might follow to correct the situation:
“I don’t feel safe when the patient room door is shut because I can’t open the door on my own.” Patients with paralysis feel real fear when left in an exam room and the door closes. Ask the patient before leaving the room if he or she would prefer having the door left open.
“I sometimes don’t understand what the doctor is doing.” Because of the demands of the clinic, doctors too often rush through exams and explanations. More two-way conversation needs to occur. Ask how the patient learns best: by writing, pictures, and/or verbal discussion.
“I feel like my doctor doesn’t listen to me.” This often occurs, so perhaps the physician can alleviate the situation by slowing down, speaking plain English, asking more questions, and taking more time with the patient.
The medical community has not kept up with the 1990 federal Americans with Disabilities Act (ADA).
The majority of medical providers do not know how to transfer patients with disabilities appropriately.
“I feel like the doctor is in a hurry. I need more time.” This is a difficult point for most medical professionals due to a variety of issues, ranging from the number of patients that must be seen by a physician in a day and insurance reimbursement issues.
“The doctor puts me in the same category as all the other people who have my condition. I am my own person.” The physician should focus more on the individual as a person and not on the medical diagnosis.
“I don’t want to do more tests. How do I say ‘no’ to my nice doctor I have seen forever?” Understand that even people with disabilities have the right to say “no” to treatment options.
“I don’t have access to my digital chart because it’s not accessible.” Digital accessibility is required by the ADA and should be adhered to. Websites and documents need to be accessible for everyone. The medical provider and the clinic should be asking themselves, “Are the documents on the website accessible? Is the My Chart system accessible?”
“I feel that assumptions have been made regarding my intellectual abilities.” We all have different abilities and physicians should give patients the benefit of the doubt.
“I want to make my own decision(s).” This is called “self-determination” for patients with disabilities.
“I need more time with my doctor.” Specify in patients’ charts that they need a specific amount of time to be adequately seen by the physician. Prepare in advance for patients with disabilities by reviewing their history. Ask patients with disabilities to bring in a list of concerns they may have, or to email them to the doctor ahead of time. Consider their access to transportation, PCA hours, and other factors. Remember that a disability is different than an illness.
“The exam table is just too high to get up on and I feel unsafe trying to get up there.” Once you get an automatic exam table in a patient-exam room, make a note in the patient’s chart for those that require the room with the automatic lift table or mechanical lift, so the scheduler will know to schedule the patient in that room when visiting the clinic.
“The medical professionals always want to grab my arm and lead me into the patient room and this interferes with my use of my cane. As a blind person, I am used to navigating with my cane.” Clinic staff should talk concisely to individuals who have vision impairment and ask the person if it would be helpful to describe the layout of the exam room.
“Can I ask my doctor to provide sign language interpreters?” Doctors’ offices are public accommodations and are required to provide auxiliary devices, such as sign language interpreters.
Create a partnership
Integrating physical health with mental health can benefit all patients. Going to the doctor’s office for a medical visit doesn’t need to be filled with stress, fear, and distrust. It should be an opportunity to look forward to working together by creating a partnership in a welcoming environment for all patients, but especially patients with disabilities and seniors.
Joan Willshire, MPA is executive director at the Minnesota Council on Disability, which advises the Governor’s office, state Legislature, state agencies, and the public on disability-related issues. Throughout her career, Willshire has been active within the disability community and has served on several boards, including the Minneapolis Advisory Committee on People with Disabilities.
Learn more
Resources for physicians treating people with disabilities:
- ADA Mobility Impairment Guidelines (HHS):
- www.tinyurl.com/mp-tips-guidelines
- “Accessible Medical Examination Tables and Chairs” (ADA National Network): www.tinyurl.com/mp-tips-02
- Re-envisioning Care for People with Involved Disabilities (Institute for Healthcare Improvement):
- www.tinyurl.com/mp-tips-03
- Medical Treatment and Care for People with Disabilities
- (Swiss Academy of Medical Sciences):
- www.tinyurl.com/mp-tips-03b
- Disability and Health Information for Health Care Providers (CDC): www.tinyurl.com/mp-tips-o4a
- Disability & Health Resources for Facilitating Inclusion and Overcoming Barriers (CDC): www.tinyurl.com/mp-tips-05
- Are Doctors or Hospitals Required to Provide Interpreters for Deaf Patients? (Disability Independence Group, Inc.):
- www.tinyurl.com/mp-tips-06
- 10 Tips to Prepare for a Doctor’s Visit for People who are Blind (Perkins School for the Blind): www.tinyurl.com/mp-tips-07
- Primary Care Physicians’ Perceptions on Caring for Complex Patients with Medical and Mental Illness (NIH):
- www.tinyurl.com/mp-tips-08
- Communicating with People with Disabilities (National League for Nursing): www.tinyurl.com/mp-tips-09
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