July 2019, Volume XXXIII, No 4
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.
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:
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.
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.
The medical community has not kept up with the 1990 federal Americans with Disabilities Act (ADA).
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 majority of medical providers do not know how to transfer patients with disabilities appropriately.
Resources for physicians treating people with disabilities:
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.