HEALTH CARE/Joan Retsinas

A Memo to Physicians: Open Up Your Offices

A Memo to Physicians: Patients need you. Not your regular patients, the ones who walk into your office, sit down in your waiting room, climb onto your examining tables. They are fine. It is the people who cannot so easily walk, sit, and climb who need you. They might want to be your patients; but they can’t enter your office, navigate through your waiting room, or hoist themselves up on your examining tables. They need “accommodations,” in the language of the 20+ year-old Americans with Disabilities Act.

In these past decades, most of the country has accepted the need for the Act – as well as the provisions. Like all pieces of major legislation, it initially prompted “sky-is-falling” predictions. Hordes of people, claiming assorted “disabilities,” would clamor for “accommodations” that would bankrupt governments, businesses, public utilities, employers. Pessimists predicted a general Armageddon, laid at the feet of the “disabled.”

Armageddon didn’t happen. Many employers accommodated people who needed Braille, hearing devices, raised desks, and wheelchair ramps. And the law allowed employers who could demonstrate undue hardship to bow out. After all, a bankrupt business would benefit nobody, least of all a disabled employee. Retail establishments realized that simple accommodations – like large-entry handle-less automatic doors – would make access easier for a lot of patrons, and large retail stores now routinely eschew stairs. Those stores recognize that greater access translates into more customers. Public spaces – parks, libraries, city halls, convention centers, courthouses – all have added ramps and handicap-accessible bathrooms. New structures routinely incorporate “universal design” into their blueprints. Even home-builders, who are not covered under the ADA, often make doorways, bathrooms, kitchens, and closets adaptable for people who need wider pathways, lower counters, handle-less doors. Those “universal design” features can improve sales.

A disappointing holdout are physicians. Some of their offices won’t accommodate a patient with a disability. A group of researchers (“Access to Subspecialty Care for Patients With Mobility Impairment: A Survey,” Annals of Internal Medicine, March 19, 2013) polled, by telephone, 256 specialists’ offices in four cities. The specialties ran the gamut, including endocrinology, gynecology, orthopedic surgery, rheumatology, urology and psychiatry. Pollsters asked about a fictional patient, obese and partially paralyzed. This patient used a wheelchair, and could not lift himself from the chair to an examining table. Could the office accommodate the patient? Could the patient enter the office? Get onto an examining table? The pollsters set a reasonable bar for “accommodations.”

Unfortunately, 56 (22%) of the offices couldn’t meet that bar: for nine offices, the building itself was not accessible. In another 47 the patient could enter, but could not get onto an examining table. The subspecialty that emerged as the least accommodating was gynecology: 44% of those offices couldn’t greet a patient in a wheelchair, who needed a lift onto an examining table.

An editorial in this issue of the Annals of Internal Medicine discusses the easy solution to helping a patient get onto an examining table: adjustable-height tables. Just as barbers have long used adjustable-height chairs that go from low to high, for toddlers growing into adults, so too those adjusting mechanisms could work for patients. Yet only 9% of the offices polled had them. In 40% of the offices, staff would lift a patient who needed help – risking back injuries.

The Americans with Disabilities Act has been on the books since 1990. The law covers physicians. It is time for all of them to comply. That is their legal obligation. But there is a moral obligation too, going back to Hippocrates. Physicians are charged to treat the sick – not just the able-bodied sick.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, May 1, 2013