Promoting Disability Inclusion in Medical Practices

Patients have specific expectations when it comes to their office visit and one is that their provider listens to them and demonstrates understanding, according to a PwC Health Research Institute survey. However, working with electronic health records (EHRs) leaves physicians little time to interact with patients. Outsourcing medical transcription helps to a great extent by allowing providers to spend less time on clinical documentation and focus on face-to-face interaction with their patients. But patients with mobility impairments face certain unique problems when visiting a physician’s office. The concerns are that medical practices are not accessible to patients with disabilities or not properly equipped to deal with them. Disability inclusion means that the needs and engagement of people with disabilities are taken into account so that each person has the same opportunity to live, work, learn, and play to the best of their abilities and desires.

Disability Inclusion

More than 20 percent of Americans or about 57 million people live with a disability, according to a 2017 New York Times report. This includes 8 percent of children and 10 percent of nonelderly adults. With the increasing incidence of diabetes, arthritis, and other chronic conditions and increased life expectancies for people with congenital conditions, the number of Americans with disabilities in all age groups is likely to rise.

Since the passage of the ADA, significant advances have been made in facilities for people with disabilities. Citing a study, a 2017 New York Times reported that patients with disabilities don’t always get the same treatments for the same medical conditions. Researchers called more than 250 specialty practices to schedule an appointment for a fictional patient they presented as partly paralyzed and unable to self-transfer from a wheelchair to the exam table. The researchers reported that more than 20 percent of the offices did not give an appointment on the grounds that their building was wheelchair inaccessible, they did not have height-adjustable exam tables, or their staff lacked training to move the patient. Even practices that agreed to schedule the appointment said they did not have the necessary gear to move the patient, and may need to omit parts of the physical exam.

As the Agency for Healthcare Research and Quality (AHRQ) notes, many people with mobility problems have a ‘thinner margin of health’. For instance, they usually have higher rates of unaddressed cardiovascular risk factors like obesity, smoking and hypertension. As a result, people with mobility impairments require a more complex array or services than people without such issues. However, in reality, this patient segment faces many barriers when visiting family physicians:

  • Physical barriers in medical offices, such as lack of ramps, weight scales, grab bars, height-adjustable examination and imaging tables, inadequate space within the practice to maneuver a wheelchair or to transfer to an examination table
  • Lack of transportation
  • Less likelihood of receiving routine medical care, including cancer screening, flu vaccines and vision and dental exams.
  • Noninclusive health or wellness programs designed for people without disabilities
  • Inaccurate or inadequate knowledge or stigmatizing attitudes of clinicians about disabling conditions
  • Inadequate training for clinicians and staff
  • Competing priorities in the health care system
  • Communication barriers, such as failure to cater to deaf patients who require sign-language interpreters

The effects of these barriers vary depending on the type of disability type, according to a study published in The New England Journal of Medicine. For instance, stigma is generally more of a problem for people with mental health or intellectual disabilities, whereas inaccessible equipment can prevent a person with a significant mobility disability from getting even basic services such as being weighed.

Cost and space are major limitations for small practices. While the price of a height-adjustable table can be as high as $6000, a wheelchair scale can cost $3400 and a ceiling lift and sling, $1800 dollars. In small practices, exam rooms do not enough space to house larger tables and chairs for family members and also have enough room to maneuver a mobility device.

The Centers for Disease Prevention and Control (CDC) reiterates the importance of disability-inclusive healthcare that applies to both communication and physical access. The CDC’s recommends that physicians can ensure inclusive healthcare in the following ways:

  • Know how to effectively communicate with patients who have a range of disabilities, including those with hearing, speech, or vision problems, or intellectual disability
  • Make accessible medical equipment available for people with disabilities, such as scales, examination tables, or chairs
  • Spend more time with patients who may need such facilities during examinations
  • Take time to meet the patient’s specific health care needs
  • Give people with disabilities the information needed to live a long and healthy life, even if they don’t ask for it
  • Listen and respond to the patient’s health concerns
  • Communicate clearly and directly with the patient

According to the New York Times report, doctors with disabilities are making a difference when it comes to disability inclusion. The reason is that people with disabilities would feel more comfortable with concerns similar to theirs.

Good medical documentation is critical to good care and promotes patients’ and physicians’ best interests. Spending more time with patients can take away from time needed for documentation tasks. Medical transcription services can address this concern by ensuring reliable, accurate and timely patient records essential for quality care.