Summer 2013

Denial of Care

Many doctors decline to treat patients who use wheelchairs, according to Baystate study

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Illustration by Juliette Borda

More than 20 years after Congress passed the Americans with Disabilities Act of 1990, nearly one-quarter of doctors declined to schedule appointments for patients who said they used wheelchairs, according to a nationwide study undertaken by researchers at Baystate Medical Center, a Tufts-affiliated hospital in Springfield, Mass.

The survey phoned 256 doctor’s offices in four cities, with the caller claiming in each case to be overweight, disabled and suffering from a variety of medical problems related to such specialties as endocrinology, gynecology or psychiatry. Overall, 56 specialty practices, or 22 percent, told callers they could not be seen, citing exam tables that could not be raised and lowered or the lack of safe procedures for getting the patient in and out of a wheelchair. In some cases, the buildings in which the medical offices were located were not accessible.

“Many doctors may not be aware that they need to see patients with disabilities,” lead author Tara Lagu, a hospitalist at Baystate and assistant professor of medicine, told the Boston Globe. “I’m shocked every time I hear from patients in wheelchairs that they can’t get an appointment with a urologist or gynecologist, or that the doctor wants them to come in an ambulance for transfer to an exam table by an emergency medical technician.” Lagu noted that about three million Americans rely on wheelchairs, and an even greater number of patients may experience difficulty climbing onto an exam table.

Survey results varied from city to city, with 30 percent of Houston offices refusing to schedule appointments, followed by Dallas (27 percent), Boston (17 percent) and Portland, Ore. (14 percent). Barriers to medical care on this scale could lead large numbers of patients to miss such timely diagnostic tests as mammograms or Pap smears or have a chance to gain potentially life-changing professional guidance in the management of their chronic health problems, Lagu said.

Relatively few doctors’ offices are well equipped to welcome disabled patients. Of the 200 practices that agreed to accept the fictional patients in wheelchairs, 103 said that although they didn’t have a suitable lift, they would attempt to transfer the patient manually from the wheelchair onto the standard exam table—a practice that is generally considered unsafe, according to Lagu.

“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,” Lagu said. The study appeared in the March 18 issue of the Annals of Internal Medicine.

 

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