Double Standard

The Link Between Mobility and Quality Health Care


If you don’t have a mobility disability, you don’t even think about it: You visit your doctor, you hop up on the examining table, a nurse takes your vitals, the doctor examines you, you hop off the examining table and you’re out of there.

If you do have a mobility disability, though, hopping onto and off of tall examination tables isn’t something you do very well. A result is that you may not get the kind of thorough examination routinely offered to people who can climb onto the table where they can lie flat at a convenient height for doctors who can comfortably perform a thorough thoracic examination and abdominal palpation – doctors’ words for poking and prodding and generally trying to feel your insides.

No lying flat, no reliable exam. No reliable exam, and serious problems, from colon cancer to liver disease, can be overlooked until it’s too late.

Mary Lou Breslin knows a lot about this double standard, and she spends a lot of time talking about it to lawmakers and physicians and journalists. Breslin is an internationally known disability-rights advocate and the founder of the Disability Rights Education and Defense Fund. Recently featured on National Public Radio’s Morning Edition, she argues that people with disabilities often get shortchanged in health care because everything from cancer-treatment centers to neighborhood doctors’ offices assume their patients are able to walk in, climb, bend, stand, and jump up on that high, gleaming exam table with the crinkly paper.

The reason Breslin knows the subject so well is that she uses a power chair, is a breast cancer survivor, and has seen the double standard up close. Turned away from a chemotherapy infusion center when she was battling cancer because she was in a power chair — “We’re an ambulatory infusion center,” the nurse told her — Breslin learned the hard way about the double standard. If you’re in a chair, Breslin said, it isn’t long before you recognize that state-of-the-art diagnostic equipment, from mammography devices and weight scales to X-ray machines and examination tables, wasn’t designed with you in mind.

“The problems that people face in gaining access to health-care services go beyond architectural accessibility,” Breslin said. “We’re talking about programmatic accessibility, which has to do with what happens once you actually get into the office or clinic or facility of a health-care provider.”

If you have a mobility disability, it’s likely to be a challenge to get thorough health care. Breslin says you’ll have to do some work, and she has some recommendations.

If you have to be hospitalized, don’t just agree to the facility your doctor designates without first checking to be sure it’s accessible throughout, not just the front door. Is there an ADA compliance officer or a patient advocate? If so, they should be able to tell you if their hospital has a clue about accessibility.

When you look for a doctor, start by making phone calls. Visits are time consuming, exhausting and expensive, so vet local providers first by phone. Speak with someone who can field your accessibility questions. Do they have a height-adjustable exam table? Does the physician routinely get patients with disabilities up on the table for exams? Does the office have access to a wheelchair-accessible scale? If the people you speak with seem aggravated by your questions or surprised that you’d ask such things, wish them a good day and try elsewhere.

Get in touch with other mobility-disabled people in your community. Word about good doctors for people with disabilities travels fast, so your neighbors can be good information sources. Breslin also says your local independent-living center can make sound recommendations.

An attorney, Breslin thinks it’s important that you understand the law and your rights. Title III of the Americans with Disabilities Act covers things like hospitals, diagnostic facilities and physicians offices. While large hospitals tend to pay attention to the ADA, the same can’t be said for the country’s hundreds of thousands of individual physicians’ offices. “The providers for the most part are not thinking about it,” she said. “It’s not really on the radar.”

According to Breslin, doctors have been notoriously slow about ADA compliance, many claiming the law is vague. That excuse is a good reason to tell your senators and representatives to support Sen. Tom Harkin’s (D-Iowa) legislation, S. 1050, that sets accessibility standards for medical equipment.

Breslin says that the way the American health-care system accommodates or fails people like her is a measure of whether it can recognize, respect and care for people with disabilities. Despite progress, she says, there’s still a long way to go.

This article originally appeared in the November 2007 issue of Mobility Management.

In Support of Upper-Extremity Positioning