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THERE is still a long way to go to make specialist medical care accessible for mobility-impaired Australians, according to a leading advocate for disabled health care.
Rehabilitation physician Dr Kathleen McCarthy was responding to an American survey published in the Annals of Internal Medicine, which found that many subspecialists could not accommodate a patient with mobility impairment. (1)
The situation was “absolutely the same here”, said Dr McCarthy, who is immediate past president of the Australasian Faculty of Rehabilitation Medicine, an arm of the Royal Australasian College of Physicians.
The US researchers called 256 endocrinology, gynaecology, orthopaedic surgery, rheumatology, urology, ophthalmology, otolaryngology and psychiatry practices in four US cities to try to make an appointment for a fictional, obese, hemiparetic patient who used a wheelchair and could not self-transfer to an examination table.
Fifty-six practices (22%) reported that they could not accommodate the patient either because their building was inaccessible or they were unable to transfer the patient to an examination table, even though disabled access is mandated by the Americans with Disabilities Act (1990). Gynaecology had the highest rate (44%) of inaccessible practices.
Just 22 practices reported they had height-adjustable examination tables or hoists for transfer.
Dr McCarthy said that, in Australia, even though the Disability Discrimination Act had been in place since 1992, there was no requirement to retrofit because it would be “hideously expensive”.
“People are not thinking about what ‘accessibility’ really means”, Dr McCarthy told MJA InSight.
“Architects look at the standards, of course, but they don’t know about the experience of a mobility-impaired person.”
Dr McCarthy said an example was wheelchair-accessible bathrooms, which might be wide enough but often had heavy doors that opened outwards, meaning disabled people often needed help to open and close them.
She said another example was pay-station car parks, which had been introduced in most large hospitals and specialist centres. In most cases the ticket machines were beyond the reach of someone in a wheelchair.
“There are no disability standards for pay stations, and there should be”, she said.
Height-adjustable examination tables presented another problem. “If you don’t have a hoist and someone who knows how to use it, then you can’t accommodate a patient who cannot transfer themselves from their chair to the table”, Dr McCarthy said.
“People often think their building or rooms are wheelchair accessible, but when you really look at the environment, you can see that they are not”, she said.
“There are the reception desks that are above head height for someone in a chair; there are stairs with no alternative provided, even if there is a ramp into the building.”
Dr McCarthy said that raising awareness was one solution.
Ms Carolyn Frohmader, executive director of Women With Disabilities Australia, said her organisation had successfully campaigned in 2009 to have height-adjustable examination tables a mandatory item in the Royal Australian College of General Practitioners’ Standards of General Practice. (2)
“I’m not sure to what extent this has happened in practice, given that the standards are about accreditation and many GPs cite the cost issue as a factor in why they can’t get one”, Ms Frohmader said.
She said it would be interesting to repeat a survey conducted in 2003 of general practices around Australia to identify how many provided access to adjustable-height examination beds. (3)
The 3553 responders reported more than 14 000 fixed examination beds but only 719 adjustable-height examination beds.
“It would be fair to say that at the time less than 5% of GP surgeries in Australia had access to an adjustable-height examination bed”, Ms Frohmader said.
An editorial in Annals of Internal Medicine said about 16% of non-institutionalised American adults had physical functional limitations and “these numbers will rise sharply in coming decades”. (4)
The author wrote that this epidemiologic imperative made eliminating physical access barriers especially critical. “That practices would decline to see patients with disabilities raises troubling questions about their commitment to a core tenet of professionalism: increasing access and reducing barriers to equitable health care”, she wrote.
– Cate Swannell
1. Ann Intern Med 2013; 158: 441-446
2. RACGP: Standards for general practices (4th edition)
3. Access for All Alliance 2003; Physical access to medical facilities
4. Ann Intern Med 2013; 158: 491-492
Posted 25 March 2013
I agree that access can be a problem which is why seeing specialists within the public hospital system is usually easiest. The down side to this is ever-stretching waiting lists to see anyone and then another waiting list to get anything done afterwards. If one can’t afford to go private then there is no option. Access to GPs, dentists, pathology sites for tests, X-ray places, audiologists and others can be problematic. Not only that but trying to fit into some of the diagnostic machines is an issue if one is a bigger person, and if one uses a wheelchair, dentists chairs and finding a good position for eye tests at an optometrist, can be tricky. It’s also good to remember that even if one can move about easily inside, a premises is not accessible if one needs to traverse stairs to get in, even with assistance.
Amy I can only assume that “poorly paid speciality” is a comparative term with regard to other specialities like neurosurgery or cosmetic and plastic surgeries, as no specialist I have ever come across is poorly paid.
Not only is it the physicality of access to specialists (oh & fyi, people with disabilities &/or mobility impairments that require them to use a walking stick/crutches/etc are also facing these same struggles, not just those in a wheelchair!!) but the cost of accessing a specialist!!!
Seeing a neurosurgeon recently left me $200 out of pocket…that’s a quarter of my fortnightly disability pension!!! If I waited to see someone in the public hospital system, I’d be waiting well over a year….
For “Shrink” who says as a Psychiatrist they are in a poorly paid speciality, I’d certainly love to know what poorly paid means!!!
Most of my professional life as a specialist I have been in rental situations where I have not had control of the structure of the premises. I did have my own premises between 1976 and 1987, but the situation was such that modifying the building’s approaches would have been prohibitively expensive. My overall impression is that only those in specialties where forming a group practice is viable can do this. I sold up and moved into rented premises as an economy measure, as the Medicare rebate slowly fell behind inflation. I had to quit bulk-billing pensioners and the unemployed about then too. Admittedly, as a Psychiatrist, I am in a poorly paid specialty.
Accessing specialists is probably only the tip of the iceberg. I work 2 sessions for Disability SA and one of the services we provide is a Well Woman clinic for those women who cannot access examination beds due to lack of hoists/lifters, they still cannot access screening mammograms though. We regularly have patients who cannot access services as their electric wheelchairs are too wide for the “Disability access” doors at practices and many patients who are ignored and assumed unable to express an opinion whilst the doctor talks about them to their support person.
We still have a very long way to go.