Specialists not catering for disabled

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