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Medical Care Often Inaccessible to Disabled Patients

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Medical Care Often Inaccessible to Disabled Patients

Your Health

Medical Care Often Inaccessible to Disabled Patients

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STEVE INSKEEP, host:

And next, let's report on your own efforts to avoid being endangered. It's our regular feature called Your Health. And today, consider a basic part of every doctor's office: the exam table. You know, the table with the hard plastic cushions and the crinkly white paper. It's awkward to climb up on. And if you cannot climb, it could actually keep some people from getting the health care they need.

Here's NPR's Joseph Shapiro.

JOSEPH SHAPIRO: Rosemary Ciotti always wore high heels, so she wasn't going to stop once she needed a wheelchair to get around. Her purple power chair has a custom designed footrest so she can still wear heels.

Ms. ROSEMARY CIOTTI: And so the people who repair wheelchairs, they all know me; you got to make it so that she can wear high heels.

SHAPIRO: Her words trail off. Ciotti's voice is a bit raspy. That's the result of thyroid cancer that was diagnosed in 2005. It took a while for her cancer to get discovered. One reason was that once she started using a wheelchair, she could no longer get up on a doctor's exam table.

Sometimes a doctor would call in a couple of strong nurses to lift her out of her wheelchair and onto the three-foot-high table. But she got dropped and twisted - and a couple of times she got hurt.

Ms. CIOTTI: It was undignified, humiliating, and you get to the point where you no longer are as proactive with your health as you should be, even knowing better.

SHAPIRO: Knowing better because by profession Ciotti was a nurse. But she started skipping routine doctors exams. The doctors she did see simply stopped giving the woman sitting in a wheelchair the kind of thorough exams she had gotten before she became disabled.

Research shows that disabled women are less likely to get mammograms and Pap smears. Another study found that those who get breast cancer are then less likely to get standard treatments and are more likely to die.

June Isaacson Kailes studies the issue at the Western University of Health Sciences.

Professor JUNE ISAACSON KAILES (Western University of Health Sciences): For people with a variety of limitations, the old instructions, the hop-up, look here, read this, stay still, can be extremely difficult to impossible, which means people don't get the procedures done they need.

SHAPIRO: Kailes did a national survey and found that people with disabilities have trouble using X-ray machines, rehab equipment and scales; also scanning devices, like MRIs.

The most common problem: exam tables. Kailes says they're particularly troublesome for elderly patients. What does it matter if the doctor examines my 90-year-old mother sitting in a wheelchair or if he gets her up on an exam table?

Prof. KAILES: Well, it has to do with thoroughness of the exam. You're missing half of a person's body when you're only looking at them sitting in a chair. You wouldn't be getting a thorough examination of your skin, looking for beginning skin changes or small cancers, if you're sitting down. You wouldn't be getting a thorough clinical breast exam. That needs to be done while you're prone.

SHAPIRO: Kailes has cerebral palsy and uses a power scooter. She has trouble with balance and coordination, which makes the exam table trouble for her. But she goes to the gym a couple times a week. She can pull herself to a standing position on a treadmill. Unlike a doctor's exam table, it has grab bars.

Federal civil rights laws require doctors offices to be accessible. But few are, and they're not easy to find.

Dr. KRISTI KIRSCHNER (Rehabilitation Institute of Chicago): There is an awful lot of frustration. You know, unfortunately there's not a clearinghouse of information.

SHAPIRO: Dr. Kristi Kirschner says it's often left to disabled patients to figure out themselves.

Dr. KIRSCHNER: And a lot of times the word of mouth and also just calling and talking to health care providers about whether they work with people with disabilities.

SHAPIRO: Kirschner helped start a clinic at the Rehabilitation Institute of Chicago, specifically for women with physical disabilities. She'd heard stories from her patients of how they quit going to doctors because they couldn't get in the door or use the medical equipment.

Kirschner tells her patients to call doctors offices before an appointment and ask a lot of questions, the more specific the better. And that's how Rosemary Ciotti found her new obstetrician-gynecologist in Arlington, Virginia. She made more than a dozen phone calls.

Ms. ROSEMARY CIOTTI (Patient): I asked specifically, do you have an exam table that lowers to 20 - at least 20 inches, which is the minimum that you would need to be able to transfer easily from a wheelchair? This receptionist actually got - put me on hold and went and measured it.

SHAPIRO: That story makes her new doctor, Sandy Caskie, smile.

Dr. SANDY CASKIE (Obstetrician, Gynecologist): Well, that's the kind of people I have working here. But they've seen other people be accommodated. So they knew we do this all the time.

SHAPIRO: The doctor shows the procedure table she now uses.

Dr. CASKIE: This raises the bed up and then lowering it back down again...

(Soundbite of bed motor)

SHAPIRO: It costs a few thousand dollars extra for a doctor to buy something like this. But Caskie says she doesn't have to twist around so much to examine her patients. And most important, she knows her patients will get the health care they need.

Joseph Shapiro, NPR News.

INSKEEP: And that's Your Health for this morning. We've got some advice on how to find accessible health care in your community. Just go to npr.org/yourhealth.

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