Imagine you are a 45-year-old female patient with a significant physical disability that requires the use of a wheelchair for mobility. Thankfully, you have Medicaid insurance, but it is difficult to find primary care providers who will accept it. The paratransit service that you rely on to get to your medical appointments is wildly inconsistent, often forcing you to cancel. When you do make it to your doctor’s office, you are not able to be weighed or receive a complete physical exam, because the provider does not have a wheelchair-accessible scale or a height-adjustable exam table. On top of this, your doctor does not know much about your disability and how it can impact your health.
Unfortunately, the scenario just described is far too common for patients with disabilities in the United States. You may be wondering, how does this relate to my life as a medical student? I guarantee that you will see and treat countless patients with disabilities throughout your medical career, and it will be crucial that you understand each patient’s unique needs, strengths and barriers they face to provide the best care possible.
There are approximately 56.7 million Americans, or 18.7 percent of the population, with a disability. This number will continue to rise as the baby boomers age. Patients with disabilities utilize the health care system at much higher rates than the general population. Paradoxically, patients with disabilities use primary and preventive care services at much lower rates, which could explain higher rates of chronic disease such as diabetes, hypertension and heart disease.
So, what is preventing this vital population from reaching the health care system sooner? Numerous barriers exist that prevent patients with disabilities from receiving proper health care. As highlighted in the hypothetical scenario in the beginning of this article, patients with disabilities face physical barriers such as inaccessible clinics, inaccessible medical equipment, or lack of transportation. Financial barriers can play a major role as patients may be underinsured or uninsured. Being able to afford necessary medications or rehabilitation services can be difficult when a patient’s disability prevents them from being able to work.
Additionally, health care providers may lack knowledge about how best to treat patients with disabilities, and this can erode trust between patient and provider. Barriers that patients with disabilities face in accessing care can lead to very severe consequences. Psychological consequences of diminished access include feelings of depression, frustration and stress. A patient’s physical condition can deteriorate without proper care, and conditions that could have been cost-effectively managed in a primary care setting often escalate to complex problems. Appropriate and timely access to care is the only solution to prevent these consequences.
So, how can you ensure that all of your patients have equal access to high quality care?
First, you can urge your medical school to teach content about treating patients with disabilities, something very few schools actually do. You can also partner with the clinics you work in to make sure they offer accessible medical equipment. If you are really passionate about access to care, get involved in policy issues relating to the Americans with Disabilities Act compliance and provisions regarding disability access in the Affordable Care Act.
Finally, always remember that your patients have a wealth of knowledge about their own disability and can be wonderful teachers. Use them as a resource as you continue to grow as a physician. Medicine has a long way to go until patients with disabilities receive equal care, and you can be a positive contributor towards this goal.