Take a moment to consider a basic part of a doctor's office: the exam table. What if you weren't able to climb up on that hard, plastic table with the crinkly, white paper? Frail elderly people often can't, and they need the most medical care. Younger people with disabilities often can't climb onto the exam table, either.
There is a lot of medical equipment that requires patients to stand or climb, and the inability to use that equipment can keep people from getting the medical care they need.
Rosemary Ciotti was diagnosed with thyroid cancer in 2005. It took awhile for the cancer to be discovered, in part because Ciotti uses a wheelchair and can no longer get up on the exam table.
Sometimes a doctor would call in a couple of strong nurses to try 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.
"It was undignified, humiliating," Ciotti says, "and you get to a point where you no longer are as proactive with your health as you should be, even knowing better." Knowing better because, she was a nurse by profession.
Going Without Care
Ciotti 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 by an autoimmune disorder.
Research shows that disabled women are less likely to get mammograms and Pap tests. Another study found that those who get breast cancer are less likely to receive standard treatments and are more likely to die.
June Isaacson Kailes studies the issue. She's the associate director of the Center for Disability Issues and the Health Professions at the Western University of Health Sciences in Pomona, Cali.
"For people with a variety of limitations, the old instructions to 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," she says.
Kailes did a national survey and found that people with disabilities have trouble using X-ray machines, rehab equipment, scales and scanning devices, like MRIs.
But the most common problem was getting onto a doctor's exam table. Kailes says the tables are particularly troublesome for elderly patients. She says that doctors often think, mistakenly, that they can thoroughly examine a person who is sitting in a wheelchair.
"You're missing half of a person's body when you're only looking at them sitting in a chair," Kailes says. "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."
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 three times a week and she can pull herself to a standing position on a treadmill. Unlike a doctor's exam table, it has grab bars.
Finding Accessible Clinics
Federal civil rights laws require medical offices be accessible. But few are, and those rare offices are hard to find. There is no one "clearinghouse of information," says Dr. Kristi Kirschner of the Rehabilitation Institute of Chicago. But people need sources of information to find doctors and hospitals that have accessible equipment, such as exam tables that go up and down.
Instead, Kirschner says, patients are left to figure it out on their own.
"Lot of times (it's) word of mouth and often just calling and talking to providers about whether they work with people with disabilities," she says.
Kirschner helped start a reproductive health clinic at the Rehabilitation Institute of Chicago, specifically for women with physical disabilities. She had heard stories from her patients of how they had stopped going to the doctor 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 to ask a lot of questions — the more specific the better.
That's how Rosemary Ciotti found her new obstetrician-gynecologist in Arlington, Va. She made more than a dozen phone calls.
"I asked specifically, 'Do you have an exam table that lowers to ... at least 20 inches?' — which is the minimum that you would need to transfer easily from a wheelchair. This receptionist actually put me on hold and measured it," Ciotti says.
That story makes her new doctor, Sandy Caskie, smile.
"Well that's the kind of people I have working here," Caskie says. "But ... remember, too, that they've seen other people be accommodated. So they knew that we do this all the time."
In an exam room in her office, Dr. Caskie shows the procedure table she now uses for Ciotti and other disabled and elderly patients. With a flick of a switch, a motor raises or lowers the table.
It costs a few thousand dollars extra for a doctor to buy something like this. But Caskie says it's also easier on her: 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.
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