Cases in Health Disparities: Patients in Wheelchairs -- Are They Getting to Your Office?

Désirée Lie, MD, MSEd

Disclosures

September 15, 2010

Case Presentation

Ms. Sansone is a 50-year-old married accountant with multiple sclerosis. She has begun using a scooter due to unsteady gait, poor coordination, weakness, and frequent falls over the past year. She is functioning well by adapting to her mobility limitations and continues to drive with an adapted car. She is now using her home as an office.

She has no recent genitourinary problems, urinary incontinence, or depression. Her last episode of optic neuritis occurred over 2 years ago.

She lives with her engineer husband of 15 years, and they have no children.

She is due for a Pap smear and a mammogram but is reluctant to have either test because of her embarrassment about transfer to the examination table and use of stirrups and using the scooter in the radiology setting. Although she has a family history of breast cancer in her maternal aunt and is concerned about her own risk, she requests an office breast examination as a screening test instead of a mammogram. She declines colonoscopy.

She reports that she and her husband are happily married and that he is adjusting to her mobility loss and is very supportive of her need for continued independence. A depression screen is negative.

As her primary care physician, what would you recommend for her health maintenance?

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