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

Désirée Lie, MD, MSEd

Disclosures

September 15, 2010

Case Resolution

Ms. Sansone has chosen to visit her physician alone, without her husband, which demonstrates her autonomy and independence. The physician discusses Ms. Sansone's expectations of wellness and need for preventive services to arrive at mutually accepted goals of health maintenance. The physician does not assume a lower standard of preventive care because of the perceived barriers. Because Ms. Sansone has indicated a concern about her risk for breast cancer, the physician discusses the current guidelines for breast cancer screening, including mammography.

In this particular case, the patient's reluctance to have a Pap smear and a mammogram stem from perceived barriers to comfortable completion of the procedures. The physician openly addresses and allays Ms. Sansone's anxiety. The help of an experienced nurse for transfer and use of an adjustable examination table for the Pap smear shows respect for the disabled patient and ensures safety in performance of the Pap smear. She will also receive the same complete breast examination (appropriately undressed) as any other patient. The physician refers Ms. Sansone to a radiology facility with mammography equipment that is accessible by wheelchair or scooter (and also has ramps and disabled parking). An advance call to the facility to verify this access helps improve the patient's adherence to the recommended mammogram.

The physician also recommends direct communication with the gastroenterologist to discuss Ms. Sansone's concerns about colonoscopy screening, given her mobility restrictions. She is concerned about the use of the bowel preparation, and she is encouraged to involve her husband in the decision to undergo colonoscopy. Follow-up with the husband present would permit careful planning for the procedure, including an overview of the physical facilities in which the colonoscopy will take place and the timeline of activities around the procedure. Follow-up on the test results should also be arranged.

Finally, the physician discusses insurance coverage for each of the preventive care procedures to provide assurance to the patient and increase likelihood of adherence and continued preventive care.[22]

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