Barriers to healthcare

Over sixty-one million Americans have disabilities and many face unequal treatment in healthcare settings. Many factors likely contribute to this inequality, one cause involves healthcare providers’ negative views and assumptions about people with disabilities. This is called disability bias. Disability bias creates barriers to healthcare access and can show up in many ways including:

• Interactions with patients
• Inaccessible facilities and equipment
• Not planning for accommodation needs
• Being reluctant to discuss disability
• Viewing disability as a medical issue rather than as a lived experience

Disability as lived experience

Viewing disability from a diversity perspective means recognizing and valuing differences in how people function. This view values the unique insights, creativity, and strength that comes from diverse life experiences. It is linked to the “Social Model” of disability which was created to oppose deficit-based views of disability. This perspective focuses on barriers in our environment and society that contribute to inequality. A diversity perspective doesn't reject medical interventions that can enable disabled people to function at their maximum capacity. Instead, this perspective recognizes that there is no one best way to look, sound, move, learn, think, or be.

Creating access

Establish standards of care for patients with disabilities

As there are currently no industry-wide standards of care for providers on how to deliver primary and preventative care for people with disabilities, one of the most effective things you can do is to establish for your practice standards of care for disabled patients. Such standards should address issues specific to your practice and patients, but might include answers to questions like:

• At what points in the scheduling / intake / exam processes are patients prompted to request accommodations?
• When is it clinically appropriate to treat a person with disabilities in their chair versus transferring them to an exam table?
• How will you schedule and bill for the extra time that may be required to accommodate a disabled patient? (E.g., time associated with using an interpreter, making transfers from wheelchairs to exam equipment, providing after-care instructions in language plain enough that a patient with a cognitive or intellectual disability can understand them?)

Start and end each visit with an access check-in

• Begin each visit by asking “Do you have any accommodation needs that we should talk about before we begin to make sure we get the most out of your visit today?”
• Don’t make assumptions about the priorities of disabled patients, ask what they want to address during the visit
• Listen, ask questions, double check for comprehension of what is discussed

Be aware of disability bias in language

When writing medical record or chart notes:

• Avoid language that insinuates disability is a tragedy (E.g., confined to a wheelchair, bedridden, suffers from, is afflicted with...)
• Avoid language that minimizes or diminishes psychosocial disabilities (E.g., “my schedule is insane,” “I am so OCD today,” “someone needs to take their meds...”)
• Use descriptive rather than value laden language in charting or medical record notes. (E.g., noncompliant, aggressive, disengaged, poor hygiene, etc.) Describe behavior, action, or appearance in neutral terms. Inquire how disability might impact experience and/or treatment of focal health concern.

Review accessibility of all areas in which patients will be

• Are there seats that will work for people of all body types and sizes?
• Is the waiting room arranged in a way that it will accommodate power wheelchairs?
• Is there somewhere for people who use canes to position them while they check in?
• Will elevators accommodate power wheelchairs?
• Is there parking with space for a vehicle that uses a ramp or lift?
• Is there a relief area for service animals?

References