INTERSECTION OF DESIGN & MEDICINE
CONSIDERATIONS WHEN
OFFICES FOR PATIENTS DESIG
WIT NIN
AUTHORS Megan B. Nelson,
H D G
MD a
nd C
ami ISA
lo
Ca
C
lose to 49 mil-
lion people live
with a disability
in the US. Just
under half deal
with a severe
disability. We
will focus primarily on
patients with spinal cord
injuries and those in wheelchairs; however, disability affects many
individuals, including those with impairments in cognition, vision,
hearing, learning, etc. A person with a severe disability is one who
is unable to perform one or more activities of daily living, has
more than one disability, or is a long-term user of assistive devices
such as wheelchairs, crutches, and walkers. Accessibility to one’s
surroundings is a function of the interaction between the physical
environment, the patient’s impairments, and the social and psy-
chological needs of an individual. Persons with any disability often
face environmental concerns that can be inadvertently caused by
design choices. A few examples for those in wheelchairs: objects
placed either too high or too low to reach, the physical pathway
between two locations lacks an efficient and safe route, steps, curbs,
bumpers, sills and narrow doorways.
Medical offices and personnel are essential for providing nec-
essary care to people with disabilities. However, according to data
from the Americans with Disabilities Act (ADA) website, “Due to
barriers, individuals with disabilities are less likely to get routine
preventive medical care than people without disabilities.” In order
to understand, let’s “stroll a mile in their wheelchair.” Imagine
yourself going to a doctor’s appointment in a wheelchair that you
self-propel with your hands or you drive with a joystick or a sip-
n-puff apparatus due to a severe spinal cord injury affecting your
independence. If you have sustained a spinal cord injury, physical
trauma, or neurologic decline in your past, then you may not have
to use your imagination. Envision entering an exam room and the
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LOUISVILLE MEDICINE
door barely closing for privacy due to the dimensions of the room
and your wheelchair, and then your physician enters trying to find
space to sit for a face-to-face conversation that somehow accom-
modates the computer EMR as well. What if you then require a
gynecologic exam, a prostate exam or even a back exam? You look
over while sitting in your wheelchair at the exam table that has the
built-in pull-out stepstool, and you know that isn’t an option. You
wonder if this office, even this doctor, is the right fit for you. Can
you get good medical care when you can’t even get a good exam?
Both Title II and Title III of the ADA and Section 504 require that
health care providers offer individuals with disabilities the following:
» Full and equal access to their health care services and facilities;
and
» Reasonable modifications to policies, practices, and procedures
when necessary to make health care services fully available to
individuals with disabilities, unless the modifications would
fundamentally alter the nature of the services (i.e. alter the
essential nature of the services).
The design of today’s medical offices must legally meet ADA
requirements while trying also to focus on maximizing the comfort
and number of patient visits, with limited time and space. This
combination is hard to envision and accomplish. The number of
examination rooms with accessible equipment depends on the size
of the practice, the patient population, and many other factors. As
physical medicine and rehabilitation physicians, we care for many
patients in wheelchairs including spinal cord injuries, amputees,
strokes, severe brain injuries, cancer and more. At the University
of Louisville Physicians outpatient clinic at UofL Health Frazier
Rehabilitation Institute, our clinic design accommodates these
patients with disability, or as we’d prefer to say, these patients who
have tremendous ability despite the challenges they have faced.
Medical exam rooms should be designed to consider hazards
faced by this patient population. The rooms should be larger, to