Louisville Medicine Volume 67, Issue 10 | Page 20

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 18 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