Authors of an article published this month in Annals of Internal Medicine report that many subspecialists are unable to accommodate patients who use wheelchairs. 

Researchers enrolled 256 subspecialty medical practices in 5 large US cities (Atlanta; Dallas; Houston; Portland, Oregon; and Boston) in the study. The practices were assigned to 1 of 2 groups: those where transfer from a wheelchair to an examination table is required for adequate care (endocrinology, gynecology, orthopedic surgery, rheumatology, and urology) and those where transfer might not be necessary (otolaryngology, ophthalmology, and psychiatry).

The researchers called practices and tried to make an appointment for a fictional patient who was obese (99 kg) and was partially paralyzed on 1 side of the body. The patient used a wheelchair and was unable to self-transfer from the chair to an examination table. The patient could not bring a family member to assist with transfer.

More of the practices that would have to transfer the patient to provide adequate care were accessible than those that might not have to transfer the patient to provide adequate care (95% vs 74%). In all, 56 practices (22%) could not accommodate the patient. Nine of these practices said that their buildings were inaccessible, and 47 said that they could not transfer the patient to an examination table. The practices gave different reasons for inability to transfer the patient, including a lack of staff who could perform the transfer (37 practices), a concern about liability (5 practices), and that the "patient was too heavy" (5 practices).

Of the 160 practices in the group that required transfer for adequate care, 22 (9%) reported using special equipment for transfer, such as height-adjustable examination tables and mechanical lifts. Another 88 (55%) planned to transfer the patient from the wheelchair to a high table that was not height-adjustable without using a lift. Gynecology had the highest rate of inaccessible practices (44%).

The authors call for improved awareness about the Americans with Disabilities Act requirements and the standards of care for patients with mobility impairment.