Tools and Tips
Women's health care can be complex and for disabled women and their care providers unique challenges exist, often calling for specialized treatment and care. While the health care community has grown more sensitive to the health needs of the disabled, very little information is available to guide their competent care. Filling that void is a new resource book?Welner's Guide to the Care of Women with Disabilities?for physicians, nurses and other care providers that address the needs of disabled women who seek routine medical care.
The book is co-edited by Sandra L. Welner, M.D., and Florence Haseltine, M.D. Haseltine, who is the founder of the Society for Women's Health Research, was instrumental in completing the book after the 2001 accidental and tragic death of Welner.
Welner was a disabled physician who suffered a debilitating stroke while in medical school. She regained her independence after five years of arduous neurological rehabilitation and dedicated her career to improving care for disabled women.
"Dr. Welner had a vision that persons with disabilities need individualized care," Haseltine said. "After she became disabled, I knew her as a determined advocate for women's health. This book incorporates her spirit, as well as her ideas."
For quick reference, Haseltine outlined 10 ways caregivers and health professionals can improve the health care of disabled women.
1. Modify doctor-patient communication.
Disabled people at times feel ignored by physicians because a doctor's communication is often directed toward the patient's accompanying caregiver instead of the patient. Depending on the nature of the visit and the extent of the disability, it may be necessary for the doctor and caregiver to do most of the communicating, but it is important that the patient have the opportunity?through the caregiver, if necessary?to communicate and ask questions.
2. Expand access to care.
Few facilities are equipped for women who use wheelchairs or have other disabilities. Even hospitals that serve disabled persons do not always provide easy access for wheelchairs. It is critical that health care facilities of all types accommodate individuals who face physical mobility and access-challenges.
3. Allow disabled women more time with their physicians.
A patient?s limited hearing, speech, or other disability can strain doctor-patient communication, which requires patients have more time than what is typically allotted to convey health information. Disabled patients and their caregivers also need ample time to discuss prescribed treatments. If, for example, the patient has an upper respiratory infection, it is important to know if the treatment will interact with or magnify the disability.
4. Utilization of special medical equipment.
Disabled patients often struggle to access common examination tables, while X-ray and mammogram equipment pose additional challenges. The problems are heightened for wheelchair-bound patients. Medical facilities should have equipment that is tailored for disabled women. Health care providers should also consult with patients and their caregivers in advance on what accommodations may be required.
5. Expand prevention and management of osteoporosis.
Prevention and management of osteoporosis is critical in women whose disabilities affect mobility. Because movement is important to maintain bone integrity, osteoporosis sets in early in women with compromised mobility, increasing the risk of fractures.
6. Manage pain.
Disabilities that affect the musculoskeletal system, pain is common and its treatment can be long-term and complicated. Pain and referred pain are sometimes the only indications disabled individuals have that an infection is present. Pain specialists need additional training in the management of disabled persons' pain and its related issues.
7. Specialized treatment of exhaustion
Disabled persons often use tremendous amounts of energy to accomplish daily tasks. As a result, exhaustion is common and its effects can be deleterious. Health care professionals must be careful to address and treat their disabled patients? exhaustion.
8. Gynecologic and obstetric care
Disabled women need access to gynecologists and obstetricians who have the appropriate equipment to examine them. These physicians must also, for example, recognize and address the interaction between contraception and the patient?s disabilities.
9. Management of urinary tract infections (UTIs)
Treating UTIs in disabled women can be a challenge. The symptoms are difficult to diagnosis in women without motor deficits, and in women with nerve deficits, the symptoms may be masked, going unrecognized for a long time.
10. Unique anesthesia issues
When surgery is needed, the anesthesiologist must understand how the anesthetic affects the woman and her disability. Labor and childbirth pose interesting problems. For example, a patient with a spinal cord lesion might not feel her labor as pain, but her autonomic system knows she is in labor and as a result her blood pressure can become dangerously high. These issues require careful monitoring.
This article originally appeared in the May 2004 issue of HME Business.