Navigating healthcare can be hard for a lot of reasons. Doctors are pressed for time; insurance is confusing; some health issues are tricky to diagnose or treat. For many patients, however, basic requirements for a successful appointment — such as being able to get to a doctor’s office and communicate with healthcare providers — are a given. That’s not always the case for people who have disabilities or face language barriers.
Fortunately, there are laws requiring healthcare providers to accommodate patients with disabilities. The Americans with Disabilities Act (ADA) says medical providers must provide “full and equal access” to all healthcare spaces and make “reasonable modifications to policies, practices and procedures when necessary.” That means, for instance, if you use a wheelchair or are part of the blind or deaf communities, you’re entitled to have access to restrooms. The Affordable Care Act built on disability access rights by establishing standards for exam room equipment, among other things.
Legal protections are less robust when it comes to communication accommodations. The crucial law to know is the Civil Rights Act of 1964, which prohibits federally funded medical providers from discriminating against patients based on race or national origin. This paved the way for services such as federally funded interpreters for some (but not all) patients who speak a different language than their healthcare providers. Outside the law, there are other ways for patients to make sure communication limitations don’t interfere with care.
No matter where you go for care, you should never be expected to pay for any legally-mandated accommodation. Below, we break down some of the most basic rights you have at the doctor’s office.
If you have a disability, you’re far from alone. Some 61 million American adults — 1 in 4 people — currently live with one. Of that group, roughly 14% have a mobility disability. Under the ADA, medical providers must have the infrastructure to make sure people with mobility disabilities can easily access care from the minute they arrive at a doctor’s office.
At a minimum, healthcare facilities must be accessible to patients with restricted mobility. Any office that isn’t located on the ground floor needs to have a ramp and an elevator, along with designated parking for people with disabilities, accessible toilet stalls and doorways wide enough for wheelchairs.
Exam rooms — and the equipment inside them — should be just as welcoming as other parts of a doctor’s office. Some offices have special equipment, such as gurneys to lift patients with disabilities, or exam tables that lower so patients in wheelchairs can get on. “Practices can’t decline a patient by saying they wouldn’t be able to lift [them] out of [their] wheelchair,” Donovan says. Instead, someone on staff needs to be trained to assist them.
There are also safeguards for people with cognitive disabilities, who make up around 10% of the disabled population. For instance, patients with brain injuries or dyslexia can have staff complete intake forms for them, or do it together in a private space — somewhere besides the waiting room, where personal information can be overheard.
Assistance for patients who are deaf
While around 600,000 Americans are considered “deaf,” 6 million report “having trouble hearing.” For this reason, most medical providers are fluent in American sign language. When ASL-fluent providers aren’t available, doctor’s offices should provide an in-person or virtual interpreter to make sure all medical info gets communicated effectively.
Ideally, doctor’s offices ask patients ahead of time how they prefer to be accommodated, Donovan says, but that doesn’t always happen. Many practices default to using their own virtual interpreter services — which are usually great alternatives to in-person assistance.
Assistance for patients who are visually impaired or blind
Healthcare facilities are required to make sure members of the blind community have access to comfortable care. What does this look like? Under the ADA, providers should read aloud what they write (or type) in medical records, have staff announce their names and titles when entering exam rooms, and speak directly to the patient, rather than their companion.
Patients who are blind and have service animals should also be allowed to bring their animals to any appointments.
Outside the physical office space, healthcare providers are required to offer blind patients medical records in Braille, large print or audio. Additionally, most pharmacies offer different options to make medication instructions accessible to blind patients.“The last thing you want is for a patient who’s blind or has low vision not to be able to see instructions and take medicine incorrectly,” Donovan says.
For patients who speak a different language than their doctor, accurate translation is essential to high-quality care. Currently there’s a growing gap between the ways patients and doctors speak. Per one recent study, only around 36.2% of clinicians speak fluent Spanish, the second most widely spoken language in the US.
“People have to be able to access healthcare services in the language that works best for them, and that’s really critical,” Donovan says. “The last thing you want is having your healthcare lost in translation.”
There are legally protected accommodations for some groups of non-native English speakers.
Healthcare facilities must supply interpreter services for all patients with limited English proficiency who are getting federal financial assistance, except for those with Medicare Part B. In most states, though, these services are unfunded, meaning the cost falls on providers. For this reason, many doctors rely on bilingual staff as interpreters. This approach isn’t optimal.
Studies show that medical providers often overestimate their proficiency in a second language. And translation errors can have consequences. In one circumstance, a medical professional misinterpreted the Spanish word “intoxicado” as “intoxicated,” instead of its correct meaning, “inadvertent toxicity.” The mistake caused a misdiagnosis and unnecessary evaluation for drug abuse, and the patient was $71 million in a malpractice suit.
(The American Academy of Family Physicians, among other expert groups, supports legislation to beef up funding for culturally sensitive interpretation services. However, there’s currently no legislation in Congress addressing this. (Being culturally-sensitive means being aware and sensitive of the different norms and values of a culture, ethnic or racial group that isn’t your own. It also means being knowledgeable about cultural differences within languages.)
If you can find a doctor who’s fluent in your preferred language, that’s the best option. Doctors typically list the languages they speak on their practice websites or wherever else their credentials are listed. (Zocdoc lets patients search for providers by language spoken.) If you can’t find someone who shares your native tongue, you can request a medical interpreter when you make an appointment.
While some providers might contract with in-person interpreters, others use video or telephone services such as LanguageLine Solutions. Providers can also have multilingual staff trained in interpretation techniques. “There is some leeway,” says Dr. Muneeza Khan, Chair of the Department of Family Medicine at the University of Tennessee Health Science Center. “Physician’s offices can choose what to offer as long as it provides effective communication.”
Know that medical interpreters can be certified, and that’s something you can check when you ask your doctor for an accommodation. Certifications are done by the Certification Commission for Healthcare Interpreters, the National Board of Certification for Medical Interpreters and the Registry of Interpreters for the Deaf.
Experts don’t recommend relying on family members or friends as interpreters. Professional interpreters are more familiar with important clinical terminology, Khan says. For this reason, in federally funded health centers, providers also have to provide interpreter services for family members making medical decisions on patients’ behalves.
It can also help when an interpreter understands how dialects of a language use terms differently (e.g., Mexican vs. Argentinian Spanish). That’s why patients should avoid simple online translation services like Google Translate.
“The biggest issue is not necessarily translation, but cultural takes on health care,” says Bonnie C. Sheeren, a patient advocate and educator with Houston Health Advocacy. “So, it’s best to have a native speaker who understands the culture rather than Google translate as different cultures view illness and death differently.”
Advocating for accommodations
While it’s in the books that all doctors and healthcare facilities have to make sure their offices are accessible to anyone who needs care, they might satisfy requirements in different ways depending on budget constraints, available resources and where they’re located. When it comes to accommodating patients, “There’s ideal, and there’s compliant, and those two aren’t always the same thing,” says Caitlin Donovan, senior director of the National Patient Advocate Foundation.
So, if you’re a patient in need of an accommodation, you may need to do a little extra work to guarantee accessible care. Donovan suggests calling ahead to ask what a doctor’s office does and doesn’t provide. Patients who feel they’re not being fully accommodated have recourse. Some hospitals and medical practices have a compliance officer on staff who serves as the point person to make sure all patients are properly accommodated. If you feel you’ve been misled or have not been properly accommodated, you can reach out to them. Patients can also file an ADA complaint with the Department of Justice.
Donavan says patients should do their research so they end up with a doctor who accommodates patients in meaningful, not symbolic, ways. “It’s all about being thoughtful when it comes to decision making,” she says.
“The key between a doctor and patient is trust,” Donavan says. “And the best way to achieve that is with effective communication.”