Months after enrolling in Harvard Medical School in the 1980s, Lisa Iezzoni, MD, MSc, received a diagnosis of multiple sclerosis. Although she completed her degree, medical educators discouraged her from seeking an internship, arguing her disability was incompatible with medical practice. In the absence of any support to go into practice, Dr. Iezzoni was forced to pursue health policy research. For the last 23 years she has investigated health policy issues related to people with disabilities. Today, she's arguably one of the world's leading experts on the topic. She is the author of the book When Walking Fails, has authored or co-authored more than 250 papers on health policy and served as professor of medicine at Harvard Medical School. We talked with Dr. Iezzoni to discuss what you can do to improve the care and comfort of patients with disability.

Q Many surgery managers may feel that if their facilities are compliant with the Americans With Disabilities Act (ADA), they have done enough for patients with disability. Are they right?

A No, they aren't. ADA is a minimal standard. It does not mean that a place is easy or comfortable to get around. Bathrooms are a good example. ADA requires enough space for a wheelchair to turn around. A standard manual wheelchair has a small turning radius, but many electric scooters do not. Sometimes, if I'm using one of my scooters, I have to pull straight into the bathroom, then back out. There is no room to turn around. I have to reach behind me to open the door. That's neither easy nor dignified.

The same thing is true for elevators. Frequently in retrofitted buildings, an elevator is big enough for a standard manual wheelchair to turn around, but not a scooter.

Also, when older facilities retrofit for ADA, they sometimes take improper shortcuts. In one older hospital, they ended up being cited for, among other things, inadequate wheelchair maneuvering space, improper arrangement of grab bars, and toilets and hand sanitizers in the bathrooms and drinking fountains that were too high.

Q Making a facility ADA-compliant is expensive already. Why should facility managers go any further to accommodate disabled patients?

A The market. A person with disability is not a small part of the population. Virtually everyone will experience a disability at some point in their lives. Current estimates are that 25% of the population has some form of disability, and it's getting more common, especially mobility issues.

When the members of the "silent generation" were 35 to 44 years old, 14% to 18% were obese. At comparable ages, 28% to 32% of the youngest Baby Boomers were obese. Obesity frequently leads to arthritis, and arthritis leads to mobility issues. Disabled people are everywhere. You want all of us to tell everyone we know that we had a great experience at your facility.

Q How can surgical facilities improve on their accommodations for disabled patients?

A Patient centeredness requires that you respect patients' preferences, needs and values, and collaborate with them on their care. This goal holds special resonance for persons with disabilities, because we often find that people make assumptions about us that define and circumscribe our lives and opportunities, and artificially limit our goals, aspirations and abilities.

If there's one rule for communicating with us, it's to make no assumptions. Ask us about our needs and preferences in the same way you would any other patient.

Right now, physicians don't do a great job with this. In one study, people with disabilities reported dissatisfaction with care for 10 of the 12 quality dimensions. Disabled patients were more likely to be dissatisfied with physicians completely understanding their conditions, physicians completely discussing their health problems and answering all their questions.

Q Any other tips?

A Put policies and procedures in place that show sensitivity to the lives your patients are living. For example, I cannot walk at all. So to me, my mobility devices are not just devices. They are my legs. If you take away my wheelchair, you literally are taking away my legs. So if I wake up in a recovery room, I'm going to immediately ask, "Where's my wheelchair?" Once, my husband parked my chair in a movie theater and someone took it, thinking it was for the public to use. I was panicked. If someone is going to take my wheelchair away temporarily, I want to know where it will be stored and that the person who is moving it knows how to operate it.

Disabilities are diverse, and what works to accommodate one disability might not be sufficient for persons with another disability. But in general, the same basic principles are true: Providers need to communicate effectively with patients prior to procedures and make sure they understand how to make them comfortable and provide high-quality care.

For example, if someone with a hearing impairment wakes up and can't locate her hearing aids, that patient is not going to be able to understand what the nurses say.

Healthcare providers sometimes strap a patient's arms to the gurney. Imagine what that would be like if you were an American Sign Language (ASL) speaker and your only method of communication is signing. You have lost your ability to communicate. Some facilities don't have personnel proficient in signing, and they ask the patient to write notes. They don't realize that 75% of people whose first language is ASL are not proficient in English. Also, writing is really difficult when you are just coming out of anesthesia. Many healthcare facilities have had to settle ADA lawsuits because they didn't provide an ASL interpreter to a deaf patient who needed one.

Here's another example: Imagine if you had low vision and someone handed you written post-op instructions. Depending on your preference, you might need those in braille, in a large print format or on audiotape.

Q Do surgical facilities need to improve the medical care they give disabled patients?

A Some certainly do. For example, some facilities do not have lifts for heavy patients and some do not have scales that can accommodate patients who use wheelchairs and cannot stand on a standard scale. If you're calculating anesthesia dosage, you need to know the patient's actual weight. A guess is not good enough.

There are other anesthesia considerations as well. Some people with high-level spinal cord injury can have reduced lung function. Consultation with a pulmonologist might be indicated.