If you find yourself going to the ER with severe pain, you're probably expecting a shot of something to make the pain go away. A new study printed in the January 2, 2008 issue of the Journal of the American Medical Association found that you should be white if you want the good stuff. It seems that Hispanic and African-American patients aren't as likely to get opiates for their pain.
Whites Get Morphine, Non-whites Get Tylenol
Opiates, such as morphine and Demerol, are the strongest pain relievers available in most emergency departments. According to the study, Asian patients are more likely than blacks and Hispanics to get the good stuff, but still not as likely as whites.
How likely? Across all types of patients (150,000 visits from 1992-2005), 31% of whites received opiate pain relievers. Only 23% of black patients and 24% of Hispanic patients got opiates. Asian patients got opiates 28% of the time.
As far as non-opiate medications go (Tylenol, Advil), non-white patients got those medications 36% of the time while only 26% of whites were given these over-the-counter medications -- probably because they were getting stronger, prescription medications.
Squeak and Get the Grease
This is a hard study for someone like me to read. I try to think I'm objective as I perform my duties, but this revelation really makes me think. Am I more likely to relieve pain for a certain group of patients than for others? Honestly, I probably am more likely to treat people differently. The only way to fix this problem as a provider is to be as conscious of it as possible.
As far as patients go, it's imperative to be your own advocate in all aspects of your medical care. If you're in pain, ask for pain medication. If you don't get pain medication, ask again. There's an old saying, "The squeaky wheel gets the grease."
It's Just a Job
I would love to say that compassion rules the emergency department, but that's no more true there than the average retail outlet. People in the hospital go to work to earn a paycheck just like everyone else and, since their jobs deal mostly with human suffering, it's important for them to leave work at the office. Each patient considers their pain important, but each caregiver has several patients to care for.
No one cares more about your pain than you do. Making your medical treatment providers aware of your pain is the only way to get what you need. Having to be more persistant because English isn't your first language or your skin is a bit darker than that of your neighbor isn't right, but do what you must to get the care you need -- there's no reason anyone should have to endure uneccessary pain.
I would hope in light of this latest study that medical professionals in emergency departments all over the country will take a hard look in the mirror. Emergency medicine is a hard job, but one that can be done effectively with standards that can certainly be applied universally across all of our patients.
Source:
Pletcher, M., et al. "Trends in Opioid Prescribing by Race/Ethnicity for Patients Seeking Care in US Emergency Departments." JAMA. 2 Jan 2008
