The color of pain
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THIS MONTH, researchers reported in the Journal of the American Medical Association that nonwhites are less likely than whites to receive narcotic painkillers or opioids when they arrive in pain at emergency departments.
The claim was solidly supported by analyses of more than 150,000 pain-related visits to US emergency rooms between 1993 and 2005.
In this study, throughout the years, 31 percent of white patients complaining of pain received an opioid, compared to 23 percent of blacks, 24 percent of Hispanics and 28 percent of Asian/other patients.
The racial and ethnic inequalities persisted even when the documented source of pain was similar among all groups a bone fracture or kidney stone, for example.
On a further disturbing note, the researchers also showed that racial and ethnic differences in opioid prescribing didn't lessen during their 12 years of observation.
In fact, in 2005 the opioid prescribing rates were 40 percent for whites and 32 percent for nonwhites.
The current study, like so many others, underscores the deeply entrenched problem of racial and ethnic health care disparities in American medicine.
While pain treatment disparities have been documented for years, this study shows how recalcitrant they've remained despite sizable public and professional campaigns to address and redress them.
Pain is a subjective experience, and doctors don't possess any objective measuring device that can quantify
Often, when a doctor can't find a visible or convincing source for someone's pain, he has to decide whether to take it on faith that the patient's complaint of pain is genuine.
Even when a plausible source of pain is found, the doctor still must determine whether the patient's assessment of its severity warrants a narcotic for relief.
The point is that there is no reliable yardstick by which to measure someone else's pain or to calculate its perfect remedy. Disparities in pain assessment and treatment aren't justified by any good measure of medical technology. Rather, these disparities are humanly created and socially constructed. They reflect serious fractures through the medical profession's ideals of compassion and justice when even breaking a bone cannot serve as a common denominator for pain treatment.
Additional factors sometimes exacerbate this differential treatment of pain.
For example, because access to pain treatment is linked with access to health care, pain relief can be further compromised when patients lack insurance, health care finances and the means and opportunity to obtain a medical provider.
Indeed, minorities are overly represented among our 47 million uninsured Americans.
A Kaiser Family Foundation report revealed that about one-fifth of African Americans and one-third of Hispanics and Native Americans are uninsured, compared to 13 percent of whites.
Several studies also have shown that pharmacies in predominantly nonwhite neighborhoods are less likely to stock narcotic pain killers than are pharmacies located in predominantly white areas.
A 1997 survey revealed that New York City pharmacies located in predominantly Hispanic and African-American neighborhoods were much less likely to stock opioid drugs than pharmacies in white neighborhoods.
Another comparative study showed that pharmacies in nonwhite areas of Michigan were 52 times less likely to maintain sufficient opioids in supply. So even if someone had managed to afford health care, access medical attention, convincingly convey pain to a doctor, and successfully obtain an opioid prescription, at the end of the day the pharmacy shutters may be closed.
The disregard and under-treatment of someone's pain is a poor medical practice that harms patients in various ways. It is dehumanizing in that it dismisses the subjective suffering of another person.
People in chronic pain are prone to experience relational difficulties with friends and family, and to develop depression and anxiety. As Naomi Wolf wrote, Pain is real when you get other people to believe in it. If no one believes in it but you, your pain is madness or hysteria.
Chronic pain sufferers often sleep poorly, decrease their physical activity, miss work and curtail their socializing. Unrelenting pain also leads to a host of hormonal and neural stresses that just makes everything worse.
Clearly, we all have much work to do to make health care delivery a more just and humane system for minority patients.
And while our nation's health care system offers enough injustice to spread around to nearly everyone, still, minority and impoverished Americans bear a disproportionate amount of its burden. Focusing specifically on racial and ethnic disparities in pain treatment is but the tip of the iceberg.
Kate Scannell is an East Bay physician and syndicated columnist.
On a training doctors in the children s hospital in the molestation of girls was reported. Yesterday morning, Children s Hospital held a meeting to reaffirm the discipline. Parents of girls have been victims of the Women s Federation for the request to get involved.
This thing is to discredit the hospital, but also to discredit the entire medical staff.
Yesterday morning, Children s Hospital Advocacy Center Houzhulin said that the hospital is very sympathetic to the children s plight, and ask doctors to treat the child s primary disease, caused by the issue, including a series of issues, such as psychological pressure, the hospital has asked psychiatrists intervention. We will carry out this matter fully remedy, and actively cooperate with the judiciary to resolve the matter.
Houzhulin, suspects Yumei September 20 last year started to Children s Hospital medical wards education, the principal tasks are doctors in the hospital under the guidance of learning, doing routine work found no abnormalities. The parents of the girls why there is no day without visiting nurses care workers found that the abnormal situation, Houzhulin said: At present, the police intervention and the hospital has not been directly contacted, the survey inconclusive.
Yesterday, a girl from the families of the two victims that light rain and snow have been sent to hospital for injuries professional seizure, of the test results is still under genital swelling, but light rain rather serious psychological pressure had refused to sleep. At present, the girls have to seek FMC parents to get involved. (Le intern reporter Xiao Xiao Yue)
Children s Hospital doctors indecent training hospital that innocent girl (AP)
Yesterday, the girls were molested children still living in a hospital ward. Wang Lei perturbation intern
12-year-old light rain (a pseudonym) in the Beijing Children s Hospital at the hospital, doctors were molested. Drizzle with SMS will inform the mother, the mother Mother then alarm. Police investigations showed that the doctor is indecent drizzle of Hospitals in Xingtai, Hebei Children s Hospital learning to doctors, he also molested a six-year-old snow (a pseudonym). Currently, doctors who have been Xicheng Jingfangxinggou.
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