Sunday, January 06, 2008

Racism in the Emergency Room

A new study in the prestigious Journal of the American Medical Association (JAMA) finds that folks who are not white in the US are less likely to be prescribed strong narcotics by emergency room doctors.

The study entitled, Trends in Opioid Prescribing by Race/Ethnicity for Patients Seeking Care in US Emergency Departments, is based on 150,000 emergency room visits by people complaining of pain in urban and rural areas over 13 years.

The major finding is that if you are white you are most likely to be prescribed strong narcotics for any type of pain. This is also true in cases where folks who are not white complain of severe pain.

The Washington Post says that Linda Simoni-Wastil of the University of Maryland, Baltimore, School of Pharmacy, thinks the racial gap may be explained by the attitude by some doctors who are "suspicious” that patients who are not white are “lying about pain to get narcotics."

Simoni-Wastila says that her research debunks the assumption that Blacks and Hispanics are more likely to abuse prescription drugs. She says that Blacks are the least likely to abuse prescription drugs and Hispanics are about on par with whites where opioids and stimulants are concerned.

The Washington Post article points out that:
In the study, opioid narcotics were prescribed in 31 percent of the pain-related visits involving whites, 28 percent for Asians, 24 percent for Hispanics and 23 percent for blacks.

Minorities were slightly more likely than whites to get aspirin, ibuprofen and similar drugs for pain.

In more than 2,000 visits for kidney stones, whites got narcotics 72 percent of the time, Hispanics 68 percent, Asians 67 percent and blacks 56 percent.

A study I used in my course on racism found that Black women and Latinas were less likely than white women to receive epidurals during the birthing process.

Doctors were found to be less likely to use epidurals because they often assumed that Black women and Latinas had a greater pain threshold than white women.

This racist discrepancy in treatment meant that it cost less for Black women and Latinas on health plans to give birth.

The essence of both of these stories underscores the relationship between racism and power.

Racism is not merely prejudice and it does not matter what the color/race of the doctors in either of the study may have been.

What is prominent is that racist suppositions direct the structural manner in which Blacks and Hispanics are under-treated.

This is racism.

(Hat tip to the AngryIndian for leading me to the Washington Post article.)



Dione said...

The logic involved by hospitals and doctors in a society that is inclined to overmedicate is ridiculous. Patient care depends upon EVALUATION. This is where almost everyone falls down, doctors are less likely to listen to their patients in general and this is especially the case if they are not white.

If these clinicians, doctors, nurses ect did their part to understand their patients (which is their job) then they should be aware of the fact that not white individuals especially African Americans are drastically less likely to even seek immediate medical care to begin with. This means that by the time they visit the emergency room or their doctor that their pain or symptoms is significantly more evident, and that there is something is usually really wrong. This is besides the dehumanizing aspect, notions that their pain isn’t real or that they are looking for narcotics which have been statistically shown to be more of a “white” substance abuse issue.

I also have to mention that the medical system further contradicts itself. If they are to assume that a non white woman has a higher pain threshold, then wouldn’t they be less likely to be addicted to pain medication? This racist institution just outed itself in my book.

Further, this irrational- rationalization on the part of medical people = “care takers”
is adding to the problem of not only racialization in medicine but also serving to contribute to the issue of how it actually costs more to be black in America. By not administering those epidurals, if something should infact go wrong during the delivery for a woman giving birth, she is then subject to more drugs than if she had the epidural (endangering her life) as well as it costing her more in the long run when issues arrive.

All people need to be very vocal with their doctors, and insist upon being heard!
They work for us!

Cero said...

I've had MD's say this to me in their *offices* ('you're just trying to get narcotics')...

Ridwan said...

Hello Dione. Thanks for your comment. The US needs a more humane medical system in my opinion.

Cero good to hear from you! Thanks for your comment. I wish you well for the new term.

Oh myyyy ... I can't believe a doctor would be so crass to you. Sorry. I hope you reported their asses :0)


nunya said...

"assumed that Black women and Latinas had a greater pain threshold than white women."

Idiotic considering that middle class white girls can afford to train in the sports that usually make childbearing easier.

I had my kid in four hours, & I had to tell them four times to quit asking me if I needed pain medication. I trained 22 hours a week during my developing years.

Ridwan said...

Hey Nunya thanks for your comment.

I never quite thought about it like that.


Anonymous said...

My paper for a medical ethics philosophy class (required for my nursing degree) was entitled "Health Care Disparity by Race, Class and Gender."

Lemme tellya, pain killers are like the icing on the cake. In this great and glorious country of the U.S., the health statistics across the board for all races any shade darker than white are abyssmal, from infant mortality rates to life expectancy and everything in between. Blacks, Natives, and Hispanics all die younger and at higher rates from all morbidities than do Whites.

Up until 1964-ish, Blacks were often refused service at "White" hospitals. So deeply entrenched was the bigotry that only the threat of not receiving Medicare funding prompted change within the hospital system.

As we can see from the past 44 years, the bigotry is still there.



Ridwan said...

Hello Shush li:

I am happy that you point to Natives in addition to Blacks and Hispanics.

The study does not refer to Natives, as is usual with most comparative race analysis.

I trust you are well sista!