Posted on 01/01/2008 10:30:20 PM PST by Morgana
Whites More Likely to Get ER Narcotics
Jan 1, 11:08 PM (ET)
By CARLA K. JOHNSON
CHICAGO (AP) - Emergency room doctors are prescribing strong narcotics more often to patients who complain of pain, but minorities are less likely to get them than whites, a new study finds. Even for the severe pain of kidney stones, minorities were prescribed narcotics such as oxycodone and morphine less frequently than whites.
The analysis of more than 150,000 emergency room visits over 13 years found differences in prescribing by race and ethnicity in both urban and rural hospitals, in all U.S. regions and for every type of pain.
"The gaps between whites and nonwhites have not appeared to close at all," said study co-author Dr. Mark Pletcher of the University of California, San Francisco.
The study appears in Wednesday's Journal of the American Medical Association. Prescribing narcotics for pain in emergency rooms rose during the study, from 23 percent of those complaining of pain in 1993 to 37 percent in 2005.
The increase coincided with changing attitudes among doctors who now regard pain management as a key to healing. Doctors in accredited hospitals must ask patients about pain, just as they monitor vital signs such as temperature and pulse.
Even with the increase, the racial gap endured. Linda Simoni-Wastila of the University of Maryland, Baltimore, School of Pharmacy said the race gap finding may reveal some doctors' suspicions that minority patients could be drug abusers lying about pain to get narcotics.
The irony, she said, is that blacks are the least likely group to abuse prescription drugs. Hispanics are becoming as likely as whites to abuse prescription opioids and stimulants, according to her research. She was not involved in the current study.
The study's authors said doctors may be less likely to see signs of painkiller abuse in white patients, or they may be undertreating pain in minority patients.
Patient behavior may play a role, Pletcher said. Minority patients "may be less likely to keep complaining about their pain or feel they deserve good pain control," he said.
Stricter protocols for prescribing narcotics may help close the gap.
A New York hospital recently studied its emergency patients and found no racial disparity in narcotics prescribed for broken bones. Montefiore Medical Center aggressively treats pain and is developing protocols for painkillers that dictate initial dosages and times to check with patients to see if they need more pain medicine, said Dr. David Esses, emergency department associate director at Montefiore.
Such standards may eliminate racial disparities, Esses said.
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.
The data came from a well-regarded government survey that collects information on emergency room visits for four weeks each year from 500 U.S. hospitals. The new study was funded by federal grants.
"It's time to move past describing disparities and work on narrowing them," said Dr. Thomas L. Fisher, an emergency room doctor at the University of Chicago Medical Center who was not involved in the study.
Fisher, who is black, said he is not immune to letting subconscious assumptions inappropriately influence his work as a doctor.
"If anybody argues they have no social biases that sway clinical practice, they have not been thoughtful about the issue or they're not being honest with themselves," he said.
JAMA: http://jama.ama-assn.org
Well this is one white who is definately disapponted with the pain management he recieved at an ER for kidney stones.
Twice.
It’s like they know the thing ain’t gonna kill you so they pretty much expect you to “tough it out”. And people who have never had a kidney stone have no idea what it’s like. I’ve had broken bones, abscessed teeth, and acute appendicitus.....and none of those touch the pain that a kidney stone can deliver.
Dude I have been told that a kidney stone is worse than having a baby!
I believe you. I've had friends and relatives with them. Wouldn't wish them on my worst enemy, well, maybe my ex wife.......
Actually I always start treating kidney stones with Toradol. Because it has an antispasmodic effect on the ureters it usually does a good job, I’d say 70-80% of kidney stone patients get relief with it. If it doesn’t work, or I can’t use it for another reason, I move on to narcs.
Frankly part of the problem is kidney stone is a favorite complaint of drug seekers in the ED, we get really tired of being played. I’ve caught patients pricking their fingers and adding the blood to their urinals, or biting their lip and spitting into the urinal to give a urine positive for blood.
My mom had surgery on both knees and gave birth twice, and she said her kidney stone was worse than all combined.
The lifesize pix look bad, damned bad. I believe it.
I don't trust any of these studies that seem to have an agenda...
Blacks don't get as many narcotics therefore the health system is rigged against them therefore we need to NATIONALIZE the whole dang system...yada....yada...yada..
My hubby, is another one! He ended up going to the ER in an ambulance one winter's day. I couldn't drive him because we'd had almost 18" of snow, and the road wasn't cleared! He was there from about 10 am until 4pm, and he got absolutely NOTHING for pain. He was almost in tears, and I certainly was, when talking to him on the phone. He had four different docs come in to see him and NONE of them could figure out what was wrong.
He'd been to the doctor on the previous Friday, complaining of back pain, and that Doc had suspected kidney stones and sent us home with a little filter to catch them as they were passed. Turns out, almost two weeks later, a physical terrorist was the one who told him what was causing his pain. He'd torqued a muscle, which in turn inflamed a nerve, which affected the fascia of the muscle that ran from the middle of his back down and around to the front, and was causing pain that felt like a lit torch behind his navel. All the Docs were mystified by his description, because it didn't fit any of their pre-conceived notions of back trouble. The man couldn't stand up or sit down. He could only lie flat with ice paks on the site. It took a few months of Physical therapy, but he hasn't had any trouble since then, and that was in 2001!
If you look real, real hard you can find evidence of racism in just about everything.
I still get Demerol if I need another stent, don't I, Doctor? I'm a white-guy, so that's better, right?
I like Demerol ... a lot ............... FRegards
Some things that may be:
“...Patient behavior may play a role, Pletcher said. Minority patients “may be less likely to keep complaining about their pain or feel they deserve good pain control,” he said...”
Two other things that MAY be:
Minority patients, paying and non-paying, may be more abusive and demanding of pain medication, and may therefore be treated with less pain medication by resentful minority and non-minority providers.
Non-minority patients may be less likely, on the whole, to present with substance-abuse problems, and may therefore be thought of by minority and non-minority providers to be more ‘honest’ when describing pain or requesting pain medication.
Next time, demand DILAUDID. People who know tell me it works.
Fortunately we have removed Demerol from our formulary. So I can just tell em “Sorry we don’t have it anymore”. (;-)
But what’s the numbers when you compare amongst those within an insurance bracket? Much closer, I suspect.
Unfortunately blacks make up a larger percentage of the homeless and truly poor. Who’s more likely to be given morphine, an office worker or a transient?
since you had to go and mess this all up by getting back on topic,,,’’’
THIS JUST IN:
10,000 people with the common racial mix of the US walk from the beach out into the ocean. Studies show the number of whites who got wet in the water were higher than the number of minorities who got wet
Whites more likely to have Insurance!
Studies show that Vanilla ice cream is more popular than Chocolate. Subtle racism? /sarc
You are right. Any statistic can be manipulated to show racism.
On none of my five gall bladder visits to the ER was a painkiller given or prescribed.
I've since heard that Demerol was a "bad" pain reliever, and I always list intolerance to Demerol as a "drug reaction" due to headache.
The kidney stones were equal in pain, but I was prescribed 20 oxycodone tablets. I only took one; however, the pain coincidentally stopped instantly, so I experienced the effect as though there had been no kidney stone.
I want to tell you that I had no idea how many other discomforts I'd simply been living with!
BTW: When I stopped taking antacids "cold turkey", there have been no more kidney stones.
I wonder if the study corrected for differential patterns of ER usage. If I had pain, I would go to my primary care physician unless it was dire and in the middle of the night. A substanial chunk of the population, however, uses the ER for routine care. A racial differential could creep in there.
Yeesh. Tell me, the doctor who finally figured out the problem—was his name Gregory House?
Many doctors that I’ve seen don’t seem to give a rat’s #ss about their patient’s pain level and don’t prescribe adequate pain meds.
“Emergency room doctors are prescribing strong narcotics more often to patients who complain of pain, but minorities are less likely to get them than whites, a new study finds”
I’m sure that was the whole point of the “study”. More Lib agenda corrupting what used to be science. I’m sure I have some “studies” lying around somewhere that prove the fatal dangers of Liberalism on the human body. I’ll have to send them in to the JAMA. I’m sure they will be eager to publish it.
The first time my mom got kidney stones she was down in Florida vacationing and the doc at Morton Plant in Clearwater gave her that. She said it was the greatest gift she'd ever received. LOL. She got them again a few months ago while back here at home in Michigan and they told her under no circumstances would they prescribe that and gave her morphine. Like everything else, it seems it depends on the doc/hospital you're stuck dealing with.
I don't go to the ER unless there is a true emergency. I have never had one in my life that required a visit to the Emergency room. Some people, usually people who don't have health insurance, use the ER as their own personal doctor's office, visiting when they just have a cold, for instance. Minor ailments don't need narcotic pain relief.
Happy New Year’s Cherry,
I wonder who conducted the study? 1. The Communist Party USA. 2. The NAACP. 3. Quanell X and posse. 4. All of the above.
I can see it in the headlines now, “Racial Brofiling(Profiling) in the E.R.
Yes they have an agenda, it is called the minority victim reparations status, “to whom the chains fit.”
Respectfully,
NSNR
Male or Female?
Minorities More Likely to Use ER for Sniffles & Sneezes and Whites More Likely to Use ER for MEDICAL EMERGENCIES!"
“Fortunately we have removed Demerol from our formulary.”
Why? Just curious.
“a physical terrorist was the one who told him what was causing his pain.”
I have heard that about them.
Most blacks who come to emergency rooms are dead or dying from gunshot wounds inflicted by their fellows and are beyond help from painkillers.
Those with normal problems receive the pain killers at the normal rate.
“Frankly part of the problem is kidney stone is a favorite complaint of drug seekers in the ED”
For a pre-caffinated second that had me thinking Viagra before the neurons fired “who goes to the emergency room for ED”?
“Most blacks who come to emergency rooms are dead or dying from gunshot wounds inflicted by their fellows and are beyond help from painkillers”
(rolls eyes) ~Sure~.
+++++++++++++++++++++++++++++++++++++
I missed that part, where was it?
I’ve been to the emergency room twice. Once with an obviously broken femur, and once with horrible chest and back pain which turned out to be a cracked ribs. Both were results of car wrecks, and I was hauled in both times by ambulance unable to motivate on my own power. All other problems went to my regular doctor or his associate. The emergency room is for emergencies. I suspect emergency room staff will treat for pain more often if the case is an actual emergency.
I think that in my 15 years of working ER and ICU the only doc I ever saw prescribe Dilaudid was a urologist. Well, maybe an oncologist too. I remember quite a few people who were our "regulars" in ER, always looking for drugs, and most of them were white.
I’d like to have time to dig into the study and see what factors have been used to evaluate the numbers. However a couple of factors come to mind.
When a patient walks into the ER, the first thing the nurse and physician do is look at their prior visits. If they have multiple visits for “pain”, their chances of receiving narcotics goes down. If they have presented with the same pain complaints and have been referred to a physician, they will likely not receive narcotics.
If a patient walks in demanding demerol, they will likely leave empty handed.
If they have a specific medication request, it raises suspician. If they list all of the alternative drugs as allergies, that is a red flag.
If they have normal vital signs, bring food and drink into the room and complain of 10/10 pain, they will likely not receive narcotics.
If they quietly sit in the room and suddenly start groaning only when they notice someone looking at them, they will likely leave without narcotics.
We can also check what medicines they have recenly been prescribed. If you have been to multiple emergency rooms with multiple narc prescriptions, you will likely not receive narcotics.
As a general rule, if you are having severe pain, tell the physician how you are feeling accurately, be honest, don’t be dramatic. Most physicians want to make you feel better but don’t want to contribute to a narcotic problem.
“I like Demerol ... a lot”
You aren’t the only one. It was taken out of our ER formulary 4 years ago just to avoid those arguments. There are more powerful narcotics that don’t provide as intense high.
As a policy in our hospital, the insurance information is withheld from all providers and is not included in the chart until discharge.
Your post is a little offensive.
They’re often called “mother’s revenge”
My doc overprescribed Flexeril and Tramadl/APAP for my lower back pain. He gave me almost a year's worth! I have not slept this well or woken up feeling this good in almost a decade. Sadly, I can't take them during 8 to 5 work hours, as they make me woozy and stoned.
Ironically, it's my 3000-yr-old herbal remedy that works the best and has the least side effects.
Compartment Syndrome.....due to trauma...
The amount of medication to ease the pain will kill several adults... Having suffered several broken bones, skull fractures, concussions, I have never known more excruciating suffering than compartment syndrome.
“Ironically, it’s my 3000-yr-old herbal remedy that works the best and has the least side effects.”
I’d pick a fresh bottle if I were you.
Truthfully, I had a hernia repaired a few years ago. I was give 20 tablets of Lortab. I took only one. Aleve gave me adequate pain relief without side effects. Aleve is a synthetic analog of birch bark but more potent and easier on the GI tract.
I never thought of that. I'll bet it would raise a flag.
Of course it’s withheld. Wouldn’t want to know that a certain percentage of your customers are going to stiff you.
I’m sorry that my post was a “little offensive”. I know that all doctors are altruistic saints and never think about the bottom line.
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