Do you administer painkillers more often to white patients?

[tniuqs]

From personal experience, I'll take the Torodol before Morphine anyday.

Not to start a argument over what type of Rx should be used for renal colic but one can see from your post that Toradol ie the type of NSAIDS have not been included in the study either, well at least clearly anyway.

My personal experiance with Toradol is that it is no where near effective as the Opiates. Funny thing all my patients have had GI complaints or PMHX of "query" peptic ulcers, cva history, salicylate allergies, renal problems, asthma or HTN. The only reason I have used it is when "in a few deployments" the laws of that land forbid the use of narcotic analgesia .... or thrown in a nasty prison cell btw.

Back to the regular sheduled thread:

Racism in Medical Delivery of Care.

[Just Plain Ruff]

yes I agree the study is racially biased anyway. There is no way that this study cannot be a racially charged study.

I have worked the whole spectrum of ems, rural, urban, very very rural and ED based.

I can honestly say that color of skin has never, NEVER come into play. If they are in pain who am I to withhold pain meds.

Honestly, if you are on an ambulance and transporting a male patient, does race even play a part in your treatment? Do you give a radio report with the patients race. I never did. Race should never come into play in treating a patient.

But this is about racism in EMS but veiled as a study. Thinly veiled I say.

I wanted to comment earlier but thought I'd wait till others replied.

[Dustdevil]

Thang is "speaking just for myself" I was born Colour Blind and an Idealist (sometimes that sucks) or maybe it was my MOM and DAD that beat some sense into me at a young age, as they listened to Burton Cummings songs.

Me too.

That's why I hate American Women.

[captainstandup]

Nope, I just don't give pain meds to anyone, I hate everybody and think they should all suffer!

Now seriously, investigate the motive behind the author of the article, the magazine or newspaper, if the story were from ABC or CNN of course its a white against black thing.

I have never administered or withheld medication from anyone based on anything other than clinical presentation. To do otherwise is damnable (is that a word dust?) How many providers make "value judgments" about frequent fliers or "drunks" labeling them as drug seekers? I don't give a damn if I have transported a patient 59 times for the same complaint, if their presentation qualifies them for narcotics, I'm administering narcotics. It's up to physicians and social workers to sort out the details regarding suspected abuse of the system or "drug seeking" I've seen patients receive inappropriate care by other crews simply based on value judgments that distorted their clinical judgment and led to errors.

A really good example of this is a young black man who we frequently transport for sickle cell crisis. This fellow lives in a really bad area, has a history or marijuana use and has had a few "encounters" with law enforcement. As most of you know one of the most common presentations in sickle cell crisis is unbearable groin or abdominal pain. I found the only effective treatment for this patient to be NRB o2 @ 15 LPM, Saline IV and 15 mg doses IV Morphine. I have seen other crews bring tis guy in without even as much as an IV. These are the same medics that never pick up a book of trade journal and sleep through inservice.

We cannot teach empathy, caring or kindness. Medics who develop the idea that they get to decide the value of another person must be helped to find other new and exciting career opportnities. Perhaps the garbage collection industry or fast food would be a nice fit.

Finally, DING! Fries are done!

[flight-lp]

I need to talk to some nurses who work in ghetto ERs to figure out how they assess patient pain. They have to have some tricks I don't. This catch all 10/10 crap I get is a waste of time. Anyone have some suggestions? I just want people to be realistic.

It's actually quite simple, pain is exactly what the patient tells you it is. You are not the "morals police" and have no right discriminating against your patients because you believe they may or may not be lying to you. You'll get burned one of these days, watch and see. Hope you have a side gig, you'll eventually need it! Hope the $.50 vial of medicine was worth losing a career over..............................

[fiznat]

Great topic! I've been thinking about this a lot lately.

It is nice to say that we give pain medications "based on presentation only," but in my experience that is nothing more than a nice-sounding phrase. Pain is a subjective thing. Sure we can look at mechanism, look at the injuries, look at the history and our objective evaluations of a patient's pain, but when it comes down to it we do NOT have a reliable way to understand pain that we are not experiencing ourselves.

So what do we do? Give the meds to anyone who asks for it? No way. We have to make decisions about these kinds of patients based on information that may not be exactly... "scientific."

I don't like it about myself, but I have to agree with others who admitted that they allow race and economic status to play a role in these decisions. When someone is in pain (and ESPECIALLY if they ask for meds), I am always on the alert for drug seeking behavior. I don't feel like this is really part of my job as a medical provider, but the reality of the world is that we need to protect ourselves from those who would use us for the medications we carry. I try to avoid giving meds to drug seekers because it reinforces an addictive behavior that is destructive to both the patient and the EMS system. Though I don't like it, I have to admit that my index of suspicion for drug seeking behavior is higher for those of certain socioeconomic backgrounds. Based on experience I have found that people from certain neighborhoods are more likely than others to overstate pain and seek drugs. Though I have found this behavior in mansions as well as shanties, the truth of the matter is that it occurs more in one group than the other.

I don't like this. I've been thinking about it a lot lately and questioning as to whether this is something that should ever come to mind as a provider of medical care. I'm glad this topic was brought up so I can see what others feel about it.

[Riblett]

Hmm....good topic.

Well just in what I have seen and done in the field over a three year period as a Basic, Intermediate and student Paramedic I think I have given and seen given more narcotic pain killers to white patients. Typically in my response district most of the callers have been white and the black callers are what you would call frequent flyers.

I am not giving morphine or toradol to a cut finger or stubbed toe, period. I don't care how much you scream or what age/sex/race you are. I am actually pretty pain killer stingy, not really sure why. Now if I think the patient needs it, like for an MI, previously diagnosed kidney stones or significant traumatic injury they will absolutely get morphine. But back pain, abdominal pain, headaches, no...you might get some toradol if there is no bleeding danger. 99% of my decision is presentation based.

I am hesitant to give narcotics to Hispanic patients because they often do not speak English well enough for me to feel that I have accurately assessed them and there is a demonstrated need for the medication. Same thing for some other minorities with linguistic differences. Not being judgmental or racist, but if I don't know what is wrong with you or what medical problems you have I am hesitant to medicate you at all.

Black patients that I encounter are often frequent flyers. So no, if you call every few weeks for sickle cell crisis and want pain medicine, you are not getting it.

[p3medic]

I'm not black, and don't have sickle cell, but I can say that it looks like it hurts...If i'm working up someone with sickle cell crisis, they get all the pain meds they want, just the way it is.

[Dustdevil]

Not only do I give narcs to anybody whose presentation suggests significant pain, I even query those who do not state or act like they have much pain to be sure they are not concealing it, just in case. This is something valuable that comes with a nursing education. You learn more than monkey see - monkey do. You learn to totally assess the patient and his/her neads, taking all factors into consideration, including their psycho-social needs. The extra psych and sociology classes help you to understand your patients verbal and non-verbal behaviour too, allowing you to better determine their needs. The fact is, a lot of the people in the most pain complain the least. Yes, it takes a tonne of experience to lear to pick up on those clues. But without the educational foundation, you probably never will, even with a tonne of experience.

It ain't my drugs or my money. They are there for me to give away, and I never hesitate to do it.

[captainstandup]

Dust, are you saying that education and cultural understanding are useful in patient care?

Surely you can’t mean that broader understanding of different cultures from an anthropological AND cultural perspective is useful in caring for them?

We have a significant American Indian population in North Carolina and I find their presentation more unique than any other ethnic group. They are very proud and very suspicious of white healthcare providers. Diabetes and associated disease processes are common in epidemic proportions. Many of these folks are non-compliant with medications and diet restrictions ordered by their physicians. In addition to a high tolerance for pain, "diabetic neuropathy" further complicates assessment.

Assumption or poor education and judgment by care providers lead to inappropriate treatment or patient refusal of transport leading to deterioration and return calls for help by the family. Not to mention idiosyncrasies of the Indian population in response to certain medications. More on that later.