Interestingly I saw one study while pulling this up from 2009 that came to the conclusion that there isn’t a major disparity in pain treatment between races and genders, but I think we’ve learned a great deal about the social determinants of health since then, and these more recent studies and articles show the opposite.
It’s less to do with a pact, and more to do with ignorance. Most clinical signs are taught in north America on caucasian skin (though there’s a really neat clinical guide put out I think by St George’s university in the UK that I highly recommend to all health care providers- it’s called mind the gap and it’s free afaik). Additionally, cultural and language differences change how people raised in different cultures express pain. Finally, women’s health is probably 50 years behind where it should be because any pain to do with female reproductive organs (and by extension abdominal pain) is often written off even when it’s debilitating.
Add in those natural unconscious biases we carry as humans and no universal pact needed, discrimination happens anyway even with people who don’t realize they are doing it.
For anyone doubting these experiences, I am a US medical student, and implicit biases and racism are big topics we are taught and made aware of due to physicians profiling their patient whether intentionally or not.
This is especially common in the ER where many people without PCPs come in for issues that are generally handled by a PCP. One of the more difficult things that physicians struggle with is balancing time with the quality of care they provide to their patients. Profiling makes the “time” component easy, but obviously that results in very poor quality healthcare.
No one should be doubting people’s experiences of racism and discrimination in the ER and beyond. Doctors are people too, and the bigoted behavior you see in other professions are just as likely to appear with your doctor.
I appreciate that, and I want to offer hopefully a more positive outlook. These topics are becoming standard courses in the US medical school curriculum, as in they have to be taught to medical students.
It won’t solve every problem, of course, but the curriculum is way more patient-oriented than it used to be instead of being a simple “solve disease” kind of curriculum, which is what most of the doctors you see today are taught with.
I rarely comment on lemmy, but I had to say something against the few people who were saying these experiences aren’t valid.
Discrimination is real, and don’t assume Doctors are perfect because they’re not. Of course be open-minded and don’t be antagonistic to the ones who are legitimately trying to help you, but if you feel your care wasn’t great, then that’s very likely a failure on the physician’s part.
That is really good news that it’s becoming standard. I sincerely hope the grueling hours don’t take its toll on you and that they’re working on that as well. Burnt out doctors shouldn’t be a thing.
I’m a medical student that is aiming for emergency medicine, and threads like these are a special kind of demoralizing. When I was working as an ER tech, there were a fair few times where aggressive or combative patients would only let me get anywhere near them for anything because I never showed any judgement or disdain. Not that I blame my coworkers. It’s hard to treat someone nicely after they fake having an overdose in the lobby and then assault one of the nurses after they “wake up” from the narcan.
I honestly think that most medical workers are a victim of the healthcare system and pharma drug pushing as much as the patients. If there was affordable healthcare and a focus on helping people live healthy lives, there wouldn’t be so much drama and life threatening decisions.
I know that the general public’s idea of what ERs are for doesn’t help. EMTALA doesn’t mean that everyone who comes into an ER will get treated for anything regardless of ability to pay. It’s that they’ll be treated and stabilized for any emergent medical condition, illness, or injury… And many people seem to have interesting ideas about what constitutes an “emergency”.
The presumption that every patient is someone who fakes an overdose until proven otherwise is precisely why so many people in this threat is suffering. We aren’t asking you to serve narcan on a silver platter to people who fakes an overdose. We’re just asking to be treated as humans, with empathy, without preconceptions about who we are or why we are at the ER based on our skin color, sex, age, and chronic medical conditions.
Trust us, we know what it’s like to feel demoralized at the ER. I’ve had enough close calls of neglecting life threatening conditions, enough of ER staff laughing off my pain, enough ER staff deliberately manhandling me and hurting my tender points to prove I’m ‘overreacting’, enough of waiting 6 hours only to be sent home with nothing and in more pain than I was to begin with, enough of being left to cry in pain for hours at the ER and being ridiculed for it. Many of us are demoralized to the point of fearing the ER and avoiding it even under life threatening circumstances, because going through another ER experience might be the tipping point to actually kill ourselves.
There is only so much suffering, pain, and psychological torture the human mind can endure. Most people in the ER have no idea how much chronic pain sufferers have at stake when going to the ER. I have had ER visits that left me more broken than being sexually assaulted as a teen. I trusted doctors, I trusted the hospital, and I trusted that I was in a safe space. Being painfully jabbed, mocked, laughed at, and told im lying and drug seeking were the last things I was expecting. Nothing will repair this breach of trust, because the stakes are too high. I cannot gamble away my physical and mental health for the sake of improving moral in ER staff. For you, at worse you become disillusioned with your career. For me, it’s my life that I’m risking.
He came in for an entirely unrelated complaint and faked the overdose to get taken back immediately. The only drug in his system at the time was meth. Literally every room was full except for the resuscitation bay where we took him, and we had to keep him there for almost 2 hours until we had somewhere to move him to. It was the biggest of the resuscitation bays we had, so if we had someone coming in that needed ECMO, we’d have been kind of fucked.
I wish we hadn’t had to deal with that guy. Every nurse in the department had minimum 5 patients, mostly high acuity, and his stunt backed up the department for an extra couple hours by pulling unnecessary attention. I much rather would have been helping the nice gentleman in the lobby who had been waiting 5 hours with chest pain and a cardiac history, or the sickle cell patient in pain crisis.
I don’t have a problem with drug seeking. Pain is horrible and substance use disorders are diseases, not moral failings. I do have a problem with attention seeking, malingering, and abuse or assault of staff. As a physician, I plan to treat pain appropriately with the necessary medications or therapies, and to treat abuse of my staff with extreme prejudice.
And an edit to add: a drug overdose is treated as the same level of emergency as a cardiac arrest. We don’t serve Narcan on a silver platter, we serve it via wide bore IV while getting set up for intubation and resuscitation if it fails because we mean to move heaven and earth to keep the patient alive. An OD gets you to the front of the line, almost no questions asked besides “what substance?” so we know what antidote to give.
I’m terribly sorry that you have had that experience, and I’m disgusted with people who have treated you that way. However, you are making similar assumptions about me that other people have made about you. Working as an ER tech, I’ve literally had mental health patients try to strangle me, then given 10 minutes or so to shake it off, and then run straight into another code on a 16 hour shift that did not include any other breaks besides that 10 minutes… and then I came back 8 hours later for another 16 hour shift because the department was so understaffed that it would have been disastrous if I called out sick.
I’ve come into work, wholly unrecovered from a kidney infection and my own trip to the ER as a patient, and never let a whisper of it show on my face so that I could provide the best care possible for my patients. I’ve been the patient in the waiting room with 9 out of 10 pain for 6 hours, and I know how much it sucks. That’s part of why I do everything I can to give every patient the time, attention, and care that they need to heal them as much as I can.
I’m sorry you had to deal with that awful guy. Abuse of staff isn’t something that you should tolerate, nor am I asking you to. All I ask is that patients are not profiled as this guy until they have proven otherwise.
This is a systemic issue, not something that you’re expected to fix alone. I’m not blaming you for all the failings of a medical system that is understaffed, underpaid, and overcharged by insurance companies. I’m just asking that people who have suffered at the ER before be heard and believed. I have tried countless times explaining the extent of this systemic issue to medical professionals, and was met with skepticism and outright disbelief about the magnitude of this issue. The many anecdotal experiences from ER visit should give an idea of how common this is among ER visitors.
Yes, it’s true that both sides are making assumptions here. However, patient assumptions that ER staff are capable of causing harm are there to keep themselves safe, and don’t turn them into abusive patients. Discriminatory assumptions made by ER staff can turn them into abusive staff.
What I have been trying to say is that we didn’t make any assumptions about that guy. We treated him with the same standard of care and urgency that any emergent medical condition would warrant until we had proof that he was faking it and after he grabbed a nurse’s breast so violently and so hard that the entire right side of her chest was bruised for a couple of weeks. We made no assumptions and only acted on his behaviors and proven medical condition.
The experiences you have had are horrible, but they are not universal. Unfortunately, the way the emergency medical system has been stretched to its limit lately means that the best the ER can do is to keep people from dying, and diagnose and treat the more straightforward conditions. For most of the more complicated and chronic stuff, there’s very strict laws about how much medication for what duration can be prescribed by an emergency physician, and a significant amount of the time, the best we can do is make sure you’re not actively dying and put in a referral to the specialists with a note that you should be bumped up the waiting list a bit depending on severity. Hell, even trying to admit people to the hospital isn’t a sure bet these days because the inpatient departments are allowed to enforce their staffing-to-patient ratios, so the ER gets stuck trying to take care of inpatient and even ICU patients with ER resources for up to days at a time.
My somewhat glib comment about people not being aware of what counts as an “emergency” is very literal when it comes to triage. We do our best to treat everything that comes through our doors, but if there’s not an immediate threat to life, limb, or permanent disability, there’s pretty distinct limits on what we’re able to do on a short timeline and what the hospital allows us to do for free. EMTALA stands for “Emergency Medical Treatment And Labor Act” and it dictates that anyone who turns up to an ER with an emergent medical condition that poses immediate threat to life, limb, or permanent disability will be treated and stabilized to the accepted level of care regardless of ability to pay, and a mother presenting in active labor will be provided with delivery care or appropriate timely transfer to a labor and delivery department if appropriate regardless of ability to pay. There’s very strict rules about the level of treatment to be provided and when or if transfer to another facility or provider is warranted and permitted, but past the stipulations of that law, it comes under the hospital administration’s rules and regulations about what level of care can be provided by the emergency department.
I’ve seen quite a few physicians defy the hospital rules by ordering some of the special labs and tests that the specialist would order so that the results are already available in the system for when (if) the patient gets seen by the specialist, but they can get in quite a bit of trouble for it, and if it’s not documented just right the patient’s insurance might not pay for it. That’s one of the other delightful limitations on what the ER can do…we have to toe the line on what needs to or should be done versus what the patient’s insurance will pay for, because believe it or not, we really don’t want to stick you with a bill for thousands of dollars of tests that your insurance denied coverage for.
Due to overwork, understaffing, antiquated training, and burnout, a lot of physicians’ and nurses’ bedside manner could use a fair bit of work, but in terms of the care provided, 99+ percent of the time, it really is the best we can do under the restraints created by laws, rules, resources, and insurance.
deleted by creator
https://www.kff.org/racial-equity-and-health-policy/issue-brief/use-of-race-in-clinical-diagnosis-and-decision-making-overview-and-implications/
https://www.sciencedirect.com/science/article/abs/pii/S0196064423002676
https://www.washingtonpost.com/wellness/interactive/2022/women-pain-gender-bias-doctors/
Individuals who are intersectional in groups that are under prioritized for health care have it the absolute worst.
https://www.tandfonline.com/doi/abs/10.1080/13557858.2021.1899138
Interestingly I saw one study while pulling this up from 2009 that came to the conclusion that there isn’t a major disparity in pain treatment between races and genders, but I think we’ve learned a great deal about the social determinants of health since then, and these more recent studies and articles show the opposite.
It’s less to do with a pact, and more to do with ignorance. Most clinical signs are taught in north America on caucasian skin (though there’s a really neat clinical guide put out I think by St George’s university in the UK that I highly recommend to all health care providers- it’s called mind the gap and it’s free afaik). Additionally, cultural and language differences change how people raised in different cultures express pain. Finally, women’s health is probably 50 years behind where it should be because any pain to do with female reproductive organs (and by extension abdominal pain) is often written off even when it’s debilitating.
Add in those natural unconscious biases we carry as humans and no universal pact needed, discrimination happens anyway even with people who don’t realize they are doing it.
For anyone doubting these experiences, I am a US medical student, and implicit biases and racism are big topics we are taught and made aware of due to physicians profiling their patient whether intentionally or not.
This is especially common in the ER where many people without PCPs come in for issues that are generally handled by a PCP. One of the more difficult things that physicians struggle with is balancing time with the quality of care they provide to their patients. Profiling makes the “time” component easy, but obviously that results in very poor quality healthcare.
No one should be doubting people’s experiences of racism and discrimination in the ER and beyond. Doctors are people too, and the bigoted behavior you see in other professions are just as likely to appear with your doctor.
It’s nice to see that someone is going to be one of the good doctors.
I appreciate that, and I want to offer hopefully a more positive outlook. These topics are becoming standard courses in the US medical school curriculum, as in they have to be taught to medical students.
It won’t solve every problem, of course, but the curriculum is way more patient-oriented than it used to be instead of being a simple “solve disease” kind of curriculum, which is what most of the doctors you see today are taught with.
I rarely comment on lemmy, but I had to say something against the few people who were saying these experiences aren’t valid.
Discrimination is real, and don’t assume Doctors are perfect because they’re not. Of course be open-minded and don’t be antagonistic to the ones who are legitimately trying to help you, but if you feel your care wasn’t great, then that’s very likely a failure on the physician’s part.
That is really good news that it’s becoming standard. I sincerely hope the grueling hours don’t take its toll on you and that they’re working on that as well. Burnt out doctors shouldn’t be a thing.
I’m a medical student that is aiming for emergency medicine, and threads like these are a special kind of demoralizing. When I was working as an ER tech, there were a fair few times where aggressive or combative patients would only let me get anywhere near them for anything because I never showed any judgement or disdain. Not that I blame my coworkers. It’s hard to treat someone nicely after they fake having an overdose in the lobby and then assault one of the nurses after they “wake up” from the narcan.
I honestly think that most medical workers are a victim of the healthcare system and pharma drug pushing as much as the patients. If there was affordable healthcare and a focus on helping people live healthy lives, there wouldn’t be so much drama and life threatening decisions.
I know that the general public’s idea of what ERs are for doesn’t help. EMTALA doesn’t mean that everyone who comes into an ER will get treated for anything regardless of ability to pay. It’s that they’ll be treated and stabilized for any emergent medical condition, illness, or injury… And many people seem to have interesting ideas about what constitutes an “emergency”.
The presumption that every patient is someone who fakes an overdose until proven otherwise is precisely why so many people in this threat is suffering. We aren’t asking you to serve narcan on a silver platter to people who fakes an overdose. We’re just asking to be treated as humans, with empathy, without preconceptions about who we are or why we are at the ER based on our skin color, sex, age, and chronic medical conditions.
Trust us, we know what it’s like to feel demoralized at the ER. I’ve had enough close calls of neglecting life threatening conditions, enough of ER staff laughing off my pain, enough ER staff deliberately manhandling me and hurting my tender points to prove I’m ‘overreacting’, enough of waiting 6 hours only to be sent home with nothing and in more pain than I was to begin with, enough of being left to cry in pain for hours at the ER and being ridiculed for it. Many of us are demoralized to the point of fearing the ER and avoiding it even under life threatening circumstances, because going through another ER experience might be the tipping point to actually kill ourselves.
There is only so much suffering, pain, and psychological torture the human mind can endure. Most people in the ER have no idea how much chronic pain sufferers have at stake when going to the ER. I have had ER visits that left me more broken than being sexually assaulted as a teen. I trusted doctors, I trusted the hospital, and I trusted that I was in a safe space. Being painfully jabbed, mocked, laughed at, and told im lying and drug seeking were the last things I was expecting. Nothing will repair this breach of trust, because the stakes are too high. I cannot gamble away my physical and mental health for the sake of improving moral in ER staff. For you, at worse you become disillusioned with your career. For me, it’s my life that I’m risking.
He came in for an entirely unrelated complaint and faked the overdose to get taken back immediately. The only drug in his system at the time was meth. Literally every room was full except for the resuscitation bay where we took him, and we had to keep him there for almost 2 hours until we had somewhere to move him to. It was the biggest of the resuscitation bays we had, so if we had someone coming in that needed ECMO, we’d have been kind of fucked.
I wish we hadn’t had to deal with that guy. Every nurse in the department had minimum 5 patients, mostly high acuity, and his stunt backed up the department for an extra couple hours by pulling unnecessary attention. I much rather would have been helping the nice gentleman in the lobby who had been waiting 5 hours with chest pain and a cardiac history, or the sickle cell patient in pain crisis.
I don’t have a problem with drug seeking. Pain is horrible and substance use disorders are diseases, not moral failings. I do have a problem with attention seeking, malingering, and abuse or assault of staff. As a physician, I plan to treat pain appropriately with the necessary medications or therapies, and to treat abuse of my staff with extreme prejudice.
And an edit to add: a drug overdose is treated as the same level of emergency as a cardiac arrest. We don’t serve Narcan on a silver platter, we serve it via wide bore IV while getting set up for intubation and resuscitation if it fails because we mean to move heaven and earth to keep the patient alive. An OD gets you to the front of the line, almost no questions asked besides “what substance?” so we know what antidote to give.
I’m terribly sorry that you have had that experience, and I’m disgusted with people who have treated you that way. However, you are making similar assumptions about me that other people have made about you. Working as an ER tech, I’ve literally had mental health patients try to strangle me, then given 10 minutes or so to shake it off, and then run straight into another code on a 16 hour shift that did not include any other breaks besides that 10 minutes… and then I came back 8 hours later for another 16 hour shift because the department was so understaffed that it would have been disastrous if I called out sick.
I’ve come into work, wholly unrecovered from a kidney infection and my own trip to the ER as a patient, and never let a whisper of it show on my face so that I could provide the best care possible for my patients. I’ve been the patient in the waiting room with 9 out of 10 pain for 6 hours, and I know how much it sucks. That’s part of why I do everything I can to give every patient the time, attention, and care that they need to heal them as much as I can.
I’m sorry you had to deal with that awful guy. Abuse of staff isn’t something that you should tolerate, nor am I asking you to. All I ask is that patients are not profiled as this guy until they have proven otherwise.
This is a systemic issue, not something that you’re expected to fix alone. I’m not blaming you for all the failings of a medical system that is understaffed, underpaid, and overcharged by insurance companies. I’m just asking that people who have suffered at the ER before be heard and believed. I have tried countless times explaining the extent of this systemic issue to medical professionals, and was met with skepticism and outright disbelief about the magnitude of this issue. The many anecdotal experiences from ER visit should give an idea of how common this is among ER visitors.
Yes, it’s true that both sides are making assumptions here. However, patient assumptions that ER staff are capable of causing harm are there to keep themselves safe, and don’t turn them into abusive patients. Discriminatory assumptions made by ER staff can turn them into abusive staff.
What I have been trying to say is that we didn’t make any assumptions about that guy. We treated him with the same standard of care and urgency that any emergent medical condition would warrant until we had proof that he was faking it and after he grabbed a nurse’s breast so violently and so hard that the entire right side of her chest was bruised for a couple of weeks. We made no assumptions and only acted on his behaviors and proven medical condition.
The experiences you have had are horrible, but they are not universal. Unfortunately, the way the emergency medical system has been stretched to its limit lately means that the best the ER can do is to keep people from dying, and diagnose and treat the more straightforward conditions. For most of the more complicated and chronic stuff, there’s very strict laws about how much medication for what duration can be prescribed by an emergency physician, and a significant amount of the time, the best we can do is make sure you’re not actively dying and put in a referral to the specialists with a note that you should be bumped up the waiting list a bit depending on severity. Hell, even trying to admit people to the hospital isn’t a sure bet these days because the inpatient departments are allowed to enforce their staffing-to-patient ratios, so the ER gets stuck trying to take care of inpatient and even ICU patients with ER resources for up to days at a time.
My somewhat glib comment about people not being aware of what counts as an “emergency” is very literal when it comes to triage. We do our best to treat everything that comes through our doors, but if there’s not an immediate threat to life, limb, or permanent disability, there’s pretty distinct limits on what we’re able to do on a short timeline and what the hospital allows us to do for free. EMTALA stands for “Emergency Medical Treatment And Labor Act” and it dictates that anyone who turns up to an ER with an emergent medical condition that poses immediate threat to life, limb, or permanent disability will be treated and stabilized to the accepted level of care regardless of ability to pay, and a mother presenting in active labor will be provided with delivery care or appropriate timely transfer to a labor and delivery department if appropriate regardless of ability to pay. There’s very strict rules about the level of treatment to be provided and when or if transfer to another facility or provider is warranted and permitted, but past the stipulations of that law, it comes under the hospital administration’s rules and regulations about what level of care can be provided by the emergency department.
I’ve seen quite a few physicians defy the hospital rules by ordering some of the special labs and tests that the specialist would order so that the results are already available in the system for when (if) the patient gets seen by the specialist, but they can get in quite a bit of trouble for it, and if it’s not documented just right the patient’s insurance might not pay for it. That’s one of the other delightful limitations on what the ER can do…we have to toe the line on what needs to or should be done versus what the patient’s insurance will pay for, because believe it or not, we really don’t want to stick you with a bill for thousands of dollars of tests that your insurance denied coverage for.
Due to overwork, understaffing, antiquated training, and burnout, a lot of physicians’ and nurses’ bedside manner could use a fair bit of work, but in terms of the care provided, 99+ percent of the time, it really is the best we can do under the restraints created by laws, rules, resources, and insurance.
Your comment was removed, I wonder why.
I think the person I was replying to deleted their comment.