Posted on 09/14/2015 4:06:24 PM PDT by don-o
Black children with acute appendicitis -- a clearly painful emergency -- are less likely than white children to get painkillers in the emergency room, researchers reported Monday.
And nearly as troubling, only about half of any of the kids got painkillers, even though they're strongly recommended in cases of appendicitis, the researchers found.
"Black patients with moderate pain were less likely to receive any analgesia, and black patients with severe pain were less likely to be treated with opioids," Dr. Monika Goyal of the Children's National Health System in Washington and colleagues wrote in the Journal of the American Medical Association's JAMA Pediatrics.
(Excerpt) Read more at nbcnews.com ...
The inner city hospitals probably have much tighter budgets. My son fell while riding his bike across the street from the hospital where he was born. Didn’t let go of the handle bars. he wasn’t much of a cryer but he just wouldn’t stop so I took him in. The doc had him make a fist, then took his hand and turned his arm in a circle and said it was a sprain or something. They took gave him some codeine to sleep and put his arm in a sling.
The next morning we went to see a specialist who took an xray and he had a dislocated elbow and a spiral fracture going up. Instead of making a fist, when you dislocate your elbow you can’t OPEN your hand straight out, but you can still close it in a fist. OOPS.
Also, the bone from his wrist to his elbow had actually bent instead of cracking so they had to force it back into shape. We had to go back to the hospital because they put him under anesthesia, the most dangerous part, but he’s ok.
It’s been my experience as an RN that many patients who come into the ER with abdominal pain are going to be waiting however long it takes for the surgeon to evaluate them before they get any pain meds, but more so for someone with suspected appendicitis because rebound pain is a cardinal sign and cessation of pain can mean the appendix is ruptured.
Having pain meds on board, while it seems more compassionate, can cloud the clinical picture and complicate care in the long run.
I’m sure that makes me a racist.
Mrs. AV
It’s been my experience as an RN that many patients who come into the ER with abdominal pain are going to be waiting however long it takes for the surgeon to evaluate them before they get any pain meds, but more so for someone with suspected appendicitis because rebound pain is a cardinal sign and cessation of pain can mean the appendix is ruptured.
Having pain meds on board, while it seems more compassionate, can cloud the clinical picture and complicate care in the long run.
I’m sure that makes me a racist.
Mrs. AV
I am sure that happens all the time. 😂😇😆 I wonder if there is any truth to the rumor, that doctors do colonoscopies on minorities with a snorkel? 😁🙀
Really it is a terrible accusation.
They controlled for a great many variables in this study, but one they seemed not to consider was simple geography within the hospital.
The way it goes once there is a diagnosis made in the ER would be this: either you are going to a room on the surgical unit for now or you are going straight to the OR.
OR patients might not get pain meds because shortly they will be under anesthesia . Patients going to a room on the surgical unit will sometimes get their pain meds when they get there.
The abstract makes it seem as if the black kids never got any pain meds ever, when it is likely that they just didn’t get them while located in the ER. Should it happen sooner? Probably, but circumstances don’t always follow ideal pathways.
Myself, I would medicate a kid before transporting them somewhere so as not to give them more pain when jostling them around on a gurney, but you do have to be careful giving opioids to kids because it can supress the respiratory drive.
If I as ER nurse was sending them to a unit where they were not going to be watched closely I might have a lighter hand with the opioids.
Race would never enter the picture though, and no nurse I have ever worked with would ever withhold pain meds based on race. That’s disgusting.
Mrs. AV
Thank you
dirt floor...check. idiot doctor...check.
My “doctor” wore a suit and had one book for reference which he thumbed through for a very long time. It said “British Medical Reference” or something like that and it was old. I nearly grabbed it out of his hands he took so long.
Finally someone suggested I go to a pharmacy in another part of town and the two Pakastani guys running it sent me to an address where they said someone could help me. My taxi took me over rutted roads into a suburban area and we stopped at a house that was actually a clinic. Inside, amazingly was a Dr from Johns Hopkins!
When I asked to pay him he said he wouldn’t accept money...what he said was “pray for us”.
African hospital care is all over the spectrum. Some we have used are fairly good. I've also been in some where the hygiene and care were worse than that received (personally) in a sandbagged aid bunker in Vietnam.
I've received very good treatment for both amoebic dysentery and Giardia in East Africa using a drug not approved by the US (tinidazole), but approved in many countries in the tropics.
For many diseases of the tropics, you will often get far better treatment from a well trained African doctor or long time missionary nurse than you would in a fancy US hospital that is not familiar with your problem. We returned to our remote Ugandan village after several weeks break in Kenya to find a woman who had fallen on a very hard, sharp broken tree branch which had pierced her abdomen and colon. This had happened a day or two prior to our return. She had a tight, distended abdomen and a high fever.
We drove her the two hours (25 miles) to the nearest bush hospital and left her in the care of a young Ugandan doctor. Two weeks later we drove out to the hospital to find her well & ready for discharge! I believe that this doctor had been educated at Makerere University in Kampala. We also have a friend who was a missionary nurse in Africa for many, many years, both in teaching and in mobile clinics in very remote areas. She would be my very first choice for treatment of African medical problems, short of major surgery.
That is amazing!
What were you doing in Uganda?
Hospitals in the hood are a little tougher than their counterparts out in the burbs.
Worked as a Christian missionary with a small, unreached tribe of hunter-gatherers living in the Uganda-Kenya-Sudan border area. First met them while flying a helicopter in support of famine relief work in 1980-81.
Before moving over to the OR my wife was the ER Director. The amount of people hitting the ER daily in search of pain med’s was astounding. They knew all the right complain’t to make and could walk away with a prescription for Hydrocodone and have them sold minutes after picking them up at the pharmacy. All the while stiffing the ER for the visit. A prescription for a dozen hydrocodones could net them 100.00 on the street, then turn that around into a heroin purchase. These are the regulars that constantly suck the life out of ER’s daily.
I would like to better understand your point. I don't know much about the technicalities you are alluding to.
If each facility is analyzed in isolation, and assuming that the total amount of data collected from that is the same as the way they did it, won't you get the same results?
Typing that, it comes to me that your suggestion could allow for more possible conclusions (and options for improvements, if truly needed). One possible conclusion might be that there are differences between urban / suburban, for example. Perhaps blacks in a suburban hospital get the same meds as whites. Perhaps whites in an urban hospital get less.
Is this what you are driving at?
I need to go back and reread how they handled Asians and Hispanics.
I agree. If you read what I just posted, some additional detail broken out regarding the situation of the hospitals themselves might be useful in understand causes other than racism.
That is what interested me in the article and study. It seems, on the surface, as just one more piece of propagit. And a few commenters on the thread blurted that, as if that explains it all.
That is impressive! You must have fascinating experiences.
I was only on safari - but we were camping in tents so that was a bit more interesting than a luxury lodge or something.
For example, let us assume there are two hospitals, call them A and B. Hospital A administers opiate analgesics to 80% of all incoming patients, black or white, who present with symptoms of appendicitis. Clearly, no racism is present.
Hospital B administers opiate analgesics to 20% of all incoming patients, black or white, who present with symptoms of appendicitis. Clearly, no racism there, either.
Now, Hospital A is in a majority white community, where 90% of the patients are white; Hospital B is in a majority black community, with 90% of the patients being black.
Therefore, from Hospital A we have 72 white patents and 8 black patients (of 100) being administered opiates. From Hospital B, we have 2 white patients and 18 black patients being administered opiates.
However, when we combine the data, 74 white patients were administered opiates, but only 26 black patients. From two sets of data which clearly show no racism, we get a combined set which shows tremendous racism.
The difference is due to the hospitals, not due to racism.
Since the data from the study does not separate out the hospitals, there is no way to tell for sure if the difference is actually due to racism, or just due to the fact that different hospitals may have different policies on administering opiates.
Excellent and EXACTLY what I was hoping for on the thread.
You make a great point, and I believe the authors of this study cherry-picked the data just like that to fit their hypothesis.
There are just too many variables in real world medicine to accurately study this, especially with such a huge sample size - the variables would increase with all the different facilities, clinical presentation, physician diagnoses, wait times, transfer times, etc. the list could be endless almost.
Mrs. AV
You are more than welcome. Glad to be of help.
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