Study says Hispanics and blacks less likely to receive proper pain control
A study of 281 minority outpatients with pain from recurrent or advanced cancer found that 65 percent of them didn't get the pain medications recommended in federal and World Health Organization guidelines.
Dr. Charles S. Cleeland, professor of medicine
and director of the University
of Texas M.D. Anderson Cancer Center Pain Research Group in Houston, says
"cancer patients who are treated in settings seeing primarily minority
patients in large urban settings are at much greater risk for under-treatment
of cancer pain" than white patients. Not that whites have it much
better. The same research team published a study showing that 50 percent
of white cancer patients did not receive the recommended medication.
The researchers offered several explanations for improper pain treatment by physicians: concerns about "drug abuse," lack of money to pay for the medications, differences in language, and lack of patient assertiveness in seeking care.
Cleeland is quoted as saying, "We health care professionals tend to underestimate the severity of pain, and as that discrepancy grows, the chances that minority patients will not get medication grows as well."
"Pain related to cancer is often not part
of the dialogue that takes place between the health care professional and
the patient, so there's often not an assessment," he says. "If
patients are going to get treatment for pain, they have to initiate that
part of the dialogue."
(Reuters, Oct 31, 1997)
See also:
Hospitals
continue to give lousy pain advice, study shows
Fear of doctor visit elevates blood pressure
for some
Hospital
study: half the patients experienced treatment errors
One wishes that this example of colossal medical ineptitude and cruelty would be so scandalous as to shake the foundation of American medicine. Instead, physicians blame their clients for lacking assertiveness in seeking proper care. On the other hand, when clients are assertive they are labeled "difficult," and diagnosed with "anxiety" or other so-called psychiatric disorders. Physicians are notoriously thin-skinned and disliking of challenge. The important issue here is not client passivity or racial category, though those are not trivial, it is the immoral and callous behavior of physicians.After an extended bout with considerable gastric pain I was referred early in 1997 to a San Francisco gastroenterologist named Kevin Olden. When I called to make an appointment I was told that the next opening was in a month. Reluctantly I took it and resolved to suffer a bit longer. When I arrived I was kept waiting for two hours, then notified that Olden was too busy to see me. The next available appointment was not for another month. When I assertively asked whether it would be possible to work me in sooner or if another patient might be willing to switch appointments with me, Olden's assistant acted as if I was an impertinent idiot.
More recently, I recently visited a gastroenterologist named Robert F. Willenbucher at the Mount Zion Medical Center in San Francisco. When I speculated on the nature of my malady he responded sarcastically, "You didn't go to medical school." True, and that may be why I haven't been utterly desensitized to the suffering of others as seems the case with many physicians.
It would be interesting to know precisely how assertive these physicians think we should be. Where is the line between "assertive" and "difficult"?
(Nicolas S. Martin, Executive Director, AiA)
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