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Minorities Less Likely to Get Powerful Painkillers in ER
Date:1/3/2008

iction to opioids, it's appropriate to prescribe them for significant pain, Pletcher said. Still, they're only prescribed about two-thirds of the time for kidney stones and half the time for serious broken bones, he said, when those numbers should be at least 90 percent.

Patients may be hesitant about treating pain aggressively because of concern about abuse of opiates, he said. Also, patients have to go through a lot of procedures to get a prescription.

"They have to come in and say they have pain, and convince a nurse and doctor that they have pain that requires an opioid. It has to be prescribed and administered," Pletcher said. "There's enough barriers that it doesn't happen as consistently as it should."

Why would doctors be less likely to prescribe the drugs to minorities? The study doesn't answer that question, but Pletcher said there are a number of potential explanations.

"There could well be an element of pure racial bias," he said. "But it's probably more subtle and insidious than that. The interaction that occurs between a patient and a physician is complex in terms of interpersonal communications, and minority patients may be less empowered to complain and to demand good pain control. They may be less willing to show weakness by asking for a pain medication."

In addition, "there may be poorer communication in general and language barriers," he said. "A lot of things can get in the way of ideal care."

Another expert voiced similar concerns.

Dr. Thomas Fisher Jr., assistant professor of emergency medicine at the University of Chicago, said a variety of factors could explain the disparity.

For one, minority patients might be less likely to demand painkillers because of their history of "negative interactions" with authority, he said. "They may not feel comfortable voicing their needs, and they may not be able to given a language barrier or issues of culture," he added.


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