Study: Whites more likely to get narcotics in ER

[Bwrecks]

We have an interesting hospital policy now: sicklers get one dose of narcs (their usual dose), and if they need a second dose, we have to call the on-call hematology fellow. The third dose requires hospital admission. No narcotic prescriptions for sicklers can be written from the emergency department until the person has spoken with the hematology fellow. We are only allowed to write enough narcotics for the sickler to get to the hematology clinic the following day they are open (obviously if they get a script on Friday it's for more narcs than on a Wednesday night).

This has had mixed results, including some sicklers balking at the idea of calling hematology with the second med administration because they claim the nurse didn't push their Dilaudid fast enough to relieve their pain, or they didn't combine it with the usual 50 mg Benadryl and 25 mg Phenergan when they gave their 8 mg of Dilaudid.

Don't get me wrong. I do aggressively treat sicklers' and anyone else's pain. I write pain meds quickly, and I dispense liberally when discharging patients with conditions that require them (broken ribs, wrist fractures, or anything else that is painful). However, I do listen to my inner sense that might scream "hey, this guy chewing on the cheeseburger can't be suffering too much pain from his toothache." If in doubt, I prescribe them.

And this policy seems rediculous! Does your ER not trust ER docs to be able to adequately diagnose and treat sickle cell patients' pain appropriately? I cant belive the Hematologist would be excited to be involved with such a policy.

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[Bwrecks]

Racial stereotypes like what?

More blacks go to inner city EDs- this is demographics, not stereotyping

There are more drug seekers in inner city EDs- again, not a stereotype

There are a large percentage of hispanics in these EDs that do not speak English- if you ever worked in one you know this is true, I spend time every day interpretting for non-Spanish speaking residents.

Hispanics are very tough- this is obviously a stereotype, but being that 3/4 of my family is Mexican I feel it is probably pretty safe for me to say in general, people who swam a river, avoided armed guards, walked across a desert to have a job where they make 4.00 an hour are pretty tough. And, no it is not a stereotype to say that a lot of Spanish speaking migrant workers are illegals, its the truth. Obviously if you live in California you experience a largely different population of Hispanics...that is the English speaking citizen, but in NC these are rare.

What are you basing this data from? I work in a suburban ED, and ANYONE will tell you we get an overwhelming number of pain patinents. Hell, we even have an area of 16 beds strictly made for them in our ED! Please dont speak based on ignorant beliefs. Have data or some sort of objective proof to back up your statements.

 

[Faze2]

What are you basing this data from? I work in a suburban ED, and ANYONE will tell you we get an overwhelming number of pain patinents. Hell, we even have an area of 16 beds strictly made for them in our ED! Please dont speak based on ignorant beliefs. Have data or some sort of objective proof to back up your statements.

Yeah, but you are basing your counter argument about this issue as a whole on what you see in YOUR suburban ED. You don't get much more subjective than that, assuming that you cannot be wrong because of what you see in that one ED. No one is arguing that your "white suburban patients" do not come in to seek drugs, all they are saying is that they notice a drug seeking trend in their innner city ER's, which the majority of the time are mostly non-white patients. If you need a link to prove that, I'll get right on it. But don't claim that these posts are illegitamate because they are "subjective" and then defend your entire argument with evidence from one ED. Doctors and nurses working in inner city ED's have been talking about the problem of drug seekers for years and years. Are they just making all of this up?