Children of color have their pains neglected more often

Judith McClellan is a social worker, lives in Salisbury, North Carolina (USA), and knows what it’s like to see her daughter in pain. Kyarra, 15, has sickle cell anemia, an inherited disease that most commonly affects black people and often causes pain so excruciating that it requires the use of opioids in emergencies.

McClellan said that when Kyarra was younger, she described the pain — caused by clogged blood vessels — as “a butcher’s knife stabbing me a thousand times in the same place.”

The social worker said that in times of greater suffering, “the protocol is to go to the nearest hospital” to receive potent painkillers that mitigate Kyarra’s discomfort until the crisis passes. But because the McClellans, who are black, live an hour and a half away from the hematologist who sees Kyarra, they often end up going to hospital emergency rooms where doctors don’t know them and often question Kyarra’s pain.

“If she says she’s in level eight pain – because she’s not screaming – they ask, ‘Are you sure it’s an eight? Or are you pretending to be an eight to get more pain medication?'” told the mother. “Sometimes I think they think she’s trying to get high.”

Andrew Campbell, director of the Comprehensive Sickle Cell Program at Children’s National Hospital in Washington, said that physicians who do not understand a condition like sickle cell anemia, characterized by severe pain, often incorrectly characterize black children, and especially teenagers, as “people who seek drugs” or “abusing opiates”. He also said that there is “a potential element of racism” that could lead to this characterization.

Last year, in an emergency department at a UNC hospital in Chapel Hill, North Carolina, a doctor reported McClellan to Child Protective Services because he found it worrying that Kyarra had received 30 opiate prescriptions from nine different doctors in North Carolina in the 12 previous months. It was too much, in his opinion.

The social worker said that when she explained to the doctor that Kyarra’s prescriptions were necessary and were in line with prescription guidelines, he replied, “If you’re not hiding anything, everything will be fine.”

Asked about the incident, Alan Wolf, a spokesman for UNC Health, said that “North Carolina legislation requires hospitals to report suspected child neglect or abuse.” In the end, the agency decided not to pursue the complaint further, McClellan said, “because it didn’t meet the criteria for neglect or abuse.”

A theme that keeps repeating itself

Emily Hartford, assistant professor of pediatric emergency medicine at the University of Washington and a scholar of how differences in care can affect children, said Kyarra’s case is part “of a theme that we’re starting to see repeated in the medical literature.” “.

In June, for example, Hartford and his colleagues published a study in the academic journal Academic Emergency Medicine that analyzed the medical records of 833 adolescents ages 12 to 16 who came to the Seattle Children’s Hospital emergency department between 2016 and 2020 with migraines.

They found that black, Asian, Hispanic or children who preferred to speak in a language other than English were less likely than white children to receive strong intravenous pain relievers, despite reporting similar pain levels.

This finding coincides with previous research, Hartford said, that when non-black children come to emergency departments with problems such as bone fractures or appendicitis, they are less likely than white children to receive appropriate pain relievers, such as opiates. Many studies have found similar variations in pain management among non-white adults.

“We would like there to be no differences by ethnicity and language,” said Hartford. “But we need to bring these differences out into the open. It’s the first step in tackling them.”

Why treatment is different

Pain is subjective, difficult to measure and often invisible. And in children, even more than in adults, it is often misunderstood, insufficiently treated and despised, a fact already revealed in research.

But treatment can be even worse for children of color. Ron Wyatt, a senior fellow at the Institute for Healthcare Improvement in Madison, Alabama, pointed out that false ideas about biological differences between blacks and whites — ideas that date back to slavery times — have had lasting effects on the treatment of people of color in environments. doctors.

For exam- thicker than white people. And 7% believed that the nerve endings of black people are less sensitive than those of white people. Participants who had these misconceptions made less appropriate recommendations about pain treatments.

Lisa Cooper, professor of medicine at Johns Hopkins University and director of the university’s Center for Equity in Health, has found in her own research that the greater the implicit (or unconscious) bias of white physicians, the worse their communication with black patients.

One of their studies found that white doctors dominate conversations with black patients more than white patients, increasing the chances that black patients’ concerns will go unheard and their medical problems and pain go untreated. “It’s a safety issue, without a doubt,” Cooper said.

Cristina Gonzalez, a professor of medicine at the Albert Einstein College of Medicine in New York, teaches doctors to recognize and manage their underlying biases. She recalled a case years ago when a young Hispanic patient came to the hospital complaining of severe pain. A member of the medical staff commented, “I don’t think he’s really in pain.” The patient was eventually diagnosed with a gallbladder infection, Gonzalez said. But the doubts could have delayed her treatment and caused her life-threatening damage.

“Delaying medical care has important health effects down the road,” she commented.

What can you do to improve your child’s pain?

Experts point out that it should not be the responsibility of patients to improve the care they receive. In recent years, an effort has been made by researchers, hospitals and policymakers to help medical professionals become more aware of their biases – which everyone has – and change their behavior accordingly.

“But these things take time,” Wyatt said. In the meantime, there are strategies that can help parents in the hospital:

Log everything. Write down your child’s medications, symptoms, and pediatrician contact details. Pass this information on to doctors and nurses. This will help them to more quickly assess the type of assistance their child needs. This is especially helpful if your child has a chronic condition and takes medication regularly.

Meet the hospital professionals. Vanessa Finch, of Fort Lauderdale, Fla., whose son Kahleeb Beckett died at age 24 during a sickle cell crisis at the hospital, said that when Kahleeb was young, she found ways to reach out to hospital staff.

“I used to work as a volunteer. I became friends with the social workers. I was always talking to the doctors. All this makes a difference”, she commented. She found that when doctors and nurses felt a more personal connection with her son, who was black, they showed more empathy for his pain.

Try to alleviate your child’s anxiety. Studies reveal a close link between anxiety and pain, and a few simple tactics can help reduce anxiety and lessen the perception of pain. You can ask your child to imagine a favorite place, listen to a guided imagery exercise, or suggest things to distract their attention, such as music or a video. You can use these strategies while you wait for the service.

Take a deep breath. “We know that the distress parents feel over their child’s pain in the emergency department really impacts how their child experiences the pain and how they respond to treatment,” said Emily Law, author of a recent study on treating migraine in adolescents and professor of anesthesiology at the University of Washington.

So do what you can to stay calm, whether it’s taking deep breaths or leaving the exam room to call a friend for support.

If necessary, file a complaint. If you feel that your child has not been treated properly, ask to speak to a hospital social worker or write a complaint to hold the hospital accountable.

Translation by Clara Allain