If you're in pain and have to go to the emergency room, it's good to be a white man.
A new study finds that women who go to the emergency room for pain treatment are less likely to receive needed pain medications, regardless of their age, ethnicity, or even the sex of the medical professional; relief than men. And nurses are less likely to record how much pain a woman is in.
Perhaps, you might think, women are less likely to show the pain they feel, but the researchers, who looked at patient records in the US and Israel, took care of that. They conducted a parallel experiment in which they told nurses anecdotes about patients' pain, and even then the nurses rated the women's pain as less severe than the men's.
Although the study published in the Proceedings of the National Academy of Sciences is new, the problem is not. A 2022 study published in the Journal of the American Heart Assn. found that women with pain waited in the emergency room almost 30% longer to be seen by a doctor. There are more studies with similar findings.
This is more than forcing some patients to suffer. It may mean missing or delaying the diagnosis of serious problems such as a heart attack. According to the author of the PNAS study, Professor Shoham Choshen-Hillel of the Hebrew University of Jerusalem: “This undertreatment of patients' pain could have serious implications for women's health outcomes, which could lead to poor recovery times.” longer durations, complications or chronic pain. conditions.”
And it's just one aspect of the wildly unequal treatment in emergency rooms.
Latino patients who go to the emergency room with chest pain wait nearly 40% longer (99 minutes instead of 71 minutes) than people from other racial or ethnic groups. Among those admitted as inpatients from the emergency room, Latino patients wait almost twice as long. Minutes can mean the difference between life and death if it is a heart attack.
Black patients with chest pain wait longer than white patients and are less likely than any other group to receive opioids for back pain and migraines. One study found that when Asian patients have to wait, it is longer than white patients. As with women, black and Latino patients were less likely to have their pain assessed.
It is difficult for patients to act as their own advocates even if they see others who came after them being seen first. They don't know who has the most severe symptoms and are careful not to disturb the medical staff. Unless a partner is there with them, their illness or pain may prevent them from speaking for themselves.
Researchers have been making recommendations for years. Hospitals need more protocols for a wider range of symptoms, so that, for example, each patient's pain complaint is assessed, which usually means rating the pain on a scale of 1 to 10. Posters in the room Emergency services must inform patients that their pain must be evaluated and they have the right to demand it. Wait times should arise from objective measurements of that pain, as well as other symptoms. Emergency room staff need training to become aware of these disparities. Audits every few years would expose any unequal treatment of patients.
None of this is particularly complicated, and yet the problem persists. A new law signed by Governor Gavin Newsom in September aims to end racial disparities in California emergency rooms and doctors' offices by requiring health facilities to develop patient safety plans and analyze complaints to see if they show patterns by race, ethnicity, and gender.
That's not enough. Patients who receive poor treatment in emergency rooms cannot wait to have their complaints addressed over long periods of time, and what about patients who are too sick to complain?
The state should require clearly posted information for emergency patients so they know their evaluation and treatment rights, and training of medical professionals to recognize racial and gender biases. There should be a set of standardized protocols for the types of medical complaints that are most likely to result in waits and unequal treatment, and independent audits to give hospitals clear information about whether they are on target.
Studying the problem repeatedly will not solve it. Only decisive new rules will achieve this.
