EMS workers may be undermining the care of Black patients. In a most recent example of racism and unconscious bias in the health profession, a study found that a patient’s race may determine whether he receives pain medication in the ambulance and on the way to the hospital.
The study — which was led by Jamie Kennel, the head of emergency medical services programs at Oregon Health and Science University and the Oregon Institute of Technology — found that paramedics and emergency medical technicians are 40 percent less likely to provide pain medication to black patients than to white ones.
Although racism in the health care professions and the disparate quality of care provided to Black people and other people of color versus their white counterparts has been well documented, previous studies have not isolated the role of race in EMS treatment, as opposed to socioeconomic status, the report noted. The study, which examines EMS data from Oregon, investigated “EMS pain management treatment for racial minority patients including (1) pain assessment, (2) pain medication administration, and (3) opioid pain medication administration for traumatic or painful injuries” to “isolate race as a risk factor in the receipt of pain medication in EMS traumatic and painful injuries.”
While the report found EMS pain treatment disparities for African-Americans, there was no evidence of differences in treatment among Latinx patients. While this is just one study, the eye-opening findings are in line with a growing trend of studies on racial bias in the delivery of health services. These revelations on the racial disparities of treatment help explain — along with lifestyle, socioeconomic status and zip code — the disproportionately negative health outcomes for Black people, the higher rates for developing certain diseases, and the higher rates of death.
For example, according to a 2016 University of Virginia study, researchers came to the disturbing realization that doctors are more likely to prescribe pain medication to white patients than to Black patients because they believe Black people do not feel pain in the same way. A survey of white medical students, residents and laypeople found that significant percentages of each group believed false medical assertions about Black people, such as that Black people have thicker skin than whites, less sensitive nerve endings, or that Black blood coagulates more quickly that white people’s blood.
Research suggests doctors prescribe opioids for patients with chronic non-cancer pain on the basis of race, with physicians less likely to fill opioid prescriptions for Black Medicaid beneficiaries, particularly when the providers are in the areas of obstetrics and gynecology, internal medicine, and general practitioners/family medicine physicians. Black people also suffer from less effective treatment for drug addiction, and there is evidence that doctors will not prescribe painkillers to patients of color under the assumption they are drug abusers seeking drugs to meet their dependency rather than a medical need.
One study in the journal PLOS concluded that there were “significant racial-ethnic disparities” in the prescription of opioids in hospital emergency departments for “non-definitive” conditions such as abdominal or back pain — conditions that cannot be confirmed through medical diagnostics tools and are often associated with “drug-seeking patients” who want a fix. In contrast, there was no such disparities for patients with toothaches, kidney stones and long-bone fracture. The report suggests the disparities in prescriptions could widen the existing racial health gap, and perhaps could even explain why poor whites are disproportionately impacted by the opioid epidemic.
“Essentially, the systematic racism within the health care system has led to increased addiction and overdoses in low-income white areas, but also, (to) insufficient treatment among communities of color,” said Joseph Friedman, a medical student at UCLA’s David Geffen School of Medicine, and lead author of a study on racial bias in the opioid epidemic. Friedman argues this has resulted in a “double-sided epidemic” in which low-income white communities have widespread addiction, but neglected Black communities are not prescribed the medications they need to treat their pain.
Further, Black children are among those who receive the short end of the stick in terms of pain management. For example, Black and Latino children in the emergency room are less likely to receive painkillers for acute appendicitis than white children, which may be attributed to a racist notion among doctors that Black children are more easily addicted, have a higher tolerance for pain, or simply are not worthy.
Further, there are racial disparities in the wait time of Black patients to see a doctor. According to a JAMA internal medicine study, Black, Brown, unemployed and less educated people waited 25 percent longer to see a health care professional. When Black patients waited 99 minutes to see a doctor, whites waited only 80 minutes. In the same study, Latinos waited 105 minutes, and other nonwhite people waited 83 minutes to see a physician.
The evidence shows that racism is painful, and it can be unhealthy.