Pain & Prejudice
By Lenore Skenazy
Originally published in the New York Daily News, OPINION, February 26, 2002
A few weeks ago I wrote about my friend Joan not taking the painkillers she was prescribed because she was afraid of getting addicted.
The more I discussed her case with pain management experts, the more it became apparent that Joan, as a black woman, was lucky to have had her pain addressed at all. A growing body of research is finding that all too often, women, children, the elderly and minorities are just not given enough painkillers.
If that sounds like almost everybody is stuck suffering, you're right. Everybody except middle-aged white males, who still tend to be the majority of doctors.
It's not that these men want their patients to suffer, explains Dr. Richard Payne, chief of pain and palliative care at Memorial Sloan-Kettering Cancer Center. It's just that, "as in the rest of society, people in health care look at each other through a lens of race and make assumptions."
Those assumptions probably not even conscious are things like black men are more likely to be junkies, so maybe that guy's faking his tears to get a fix. Other assumptions are that old people whine, kids don't feel much pain and especially that women are complainers.
"The stereotype is that women are 'hysterical,'" says Payne's colleague, William Breitbart, chief of psychiatry at Sloan-Kettering. "So if they say their pain is an 8 or 9 [on a scale of 1 to 10], the doctor assumes it's really a 4 or 5."
A physician reasoning this way will prescribe only enough painkiller to treat mild discomfort, not agony. Net result? Women are three times less likely than men to get adequate pain relief. And this same outrageous statistic holds true for minorities: In a study Payne did of cancer patients, minorities were two to three times more likely to be "undertreated" for pain than whites.
What prompted Payne to turn his attention to this inequity? In a truly inspiring instance of "Physician, heal thyself," Payne who is black first noted this discrepancy in his own treatment of Latinos.
"I started questioning my own assumptions," admits Payne. "We looked at Latino patients and found that they were being discharged from another hospital I worked at with higher pain scores than white or black patients."
Why? It was partly a case of language barriers, Payne realized. But it was also partly a case of what Payne calls those "stereotypic assumptions" again.
The problem boils down to one of empathy: The more a patient reminds the doctor of himself, the more the doctor believes him and wants to relieve his suffering. This bond makes the doctor more willing to prescribe the strongest of painkillers narcotics.
Unfortunately, it takes a real push for doctors to give narcotics these days, as "opioid" prescriptions are closely monitored by everyone from state medical boards to the federal Drug Enforcement Agency. Any doctor who appears to be dispensing too many narcotics raises a red flag with these agencies, which may suspect him of dealing drugs. No one wants to be investigated as a drug dealer, of course, so many doctors choose to prescribe as few narcotics as possible.
This happens even in cases where narcotics are clearly called for. One recent study showed that a quarter of the time, doctors actually prescribe less medicine than they know their patients need, just to keep their numbers down. The patients suffer so the doctors won't.
This is truth that hurts, literally. And it is particularly galling now that we are learning whose painkillers are being withheld: all those people that well-off doctors least identify with.
Until doctors take these studies to heart and start forcing themselves to feel for all their patients or at least prescribe as if they do too many people will suffer from the twin evils of pain and prejudice.
