As someone who suffers from kidney stones, I’m always on the lookout for news about them and how I might better avoid another round of the excruciating pain that come with them. I recently noted several reports recounting a recent study in JAMA on how kidney stone pain is treated in emergency rooms by RACE.
You probably won’t be entirely surprised to find out that White people presenting with kidney stone pain symptoms are more likely than Black people to receive strong narcotics to deal with the pain, at about a 3:2 ratio.
The authors aren’t entirely sure what is the cause of this discrepancy, but I think I do. From my own personal experience, I know that, without some serious tests, it is not clear to doctors that abdominal pain is caused by kidney stones. The first time I had them, it took weeks and a whole battery of tests for them to actually find them. This is because there is a lot of variety among kidney stones and they have ways of hiding from different kinds of tests.
So, the doctor is faced with treating the claimed pain without being able to make a clear diagnosis. Faced with this kind of uncertainty in a social situation, people really on heuristics–short-cuts that help them make probabilistic judgments without direct information. And, anyone who has been around sociology for a few minutes know that race is a very commonly use heuristic for assessing, to one degree or another, just about any kind of character trait. And when it comes to drug use, the schemas our media have helped us create have associated Black folks much more with drug use, illegal drugs, and narcotics.
In my case, the last time I was in, the doctors were pretty reluctant to give me the morphine until they finally got my records and found I had a history of kidney stones. Up until then, it was pretty clear to me that they suspected I might have been trying to scam a fix of morphine.* Add race to that scene and all the baggage we attach to it, and you’ve got a powerful social situation which is going to skew the delivery of treatment away from Black people.
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* Experience speaks: Screaming “Give me the morphine, dammit!” is not going to help your case.
4 Comments
Very interesting post.
For an early sociological analysis:
Roth, Julius. 1972. Some Contingencies of the Moral Evaluation and Control of Clientele: The Case of
the Hospital Emergency Service. American Journal of Sociology 77(5): 839-856.
For a (new) doctor’s perspective:
http://hemodynamics.blogspot.com/2007/11/differential-pain-vs-fos-vs-pain-fos.html
RE: the footnote. Experience not from a kidney stone, but from giving birth and not morphine, but dilaudid. Here s the advice: no matter how much you want to, don’t ask for a doggy bag. they cut you off.
If getting morphine depends on having your kidney stones already on file, maybe whites are more likely to get morphine because they are more likely to have the documentation in a hospital dossier.
I HAVE FRIEND WHO IS WHITE.He has cancer.He has recieved so much medication,(methadone and morphine) from the doctors,as an outpatient,that he has overdosed twice.He was commatosed on both occasions.He’s a former herion addict.THere’s no way for a fact,that he would have gotten meds so easy if he wasn’t white.The overdoses have excellerated the dying proccess.