The following excerpts are from an article in this week’s Science section of the New York Times:
“White patients receive more pain treatment in emergency rooms than black patients and other minorities, a new report suggests.
“Researchers studied 4 years of data collected nationally at the Centers for Disease Control and Prevention. They used a sample of 6710 visits to 350 emergency rooms by patients 18 and older with acute abdominal pain.
“White and black patients reported severe pain with the same frequency. But after controlling for age, insurance status, income, degree of pain and other variables, the researchers found that compared with non-Hispanic whites, blacks and other minorities were 22 to 30 percent less likely to receive pain medication.
“Patients were also less likely to receive pain medication if they were over 75 or male, lacked private insurance or were treated at a hospital with numerous minority patients.”
The study is in the journal Medical Care. This is the way the senior author of the study explains his findings: “It may be that different people communicate differently with their providers. If we as providers could improve our ability to better communicate with patients so that we could provide more patient-centered care, we’d be taking several steps towards reducing and hopefully eliminating these disparities.”
That sounds to us as though the patient was at fault in communicating his distress.
Those of us who have had occasion to visit an emergency room in a hospital will remember that the first question Admissions asks is whether or not we are covered by insurance. Have we our insurance card with us?
Then, far too often, we wait, anywhere from ten minutes (or even just one) to hours to see a physician.
We have a great deal of sympathy for the director of this study, pushed out through the stage curtains to discuss this report with the press. No matter how he phrases his findings, his listeners know that what he’s doing is covering his behind, and those of the personalities in emergency rooms across the country.
Assuming what he says is true, and we do, it is only after an inquisition at Admissions that a man or woman is likely to be able to break through to real assistance and comfort. The “age, insurance status, and income” are not variable. What is, is how the staff in the emergency room chooses or inadvertently selects his or her vision of the patient before them.
Which is to say the only variable here is the attitude of the care-giver. Communication is not a problem. Racism is.
In this week of Chicago’s awakening, and after this summer of Black Lives Matter, we have clear evidence that, to many, they don’t. Not to mention the lives of people over 75, or even men.
What could possibly account for this?
We think the problem is systemic and not relegated to emergency rooms in hospitals. In fact, we believe that in any industry organized hierarchically, from the top down – like police departments in large cities – stepping outside the lines of authority or challenging the powers-that-be even accidentally may cause the loss of a family’s income, home, education, and welfare.
If there is Omerta on the streets of Chicago, there is the same thing within the confines of a hospital.
We think that statements like the ones in The Times are simply a gathering of the wagons. Actually, we’re calling it as we see it: defensive, dishonest, disingenuous.
Which means we’re seeing and hearing about a cover-up, paid for by the very people the institution or department professes to want to help.
“The Chain of Command.” From emergency rooms and police departments to the Army, Navy, Marines and Air Force. To the stock markets. To General Motors and Volkswagon. To the Senate and House, to their committees. To ad hoc reviews of Ferguson, San Bernadino, Savannah, Chicago, Aurora. To any and most industrial concerns: big oil, construction, infrastructure, tax experts, attorneys. If there is a big behind in trouble, we are likely to watch helplessly as the wagons ARE gathered and truth goes missing.
Racism in emergency rooms is a result of speed, among other things. Instantaneous decisions about the value of the human life before technicians on a gurney. And technicians are human. They have learned, they have been taught, they have understood one doesn’t crusade for fairness if income and speed are the determining factors. They want to keep their jobs. They’ll bury the shame and guilt, but their families will eat and be clothed. Regardless of how they themselves might feel, they are under the thumbs of the hierarchy. This is not individual racism so much as institutional. But the effects are the same.
In one way, systemic racism is the cement that keeps Berlin-like walls standing.
Our task is to hand tools up to the top of these chains of command to help the people there understand that enough is enough, that they will have our support if they do, in fact, make an effort to change. Otherwise, we’re stuck in the Fifties, and life can never improve for what are officially termed ”non-Hispanic whites, blacks, and other minorities.”
It’s time to stop dividing the population into classes and sub-categories of deserving and non-deserving types. The wagons should be drawn around them, not the hierarchies that disdain them.