A Patient and her Pain: the role of bias in the management of Sickle Cell Disease
Date
Language
Embargo Lift Date
Department
Committee Members
Degree
Degree Year
Department
Grantor
Journal Title
Journal ISSN
Volume Title
Found At
Abstract
Background:
Sickle cell disease impacts approximately 100,000 Americans, with chronic pain being the most common reason to seek medical care. Pain management for patients with SCD is directly impacted by the implicit biases of healthcare workers toward chronic pain and addiction. Cooke et al. (2023) found that the current CDC guidelines for increasing opioid safety and decreasing bias have led Black patients to feel they were disproportionally discriminated against compared to other groups. Perceived discrimination within the healthcare setting perpetuates medical mistrust and contributes to health disparities observed in this population.
Case Description:
The patient is a 32-year-old African American female with chronic use of opioids for SCD. During a hospitalization for a pain crisis, the care team had difficulty controlling her pain. She told a social worker that the nursing staff was not timely in delivering her pain medication. As a result, the patient became more withdrawn.
Clinical Significance:
This patient’s healthcare experience differed by setting. She felt comfortable with her primary care provider but felt discriminated against during her inpatient stay. The patient’s pain required high doses of opioids for adequate management and depleted her emotional resources. She expressed dissatisfaction multiple times during the hospitalization because she felt she was not provided adequate pain control. While hospital staff may have identified this patient as drug-seeking, she suffered significant pain and perceived discrimination. This disconnect led to insufficient care, which could deteriorate into an even poorer patient-provider relationship.
Conclusion:
Unfortunately, stories like this are not uncommon among SCD patients. Enabling non-hematology hospital staff to better distinguish drug-seeking behavior from true pain through formal education about the SCD population can reduce discrimination and prioritize patient health and wellness.
