Protocolizing Uncertainty: Pain Management in Sickle Cell Disease Restricted; Files & ToC

Zimmer, Anna (Spring 2022)

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Sickle cell disease (SCD) is a group of heritable blood disorders that are characterized by abnormally-shaped red blood cells that lead to acute, excruciating pain. There is a high frequency of SCD in sub-Saharan Africa, so, due to the transatlantic trade of enslaved persons, people suffering from SCD in the United States tend to be Black. The combination of pain, race, and SCD places people with SCD in challenging positions when seeking healthcare in the United States, in large part due to the long history of racism in medicine. In the hospital setting, physicians use a combination of history, observation, examination, and laboratory values to estimate the pain for patients with SCD.  These subjective data leave space for judgment and bias. Some have proposed that protocolizing pain management could help mitigate the discrimination faced by patients with SCD (Power-Hays and McGann 2020). Through interviews with patients and hospitalists, this pilot project aims to elucidate the role, if any, pain protocols could play in diminishing discrimination in pain management for patients with SCD. I ultimately argue that while protocols have a role in helping to ensure the standard of care for patients with SCD, they do little to address the issues of trust and belief among physicians and patients.

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