A Painful Judgment

For as long as I’ve been a nurse I have been frustrated with the attitude of many of my peers regarding patients with chronic pain. I have never understood why so many nurses feel it so crucial to pass judgment on patients who are in obvious pain. I think part of it is the social worker in me (I was a social worker before being a nurse) and some is just that I was brought up to believe that most people are not bad and are not out to get something from you. Whatever it is, somewhere along the way, many nurses pick up the attitude that if a patient comes in with the complaint of pain and they know exactly what pain medication in what dose works for them, then isn’t it obvious? They are drug seeking. And especially if that person is of a different background that you, well how much easier to pass judgment. I have tried to make the point to the many nurses that I have educated over the years that it is not our job to pass judgment. That we can only begin to imagine what it is like to live your life with pain. That when someone with chronic pain states what they need for pain it’s most likely because they’ve been dealing with it for years and know what works. And if, in all honesty, we believe someone is abusing medication then it is our job to still treat their pain, but also treat their addiction. Those who have heard me on my soapbox about it, are confident in how strongly I feel.

A couple of weeks ago I was asked to give a talk on anemia at a large Med/Surg nursing conference. At the end of each speaker’s presentation, the audience could write questions that we would then answer. I learned a lot about anemia for sure. Did you know there are over 400 kinds of anemia? But that’s another blog another day. One of the anemias that I did speak about was sickle cell. Even in sickle cell, there are various types of the disease and/or trait. I spoke about how when we see these patients it’s often because they are in a pain crisis. Their blood cells, instead of flowing easily through their circulatory system are misshapen and start to clump together. The clumping of these sickled cells cause a blockage which then causes the pain. And the pain can be severe. The other aspect of the disease is that it mainly affects African Americans. So the stigma of the use of narcotics for pain control coupled with the disease often occurring in a lower socioeconomic people brings on all sorts of prejudices and judgments.

But I was in a room full of professional nurses. Surely they want to know how best to treat their patients. So I thought, until I got the questions. As I read the one question, I could feel myself getting worked up. I had to remind myself that I was a professional and that I needed to act professionally. The question was “Do people with sickle cell take a class to learn that if they take Benadryl and Dilaudid together that they will get a buzz”? I was appalled. The only thing I could do was read the question out loud and remind them that we were all professional nurses with a duty to treat our patients with dignity and respect, to treat their discomfort and, if we felt it necessary, to treat their addictions.

It really bothered me for a while but then I realized it’s really about ignorance. When we don’t have the knowledge or choose not to get the knowledge then we cannot make intelligent decisions. So in my next blog, I will impart some knowledge about the difference between addiction, dependence. Armed with this knowledge, maybe we have a chance of being more understanding, tolerant and compassionate with our patients in pain. And maybe just one person will open their eyes to a more nonjudgmental way of viewing patients. We’ll see.