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December 9, 2009

Treatment of Sickle Cell Pain: Fostering Trust and Justice

Author Affiliations

Author Affiliations: University of Connecticut School of Medicine, Pain Relief Program, Connecticut Children's Medical Center, Hartford.

JAMA. 2009;302(22):2479-2480. doi:10.1001/jama.2009.1811

The following scenario serves as an example of an emerging literature on injustice in health care.1,2 A 19-year-old man with sickle cell disease presents to the emergency department with progressive leg and back pain. His hooded sweatshirt is pulled over his eyes, he is wearing headphones, and is singing along to an unheard tune. His attempts to manage his pain at home have been unsuccessful and he tells the nurse that his pain is a 9 on a 10-point scale. The nurse responds with apparent disbelief and says “Really?” then sends the patient to the waiting room where he sits for several hours before seeing a physician. The patient's request for a specific dose of morphine is met with doubt and disdain.