Social Exclusion in Emergency Care

Social exclusion of people experiencing homelessness can occur in hospital emergency rooms and delay access to health care.

Many hospital emergency rooms in the United States will render care to a person regardless of their ability to pay or level of insurance coverage. Although the type of care may vary, the one constant I have experienced is an emergency room’s “triage process.” The process involves an intake nurse, a financial status representative, and a preparatory registered nurse. Generally, a nurse takes your vital signs before a doctor sees you, and this process can be efficient and courteous. However, for someone experiencing homelessness, it can be more like an interrogation.

During this triage process, one can get the feeling of being corralled into the stereotypical mindset of medical personnel, who might think such an individual is just after drugs, a way out of the cold, or someone to talk to. From the insurance liaison to the prep-nurse to the doctor, staff may ask dismissive questions seemingly formatted to confirm their suspicions of a troubled person dependent on drugs.

Permit me now, dear reader, to share with you a personal medical problem I had. This is a graphic illustration of the pitfalls people experiencing homelessness might endure at the emergency room.

Struggles of Social Exclusion

In early 2011, I began experiencing a very painful condition in my right leg. Needing medical care, I went to a nearby hospital emergency room for a diagnosis of what was wrong with me, a solution for the problem, and pain medication.

I was told it was my sciatic nerve that was acting up and that it would eventually get better. I was given a prescription for a limited supply of narcotic pain medication and sent on my way.

It didn’t get better, so I started to visit other hospital emergency rooms, trying to get a reasonable explanation as to why my condition persisted. I was given various diagnostic solutions spanning from “give it some rest,” to “try some rehabilitative exercises”. The very existence of a person experiencing homelessness is a rehabilitative exercise. And, after more very sincere talking, the doctor would reluctantly prescribe more pain medication.

After visiting too many emergency rooms, one of the hospitals decided they would give me an X-ray of my spine. It showed nothing wrong—exponentially arousing the medical staffs’ suspicions of me just wanting drugs.

My future visits became a bewildering process of not knowing what was wrong with my sciatic nerve, if there would ever be a long-term solution, but still needing strong narcotic pain medications. I found myself having to travel to other cities, to other emergency rooms because of the aggravating dismissive attitudes of the physicians I had been in contact with.

After a couple more months of enduring this blackened future of continuous six- to seven-pain level without medication, I experienced a happening close to a miracle when I encountered an intelligent, compassionate doctor who realized that I should be given a magnetic resonance imaging (MRI) test, a much more precise and discernible diagnostic test than an X-ray.

The MRI graphically displayed a synovial cyst at the bottom of my spine pressing on my sciatic nerve: the cause of my incessant and unremitting pain in my right leg.

This exceptional doctor then referred me to a spinal institute where a neurosurgeon agreed to remove the cyst; the procedure was done shortly thereafter. After the surgery my pain was completely gone.

Fighting for Social Inclusion

So, my dear reader, after months of exhaustive, humiliating, painful treks to various hospital emergency rooms, the frustrations of trying to break through the stereotypical attitudes of the medical personnel to convince them there was something seriously wrong with me, the nightmare was over.

However, it is profoundly significant that I add that, although my physical pain was gone, I was indelibly left with the memory of how, as a homeless man, I was treated by many professionals in the medical field.

Finally, I want to accentuate how the lack of a concerned, intelligent medical diagnosis over many months of hospital visits forced me to bounce around from one to the next, seeking temporary narcotic pain medication. The ultimate irony to this fractured scenario is that even though the cause of my pain was finally accurately diagnosed and corrected, with all of the narcotic pain medications I had taken, I had become—despite the successful surgery—the stereotype of a person experiencing homelessness who visits emergency rooms … a “drug addict.”

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Roger Wade
Last Updated: 04/19/2016