Social Stigma and the Dilemmas of Providing Care to Substance Users in a Safety-Net Emergency Department

Abstract

There has been increasing interest in how social stigma affects health care delivery to vulnerable patients but few examples of the dilemmas that may arise for providers who care for stigma-vulnerable populations. Using qualitative data, the authors examine care delivery in a safety-net emergency department where many patients were socially disadvantaged and vulnerable to stigma because of substance use problems. Analysis of our data revealed five themes related to the dilemmas of providing care for this patient population: 1) providers valued assisting vulnerable and underserved patients; 2) providers' interactions with patients could be challenging; 3) providers did not know if substance involved patients provided accurate medical histories; 4) providers were concerned about drug-seeking behavior; and 5) providers had to balance substance-involved patients' needs with the necessity of managing limited resources. We discuss how these themes relate to care dynamics and social stigma in the safety-net setting.

“Rewarding and Challenging at the Same Time”: Emergency Medicine Residents' Experiences Caring for Patients Who Are Homeless

“…12 At the same time, providers in prior studies as well as the current study expressed satisfaction and pride in caring for such vulnerable populations. 11,12 Provider frustration is linked with quality of care 40 and may contribute to the high levels of burnout observed among EPs. 41 EM residents, and ED providers more generally, would likely benefit from formal and constructive outlets for their emotions around caring for patients who are homeless, in addition to new tools to enhance their ability to care for them.…”

“…6,10 Patients who are homeless present unique challenges in ED diagnosis, management, and disposition. [11][12][13][14] Despite the frequency with which patients who are homeless are encountered in the ED, little prior research has examined the ED care they receive.…”

“…Much of the emotional burden appeared related to the subpopulation of patients who were chronically homeless and frequented the ED for alcohol intoxication. Prior qualitative research with ED nurses 13 and other providers 11,12 has similarly highlighted provider frustration in caring for frequent ED users, 13 indigent patients, 11 and patients with substance abuse problems. 12 At the same time, providers in prior studies as well as the current study expressed satisfaction and pride in caring for such vulnerable populations.…”

“…Prior qualitative research with ED nurses 13 and other providers 11,12 has similarly highlighted provider frustration in caring for frequent ED users, 13 indigent patients, 11 and patients with substance abuse problems. 12 At the same time, providers in prior studies as well as the current study expressed satisfaction and pride in caring for such vulnerable populations. 11,12 Provider frustration is linked with quality of care 40 and may contribute to the high levels of burnout observed among EPs.…”

Stigma, Ethik und das Recht auf Opioidsubstitution

“…Macht es Sinn, S ü chtigen die gleiche Behandlung zukommen zu lassen wie Nicht-S ü chtigen [6] ? Generell werden die negativen Haltungen gegen ü ber Drogenkonsum auch vom Gesundheitspersonal auf die Abh ä ngigen projiziert, was zu schlechter und unbefriedigender Behandlung f ü hrt, und die Drogenkonsumenten werden an die Spezialistenteams abgeschoben [7] .…”