Friday, July 22, 2011

Chronic pain in homeless people not managed well

Today's very promising applicant for the Dept. of the Blitheringly Obvious: "Chronic pain in homeless people not managed well":
My cynical side is just delighted that people got paid to write that down in black and white. Smacken zie forehead.

For a change, I'm going to ignore the disingenuous and smug language putting inappropriate blame on the patient, because there's so much basic information missing.

As anyone who has been homeless or worked with the homeless knows, indigence involves the following facts of life:

- Assuming you can even get to treatment sites ...
- Doctors won't take you.
- Hospitals don't want you.
- Clinics can rarely fit you in.
- Pharmacies hate to see you -- a gaping well of need -- coming through the door.

And that's just the medical side. In regular life,

- There's no decent surface to lie down on.
- There's rarely a good way to get clean.
- The concept of "good food" is irrelevant. You have to eat what you can get, regardless of whether it triggers a flare or messes with your brain, and are expected to be grateful.
- If you're a woman or a kid alone, you're going to wake up with some guy on top of you. This is very bad for back and hip pain, among other things.

Facts you should know:

- Being homeless is a perfect recipe for mental ill-health.
- Disabled people are over 10x more likely to be homeless than their equally-educated & -skilled cohorts.
- Chronic pain is part of most disabling conditions.
- Because of the economy, and despite the masses of money floating around in the stratosphere, disability and indigence are hitting historic highs.

Clinical take-aways:

- Take note of the link on the right to contact your political representatives. Let them know how you'd like the situation to change.
- ALWAYS ask indigents about pain: what, where, when, exacerbates, what they do about it, & most importantly, what they'd like to be able to do about it. Answers to the last will surprise you, because most of these people aren't stupid. (Just weird.)
- Provide freebies, including toothbrushes and emesis basins. What they can't use, they can barter with.
- When prescribing, be as generous with free samples as your drug reps' handoffs permit. Your insured patients only need enough to get started; your impoverished patients need to get so used to feeling better that they'll prioritize accordingly (beg, borrow & steal for their scrip instead of their booze? It happens.)

Keep in mind that a few days' relief is just a break, but a few weeks' relief lets them start to function for a change. Some will abuse your kindness, but big deal.

The rest will take the opportunity of having their burden lifted a little, to move forward in a way they couldn't do before. And thus a good deed goes onward, invisible to you but not to those ahead.

Make it a habit. Eventually, you'll see it come back to you. The feeling when it does is indescribable.

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