"Medical discrimination, dangerous prescribing"

I presented to the Emergency Department at Rockingham General Hospital last week around mid-afternoon due to severe (6/10) left-sided chest pain radiating to my back, up my neck, and down my left arm, restricting my breathing; and intermittent heart palpitations. I have a chronic illness that causes chronic musculo-skeletal pain and vascular problems. The pain began when I got out of bed that morning so I tried all my available pain management techniques; paracetamol, heat, cold, TENS machine, massage, stretching, and even ibuprofen (despite my NSAID intolerance) to no avail. I mention this as it will become relevant later.

After a wait in the emergency room (punctuated by nurses taking my blood pressure and O2 saturation), I was taken in for a heart trace (which was clear), another wait, then an X-ray (also clear), another wait, then I was taken into the observation unit (unsure of the proper name). I was hooked up to a heart monitor, BP cuff, O2 sat, some bloods were taken (results normal), and a urine sample collected (normal as can be). Despite all the normal test results, the pain persisted. It was almost 4 hours later before I was given any pain relief at all (1g paracetamol).

Shortly after taking that dose, the doctor - whose name escapes me but I recall wearing a light blue clay name badge with rainbow on it - entered and told me that I would be discharged shortly. As they were removing my IV catheter, I asked about pain relief again as the paracetamol had made absolutely no improvement. I was told to go home and exercise, try to find a low-cost physio in the area, and that I was too young for anything stronger, and I recall they said that, anything else they give me will make me sleepy so I won’t exercise. A point that I felt doesn’t matter given it was late at night and I was not about to exercise in the next few hours. I pushed back against this – I am in my 20s with 6/10 pain that was restricting my breathing. I informed the doctor that the TGA product information for all opioid analgesics clearly states that everyone is entitled to adequate pain relief irrespective of individual factors (eg; addiction, medical history, age, disability status, etc.). They walked out.

A few minutes later they returned to ask for the code to get into my MyHealthRecord account to check my prescribing history – I told them what I had thought the code was, but it didn’t work for whatever reason. The doctor eventually decided to give me 50mg of Tramadol and said again that I was too young for oxycodone. Fine, it’s better than nothing I thought.

My complaint is that this doctor's actions and clinical decisions were, I felt, not at all backed up by evidence. I believe there is no recorded age limit for the short-term use of IR opioid analgesics – in fact the ANZCA guidelines for acute pain management describes opioids as, I quote, “the mainstay of systemic analgesia for the treatment of moderate to severe acute pain.” (p.69). Despite the doctor's apparent concern for my safety, the dosage of paracetamol they prescribed (1g – the standard adult dose) is, I feel, not appropriate for me due to my body weight. I believe a safe dose for someone my size should be around 665mg. In addition to the overdose of paracetamol, oxycodone actually would’ve been both safer in my opinion, and more effective for me than tramadol. The reasoning is as follows; I am not opioid naïve, I have a chronic pain condition that is partially treated with a low-dose opioid antagonist which would interact to reduce side-effects, and my regular medications are highly serotonergic – meaning Tramadol has a high likelihood of causing serotonin syndrome.

The fact that this doctor decided to deny me safe, clinically appropriate pain relief based on my age is, I feel, highly discriminatory. Even worse is the fact that it seemed they actively chose to instead prescribe a medication with a much higher risk of life-threatening side effects. I doubt that next time something like this happens I would willingly return to Rockingham General based on this experience – I feel I’d rather risk a heart attack than spend 5 hours in a hospital only to be sent home with Panadol and advice to do some push ups. Thanks, but I can do that at home.