Thread by @AlmostDrSalomon

Jokes like these are especially damaging and hurtful to patients with chronic illnesses. Additionally, they "validate" provider bias and "normalize" providers' lack of compassion when caring for certain groups of people. There's a lot to unpack, so buckle up 🧵🧵. 1/x

1. Using "frequent flyer" as a term to describe patients is dehumanizing, provides very little clinical information and context besides the fact that you think this person comes to the ER/ hospital frequently, and has been shown to ⬆️⬆️ implicit bias of those who read the chart.

Using unproductive terms like "frequent flyer" provides no differentiating information. The person with a life-long #chronicillness, a child who frequently is hurt, an under-resourced adult, and someone with a substance use disorder all fall into the same bucket clinically.

The term "frequent flyer," most of the time, provides no clinical value and is more representative of a group of people medical professionals are tired of taking care of. "Frequent flyer" is a means to deny appropriate care to patients that are societally "undeserving."

2. This joke perpetuates ideas of what a sick patient should and shouldn't look like. This is damaging because if a patient is eating a sandwich and playing with their phone in the ER, all of a sudden they are not seen as needing care.

Ironically, the same person can come in kicking and screaming in pain but are told to be quiet as to not disrupt the rest the ER. This presents a dichotomy that patients living with life-long diseases requiring frequent ER visits will always be harmed by.

As a #medicalstudent living with #SickleCell, I have been told that I can't possibly be in pain because I had a Chipotle bag and I was "playing" with my phone. Ironically, I hadn't eaten the burrito and I was actually doing my Anki flashcards. In any case, WHY DOES THAT MATTER?

People with chronic conditions learn to survive in a world that doesn't stop for them. Criminalizing them for being able to "appear normal" in a world that is inaccessible and benefits the able-bodied is adding insult to injury.

3. This joke perpetuates the idea that anyone who asks for a narcotic is somehow "up to no good." I was taught to be very informed about the medications I need to improve pain during my #sicklecellpaincrisis. I will ask for morphine and dilaudid because that's what works.

#medicaleducation does a horrible job of teaching medical students how to have nuanced conversations around opioid use. We were taught to simply deny it without any investigative line of questioning and discussion. This ignorance and lack of competence shows itself in real life.

4. This joke promotes using personal judgment for dx of SUSPECTED substance use issues. Last time I checked, eating a sandwich, sleeping, and asking for dilaudid are not criteria for a DSM5 diagnosis. Get a work up. Ask clinically relevant questions. Stop relying on opinions.

5. Lastly, this joke makes it permissible to laugh and mock patients with SUSPECTED substance use issues. Instead of making jokes about this patient, maybe we should be working towards doing better by them.

As a med student and a patient living witha chronic dz, jokes like these hurt a lot and make me feel embarrassed to be a part of the field we call "medicine." I hope you see where I'm coming from.

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