Can casual use of medical evidence cause harm and erode bioethical values?
Ms. M. is a 19-year-old African-American female, presenting to the emergency department (ED) with bilateral leg and back pain that has been present for 3 months but has worsened over the past week. She is not able to sleep and has recently had recurrence of suicidal ideation. Ms. M. is withdrawn with a flat affect, and she has the hood of her sweatshirt pulled over her eyes. She is wearing headphones and is singing along to the music. Ms. M. states that attempts to manage her pain at home with ibuprofen and alcohol have been unsuccessful. She smells of alcohol and of urine, and her wet clothes appear to indicate she has been incontinent of urine. She describes her pain as a 9 on a 10-point scale. The PA providing the triage evaluation sends Ms. M. to the waiting room, where she sits for several hours before being seen by another PA, who elicits a medical history of depression, suicidal ideation, and psychiatric care. Ms. M. also requests a prescription for Vicodin. Unemployed, she live
