Today’s Post was written by Rebecca Lubelzyk MD. Rebecca works in the Massachusetts prison system. She is a past president of the American College of Correctional Physicians and the editor of CorrDocs, the official publication of ACCP. This article was originally published in CorrDocs.
I’m on a medical school listserve that publishes writings and academic accomplishments of faculty and students. One week, a mindfulness moment was added to address the stress that physicians feel. The well-intentioned addition brought forth a fairly online virulent discussion about the non-medicine stress that disgruntled physicians feel every day, and how a “mindful moment” will do little to change the extreme performance demands generally imposed upon our profession.
I followed the discussion peripherally but with interest. It was clear all the contributors were dedicated professionals who loved their patients and providing care to them and their families. However, the bitterness towards the insurance/compensation/financial system was prevalent.
How bad it was “out there” became even more apparent when I had a prospective physician shadow me in clinic for a day. I explained how there can be several benefits to correctional medicine (your “no show” rates are essentially nil, patients have their blood pressures and blood sugars checked by a nurse, diets, commissary purchases can be reviewed in detail, etc.) I expressly noted the unique challenges, including the requests for non-medical items or privileges as well as the negative attitudes one encounters when the patient doesn’t want to hear the word “no”.
The physician candidate surprised me, stating that it was the same on the outside. “Once, I had a patient call me to request that I write a prescription for dog food for her therapy dog since she couldn’t afford it. I told her that in another month, we’ll have people here in this clinic who can’t afford food for themselves, let alone a therapy dog, and I couldn’t help her.” “Well, I bet she didn’t give you an attitude and she understood”, I replied. “Oh, no. She got very angry and couldn’t understand why I wouldn’t do it for her.”
“Well, I can promise you that you’ll never get asked to write a prescription for dog food at this job. We do have a ‘dog program’ here, but the correctional staff ensure they have enough food. In fact, even our patients have food and shelter and don’t go hungry in the cold months. You don’t have to find food for them again.”
In fact, our patients’ incarcerated state simplifies much of the care we deliver to them so that we can significantly concentrate on their medical needs and less on logistics and basic needs that often are not within reach of the non-incarcerated population. When this visiting physician tells her patient that they have to stop lifting heavy objects over their head or else their shoulder/neck/back pain won’t improve, there is little they can do since they need to perform those activities to feed their families.
Most of my patients aren’t sending their $5/week earning home to feed their families so they can usually afford light duty work if it means saving a joint from surgery. And hold off from weightlifting if they had to. I do a lot of education on how to improve themselves physically and what they should and shouldn’t do so they don’t injure/re-injure themselves.
But don’t look at me for when they get out where they are going to find food, shelter or work. We have programs set up to help them with that, but I still worry as the weather turns cold, if they’ll be okay.
Them and their dog.