Inmates cannot go out to find good doctors in the community. Good doctors have to choose to go to them!

I remember the first time someone told me that I was “wasting my talents” by working in a jail. At that time, I had no ready witty rebuttal. I love my job and I especially appreciate working with a patient population that is disadvantaged and underserved. Of course, the idea that incarcerated inmates are worthy recipients of medical care is, well–controversial. Inmates are not as politically correct as other medically disadvantaged populations.

As an example, if you were to tell your family and friends that you were going to work with at a medical clinic for the homeless in an inner city, or to provide medical care in a needy third world country, the reaction probably would be something along the lines of “Good for you! I admire your selflessness and dedication!” Yet when you tell these same people instead that you are going to work in a prison, you are much more likely to get this reaction: “What’re ya, nuts? Why would you waste your talents working with them?” I personally have heard the “you’re wasting your talents” line more than once.

“Wasting your talents” is a double insult. It assumes that inmates do not deserve medical care. It also assumes that if you are going to work in a jail or prison, there is something wrong with you.

I’ve tried to think about why otherwise good and kind people often have this reaction to the notion of providing medical care to inmates. Upon reflection, I believe that this is an emotional response based on the following assumptions:

1. Inmates are incarcerated as a punishment.
2. So they don’t deserve good medical care.
3. Therefore, jail and prison medical providers, like you, must be there specifically to not provide good medical care. What kind of doctor does that?
4. Also, everyone I see portrayed on TV and in the movies who works in a prison is a loutish brute. Maybe you are a loutish brute, too.
And, finally:
5. I’m basically fearful of the whole idea of inmates and prisons. I don’t want to think about it.

In the end, if you go to work in a jail prison, your reputation may suffer. Colleagues, especially, may look at you askance. You may become stigmatized.

But it should not be that way! All of these assumptions are incorrect.

Let’s look at the incarcerated population more objectively, using terms that could be assigned to other medically disadvantaged groups that are considered worthy, like those in a third world country or the homeless in an inner city:

Disadvantaged.” Of course inmates are disadvantaged. That’s what going to prison is all about, losing normal societal privileges. However, one right that inmates do not lose when they go to jail or prison is the right to necessary medical care.

Underserved.” Yes, inmates, as a group, are underserved. Doctors are not lining up to go work in prisons! It is not atypical for correctional medical positions to go unfilled for a long time. In fact, that is how I myself initially got involved in corrections. My county commissioners could not find any local medical doctor to staff the local jail for months!  Thank goodness they finally asked me.

Disenfranchised.” Inmates are beyond disenfranchised. They have been formally banished from society. In fact, one reason for the negative reaction to the announcement that “I’m going to work in a prison” is that by doing so, we are breaking the unwritten social rule that “We’ve agreed not to associate with those people.” Those people, of course, are incarcerated inmates. That’s what people mean when they say: “you’re wasting your talents.”

People think this about inmates and mean it. But if, instead of inmates, “those people” you are referring to are some other broad social group—like women, or immigrants or Muslims, the statement is instantly recognizable as blind prejudice. Inmates seem to be the only social group where prejudice and contempt are socially acceptable.

In the end, inmates are indeed socially disadvantaged. Inmates cannot go out to find good doctors in the community. Good doctors have to choose to go to them. Inmates have that in common with many people in the third world, where a medical mission may be the only medical care available, such as this one run by my friend Dr. Patricia Ruze.

So, if you want to do work that is socially meaningful, working with patients who are socially marginalized and lack ordinary access to medical care, you could volunteer to work at Dr. Ruze’s clinic in the Dominican Republic. You could work in a similar medical clinic in an inner city. Or you could instead go to work in a jail or prison!

I myself started out in the traditional world of US medicine, as an ER doctor for over 20 years, before I discovered corrections. And I did not dislike my work as an ER doctor. I certainly was not dissatisfied. But I have enjoyed my career in correctional medicine more—and I feel like I have done more overall good. The reason for that is that in the jail, I began to see many people who had not had access to medical care on the outside. Maybe they were homeless. Or poor and without insurance. For these people, jail was the first place where they had consistent and easy access to a doctor, a dentist and a mental health professional. I have to say that this kind of medicine can be pretty gratifying.

We correctional professionals need to embrace the fact that we work with a disadvantaged and marginalized population. When a fellow physician says “You work in a jail?” with one eyebrow raised, we need to say back “Of course I work in a jail! That’s where the sick and needy people are! Why aren’t you working in a jail?”

As always, what I have written here is my own opinion. I could be wrong! But if you disagree, please say why in comments . . .

How do you feel about working in corrections? Please comment?

7 thoughts on “Inmates cannot go out to find good doctors in the community. Good doctors have to choose to go to them!

  1. grid

    That inmates cannot go outside to choose their own doctor is still not as bad as the fact that, once imprisoned, they tend to be abandoned by their formal healthcare practitioners (if they ever had one). Unfortunately, even longtime doctor-patient relationships (worth years of mutual confidence and trust) come apart quite swiftly after the patient ends up behind bars… Apparently, such disassociation has very much to do with the fear of doctors of having their reputation tainted if anyone hears what kind of patients were they treating.

    I would imagine that the same kind of reaction would develop if, let’s say (by a stretch of imagination), a prestigious medical clinic opened its doors to homeless people, by offering them free consultations and treatments). My guess is that even their most devout patients would quickly find ways to say their good old doctors good-bye.

    There is no wonder, then, that when a fellow physician displays a bit of mistrust towards correctional healthcare settings, what’s really at stake is not necessarily a fear of professional standards going bad (since they do not even know what those standards are in corrections), but rather a basic fear of becoming associated with a world of bad fame, likely to contaminate the strongest of reputations.

    Luckily, however, practitioners outside also have a funny way of overcoming such superstitions: some of them quickly fall in love with the conundrums posed by the pathology occurring in a correctional facility, when they are asked an expert opinion (and this is also when they come to appreciate the work of doctors inside).

    What’s even funnier is that, more often than not, every time an outside doctor has a dismissive attitude towards a patient referred to him from a correctional facility his reputation will indeed be put in dire straits, because the outcome will be unfavorable. Indeed, it is almost a mystery how the success of treating correctional cases comes from a having a mindset free of bias, and a clinical reasoning well-attuned to the reality of the patient, rather than to just his data.

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  2. Anne Fuqua

    Thanks you for serving this most vulnerable population. You’re right. Inmates depend on good doctors and nurses CHOOSING to come to them. Add to that not everyone in jail or prison is guilty .there are innocent people behind bars.

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  3. Lisa Hirsch

    I have always enjoyed both public health and working in the ED…working in Corrections is a blend of both and I’m so happy I stumbled upon this area of nursing. Not a day goes by when I don’t learn something new. I believe there is a huge misperception about Correctional Nursing and I often hear “why would you work there, only nurses that can’t find a job somewhere else work there”. As a supervisor at a County Jail, I can tell you that in order to be a successful Correctional Health RN, you MUST have strong assessment skills, sharp critical thinking skills and the ability to triage and prioritize like no other area of nursing. It’s a pretty selfless area of nursing as you don’t get many “thank you’s” and rarely do I hear a “please” but the satisfaction of watching a patient’s A1C go from 10.3 to 6.0 or watching a chronic deep wound heal is astounding and very rewarding. It’s also challenging and at times rewarding to be astute enough to be able to recognize a feigned seizure and to differentiate the behavior as drug-seeking or a plea for help to be removed from a certain pod. I have been a nurse for over 25 years and without hesitating I can say that this is the hardest area of nursing I have ever worked in yet I wouldn’t trade it for the world. We are striving to change the perception of Correctional Nursing by offering tours to health professionals so they could get a glimpse of the high level of care and professionalism that we have adopted. These inmates are individuals that deserve good quality medical care. So now when I am asked why I work at a jail I simply say “Because I’m a really good nurse and want to help people and learn new things every day!” If I were in a car accident and needed medical attention, I could only hope that if a nurse or doctor stopped to help, that it would be nurse or doctor that worked in a jail!!!

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  4. Cheralee

    As a nurse in a small town jail, I am often asked by the public where I work. When they hear that my employment is at the jail, they often walk away. The paramedics and ER staff have made comments that we work at the jail because we cannot “hack” it working somewhere else. I feel very different as working in the Jail is a constant challenge. Mundane tasks are not very common and we never know what will happen next. They do not see what goes on in our facility. General population only see the outside walls not wanting to know what really happens in jail.

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  5. T

    A lot of the inmates at the facility I work at are homeless or come from bad areas that often have street vans providing food, medical needs, laundry etc. Why is it a good deed to care for the homeless/lower socioeconomic demographic outside of prison, but not a good deed when we provide health care to those very same people when the are incarcerated? They are still the same person whether inside those walls or outside of them.
    The facility I work at is maximum security remand. Meaning they are awaiting trials or sentencing. It’s so difficult for people to understand “hey, these prisoners could be you if you are ever picked up by police for public nuance, unpaid fines etc. Or you could be in there accused of murder when in reality you were sitting on your couch and didn’t even know of the event that happened 3 hours away”. Anyone could end up in their situation, innocent or guilty. It’s actually a terrifying thought that mistaken identity could lead to being incarcerated before an investigation is even really getting started.

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  6. Maureen

    I love my job as an LPN in a correctional facility in British Columbia. We have a wonderful opportunity to make a difference in a human life. It might anything from patient teaching in nutrician to wound care to counseling for drug and alcohol abuse. I love my job everyday.

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