This article was first published here on MedPage Today. How safe is correctional medicine? People naturally assume that working in a jail or prison is dangerous. "Aren't you nervous about working there?" they ask me. What people have seen of jails on TV looks pretty rough! After all, that's where they put the violent criminals, right? The problem is, it just isn't so! Jails and prisons are not dangerous places to work; to assume so is just one of many misconceptions people have about correctional facilities. In fact, my jail medical clinics have been a much safer work environment than where I worked before.Posted in: Jail cultureMed Page TodayRestraint Read more... 0 comments
Today's post is the first in a series of sample clinical guidelines. These will be placed under the "Guidelines" tab (above) as they are published. These guidelines are open access; you may use them in whole or in part as you see fit. I view these sample guidelines as a group effort! If you have a suggestion, critique or simply a better way to phrase some concept, say so in comments. This particular clinical policy addresses a common problem in jails (less so in prisons). I addressed the issue of allowing personal shoes in jail previously in "A Quick-and-Easy Solution to those Pesky 'Own Shoes' Requests," (found here). As a result of that post, I have had many email requests for a sample "Own Shoes" guideline.Posted in: Comfort itemsGuidelineUncategorizedTagged in: Read more... 3 comments
Medical Approval of Personal Footwear in Jails
This clinical guideline is intended to be used as a template to help clinicians and administrators create their own policy on personal footwear. This sample guideline must be modified to make it applicable to each unique correctional facility. This guideline is not intended to apply to all patients. Practitioners should use their clinical judgement for individual patients.Introduction. Inmates housed in county jails are provided footwear by security personnel. Occasionally, inmates will state that they have a medical condition that requires them to wear their own personal shoes. If an inmate asks medical personnel to authorize him to wear his own personal shoes, medical providers should re-frame the question as “does this patient have a legitimate medical need to wear his own personal shoes?” Inmates may desire to wear their own shoes for many non-medical reasons, such as convenience, as a sign of increased status among other inmates and as a way to smuggle contraband. This guideline addresses the question of when inmates have a medical need to wear their own personal shoes.
I have begun a new blog that is being published on MedPage Today entitled "Doing Time: Healthcare Behind Bars." The difference between that blog and JailMedicine is the audience. JailMedicine is written for medical professionals already working in a jail or prison (bless us all!). The MedPage Today blog is written for medical professionals who have no idea what Correctional Medicine is all about. The first post of Doing Time follows:Posted in: Jail cultureMed Page TodayMedical PracticeMedPage TodayUncategorizedTagged in: Read more... 2 comments
In the last JailMedicine post, I discussed the use of NSAIDS for pain. Pain management is probably accounts for 90+% of NSAID prescriptions in primary care. Oftentimes, though, we delude ourselves into thinking that we are also treating inflammation. Usually we are not and that is the subject of today’s post. To show why, we have to delve into the NSAID inflammatory effect. How NSAIDS act to affect the inflammatory response is well known (unlike their pain effect, which is still a mystery). All practitioners should know the basics of how NSAIDS work. This is essential knowledge for rational prescribing.Posted in: Uncategorized Read more... 2 comments
After many years of reviewing prescribing practices of physicians both within correctional systems and outside of the walls, here is something that I strongly believe: Non-Steroidal Anti-inflammatory Drugs (NSAIDS) just may be THE most misunderstood and overprescribed drugs in clinical medicine. It appears to me that, in general, we practitioners overestimate the benefit NSAIDS give. We underestimate the risks NSAIDS carry. And we prescribe NSAIDS in ways that are not evidence based and not in our patients’ best interest.Posted in: Uncategorized Read more... 6 comments