Tag Archives: inmates

20130925

Antibiotic Over-prescribing and The Looming Threat of Resistance

I ran across a couple of interesting articles about antibiotics recently.

In the first article, entitled We Will Soon Be in a Post-Antibiotic Era, CDC researchers predict that the end of the antibiotic era is coming quickly. Antibiotic resistance is developing so rapidly now, that it is only a matter of time until antibiotics just don’t work anymore. This actually is not surprising when you think about it. If we kill all of the microbes that can be killed by our antibiotics, then of course the only ones left will be those that cannot be killed by antibiotics, in other words, that are resistant. The fact that this will happen eventually is a no-brainer.imgres Continue reading

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Reader Question: How to Handle Swearing in the Medical Clinic?

My good friend Al Cichon in Maine writes:

Dr. Keller,

What are your thoughts regarding disrespect?swear

As health care providers we are trained to be tolerant when patients are less than pleasant – excusing their behavior as a result of their illness / injury. Certainly there are occasions when this is appropriate. However, that tolerance can be abused in the correctional setting. Continue reading

You’ve Heard of Placebo. But What About the Nocebo Effect?

I ran across a quite good article the other day entitled A Powerful Tool in the Doctor’s Toolkit written by Dr. Danielle Ofri. It was about how the placebo effect is underappreciated in medicine. Far from being an esoteric “Gee-Whiz!” phenomenon, the placebo effect and its counterpart, the nocebo effect, are things we can use to our advantage in almost every clinical encounter.images-1 Continue reading

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Rectal Contraband. What Would You Do?

Hey Jeff,
 like you I am an ER doc and am the Medical Director of a 550 bed jail. I would like you thoughts on body cavity searches. We had a case last week where an inmate was seen putting a baggy in his rectum. A search warrant was issued and the inmate was sent to the ER for a body cavity search. The inmate refused to let the ER personal touch him. He told the ER doc that it was a baggy of tobacco. The ER observed him for several hours and sent him back to the jail. No cavity search was done. The ER doc felt she would have to sedate the inmate to do the search and felt uncomfortable doing this against his will. The NCCHC frowns on the jail medical providers doing evidence related procedures or searches. My policy is to do the searches if the inmate will sign an informed consent and allow it to be done. If the inmate were to have a complication of sedation or the removal procedure that was done against his will, I would think a malpractice claim could be supported. How do you handle these types of situations in your jail?
 Thanks,
BJFUnknown Continue reading

Reader Question: How Do You Handle Ramadan At Your Facility?

Dr. Keller,
I am curious to see how other jails/prison handle fasting during Ramadan. We only KOP inhalers and creams at my facility and have no medical commissary. We do a very early medication pass for those who are fasting, but it does cause occasional problems with the management of diabetics and some other chronically ill patients. How do other facilities handle this?
Thanks,
 Jill McNamaraimages-2 Continue reading

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Beware of Lithium Toxicity!

If you have read the title of today’s blog post, you already know the answer to today’s case.  The answer is “Lithium Toxicity.”  I could have instead presented a “Can you figure this case out?” type of format.  But I did not want to do that because, really, what was causing this particular patient’s symptoms is not obvious, especially early on.  This is an introspective learning case.  I want you to read the case knowing the answer.  The answer is “Lithium Toxicity.”  As you read this case presentation, I want you to ask yourself when the possibility of lithium toxicity would have first entered your head and when you would have stopped this patient’s lithium?lithium1 Continue reading

Interesting EKG. What is Your Interpretation?

Your patient is a 29-year old male who presents to the medical clinic stating that he has been having a feeling of a racing heart off-and-on for the last couple of months.  It comes and goes, maybe two or three episodes a week.  They only last a few minutes.  He feels odd when this happens but he does not have to stop his activities.  He has noticed no pattern to these; they have happened at work (he is an inmate worker), in the middle of the night and every time in between.

His physical exam is normal including blood pressure of 124/78, regular heart rate of 68 and normal heart sounds.

What do you think is going on?  Would you order any tests?Original EKG Continue reading

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Reader Question: Medication Approval

My friend Al Cichon recently asked the following questions:

UnknownWhat ‘authority’ does a jail provider have to change the prescription of an inmate coming into the jail?

I have been asked when I would not approve an existing prescription – non-compliance (over / under); diagnostic mismatch (extreme example anti-viral for bacterial infection); – can you think of others? Continue reading

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Beware of “Friendly Prescribing!”

doctor-with-prescription-padImagine that you are a healthcare provider in a jail medical clinic. One of the jail nurses comes to you and says “Will you call me in a prescription for my hypertension meds? I have no more refills and my doctor charges $100.00 for a visit just to get more!” Or perhaps it is a detention deputy who asks, “Can I get a few Ambien from you? This shift work kills me and I need them occasionally.” Or “Can I get some Augmentin? I have Bronchitis.”

Continue reading

Essentials Of Correctional Medicine, February 2014

I am pleased to announce the Essentials of Correctional Medicine Conference 2014!

Cool city shotIt will be held February 18-21, 2014 in the Downtown Hilton Hotel in Salt Lake City, Utah.

Last year’s conference was a great success.  We had much greater participation than we had anticipated and the comments we received from the conference participants were almost all positive.  However, we did get some suggestions for improvements that we are using to make Essentials 2014 even better!

Much like last year’s conference, here is what you can expect:

  1. This is a working conference.  Do not expect a lot of free time.  Do expect to learn a lot.
  2. This is a conference for Correctional Medicine Professionals.  Each and every lecture will specifically pertain to medicine practiced in jails, prisons and juvenile facilities.
  3. Excellent, engaging speakers.  We have three requirements of our speakers.  First, that they teach up-to-date, useful material.  Second, that they are enthusiastic and engaging.  Useful information does no good if the presentation is so boring that you slept through it.  Finally, they must relate their presentations to correctional medicine. We in correctional medicine must always keep safety, security, and the possibility of symptom magnification for gain in the back of our minds in a way that outside physicians find foreign. 

We have made several changes and improvements to the conference format based on the suggestions and critique of last year’s participants:

  1. Fewer speakers speaking on more topics.
  2. More time for questions.  Each speaker will devote time to answering questions.  Also, each day we will bring all of the speakers together with the conference participants and have a question and answer and discussion session.  Expect debates!
  3. Protocols.  Each clinical lecture will come with a sample protocol.  Whether you call them Policy and Procedures, Standard Operating Guidelines or simply Protocols, writing these suckers is hard work.  So besides lecture notes, conference participants will leave with a good number of clinical policies that they can easily adapt to their particular institution.
  4. More vendors.  We especially are looking for vendors with new products that can make our lives better.
  5. More “working on a full stomach.”  Since this is a working conference, continental breakfast and lunch will be provided most days so we can keep on learning! 

2014 Conference Topics.

  1. Infectious diseases.  Our Keynote Speaker, Dr. Joseph Bick, is an expert in infectious diseases and a great speaker.  He is currently on sabbatical working as a correctional physician at a prison in Malaysia, of all places.   Dr. Bick will share those experiences with us in the Keynote Address, and then will address many of the infectious disease conundrums we face in Correctional Medicine.
  2. 032Dermatology.  Every correctional physician needs a dermatology consultant to send grody rash pictures to.  Mine is Neelie Berlin, enthusiastic rash expert who also happens to also be a wonderfully entertaining speaker.
  3. Medico-legal matters.  I personally always enjoy legal discussions and case analysis.  Hearing about bad-outcome legal cases is like driving by a bad wreck on the freeway—you just can’t look away.
  4. Symptom magnification and malingering.  Does any medical profession have to deal as much with this issue as we in corrections do, day after day after day?  Answer:  Ah, no.  Essentials will have presentations about detecting deception, properly documenting these encounters in a medico-legal friendly way and dealing effectively with these inmates without confrontation.  Forensic Psychiatrist Dr. Noel Gardner will discuss symptom magnification and malingering in the psychiatric realm.  Wonderfully entertaining as well as essential information.
  5. Formulary development and maintenance.  It is easier than you think!
  6. Chest Pain and Abdominal Pain.  Simplified approaches to assessing these complaints.
  7. And More! 

More conference information is found under the “Essentials Conference” tab at the top of the page!

Do you have questions?  Suggestions about how to make this and future conferences better?  Contact Us information is found at the conference website:  Essentials of Correctional Medicine.