Five months ago, the Journal of the American Medical Association (JAMA) published an editorial entitled “Can Physicians Work in US Immigration Detention Facilities While Upholding Their Hippocratic Oath?” (Spiegel, Kass and Rubenstein, JAMA online August 30, 2019). This article generated a lot of interest and comment in the lay press. As just one example, NBC News wrote “Medical care for detained migrants violates doctors’ oath, says physician in JAMA commentary.”
Imagine, if you will, a nurse who is assigned to take care of 50 patients on a medical floor—by herself. Clearly, this is an impossible task. There are just too many patients for one nurse to adequately monitor. But this nurse gamely does her best. Now let’s say that there is a bad outcome and an investigation. Even if the understaffing problem is recognized, it would be easy—and tempting–to scapegoat the nurse, especially if there was no intention of fixing the staffing problem (“We can’t afford to hire more nurses!”) Instead, the scapegoated nurse would be replaced by a new nurse, who, once again, would be expected to care for 50 patients.
Such were my thoughts when I read this article about the problems with the medical care for inmates in the Illinois prison system (found here): https://www.chicagotribune.com/news/local/breaking/ct-met-illinois-prison-health-lawsuit-20190103-story.html. The article says that there have been so many problems with medical care in the Illinois prison system that a class action lawsuit has successfully forced Illinois to make sweeping changes to the prison medical system. What is not mentioned in the article is that similar lawsuits have happened before in other states and will happen again.
Continue readingOne of my good friends is a die-hard Oakland Raiders fan. Those of you who follow pro football know that Oakland has fallen on hard times recently. They went from being one of the best teams in the league two years ago to one of the worst teams in 2018 with a dismal 4-12 record. As a result, my friend has had to suffer taunts from fans of better teams—like me! He has become despondent.
But it doesn’t have to be this way! The Raiders can quickly and easily turn their season around by using the tried-and-true techniques of medical research. If a pharmaceutical company did 16 clinical trials of their new potential blockbuster, Drug X, they would never let a 4-12 outcome get them down. When published, I guarantee those trial results would look a lot better than 4-12. The Oakland Raiders can use the same techniques to improve their own season record.
This article was initially published on MedPageToday, found here.
I remember walking into one of my jails and seeing a patient on the floor of his cell twitching and shaking. “Don’t worry about him,” said the sergeant on duty. “He’s faking it.”
Boy, that spun me up! Nothing will make me more anxious than hearing “he’s faking” or its close cousin, “he’s malingering.” I hate and fear those words. Now, I know that medical personnel, both in my jails and in the emergency departments where I used to work, get upset when they think that they are being deceived or manipulated by a histrionic patient. But charging a patient with “faking it” is almost always a bad and dangerous idea.
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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.
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:
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