Those of us who have practiced medicine in jails and prisons (correctional medicine) know this is a great job! We often see patients who have never had easy access to medical care. As a result, we get to diagnose and treat a larger variety of medical diseases than most medical professionals. We get to see the striking improvements our patients make due to our interventions. Since correctional medicine is largely free from traditional government/private insurance, we are freed from ICD-9 codes, diagnostic-related-groups (DRGs), and billing. We work with a disadvantaged and underserved population that appreciates our efforts and are grateful to have us. Our work is emotionally rewarding!
But it is also true that correctional medicine is different in important ways from medical practice “on the outside.” For example, we cannot fire our patients and they cannot fire us. Because of this, we must learn “verbal jiujitsu” skills to effectively communicate without animosity. We also must be scrupulously fair with our patients in a way that simply does not happen on the outside. And, of course, we must practice in a loud, hectic concrete and plexiglass building with TSA style security checks. These differences can be enough to overwhelm some medical newcomers with sensory overload.
The Best of Jail Medicine: An Introduction to Correctional Medicine consists of 47 articles from the popular Jail Medicine blog that discuss must-know aspects of practicing medicine in a jail or prison. Each section contains several articles highlighting a different essential aspect of correctional medicine.
Why Correctional Medicine is a Great Job
Communication with Incarcerated Patients
Unique Operations in Jails and Prisons
Comfort Items: The Special Problem of Correctional Medicine
Treating Withdrawal—Every Time
Issues of Medical Care in Jails and Prisons
In My Opinion
The Best of Jail Medicine: An Introduction to Correctional Medicine is available now on Amazon.com (here)
I will be meeting a new jail patient with multiple medical
problems today in my clinic. I know this
much before I even meet him: He will
almost certainly be scared, especially if this is the first time he has ever
been to jail. He will likely be
suspicious of me. He may even be downright hostile. I know this because this is
the norm for correctional medicine. I can’t be an effective doctor unless I can
turn this attitude around.
Consider the situation from my patient’s perspective. Prior to seeing me, he was arrested,
handcuffed and driven to jail in a police car.
Once at the jail, he was thoroughly searched (spread-eagle against the
wall), fingerprinted and had his “mug shot” taken. His clothes were taken away and he was given
old jail clothes (including used underwear).
He was placed in a concrete cell.
Now he is summoned by a correctional deputy and told (not asked) to go
to the medical clinic.
He did not choose me to be his doctor. Though he doesn’t know anything about me, he
has no choice but to see me for his medical care. Not only did he did not
choose me; he cannot fire me or see anyone else. He may fear that I am not a competent doctor;
otherwise why would I be practicing in a jail?
This is the attitude that I have to overcome. How to do this is an essential skill for
correctional practitioners. And, of course, the single most important encounter
is the first one. A negative first impression is hard to overcome–and I am already
starting out at a disadvantage. What I
have to do in only a few minutes is convince my patient that I am a legitimate
medical doctor and that I care about him. I have learned in many years of doing
this that these things are essential:
I work at a prison and your blog has been such a resource for our unique niche of medicine. There’s nothing like practicing “behind the walls!” . . . Recently I’ve been incorporating more conversations about functionality and short-term/long-term goals and visits are mostly positive. However, there are the difficult patients . . . wanting to bargain “well if you’re not going to do anything, can I have an extra mat?” Or “Can I have a bottom floor restriction?” “Transfer me then!” “Give me insoles.” …and other requests like this. How do you recommend I come to an agreement with these patients that are difficult to have conversations with? . . . If by the end of the appointment we do not come to some sort of agreement, they end up right back in sick call with the same complaint. Then the cycle repeats. KR