Complete Article List

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Abscess Incision and Drainage, a Photographic Tutorial


Skin abscesses are quite common in correctional facilities, especially in the MRSA era, and so all correctional practitioners need to be comfortable with the procedure of abscess incision and drainage, also known as “lancing” the abscess.  Also “Let’s cut that … Continue reading

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December 9, 2012


Interesting Article of the Week Plus Price Check!


An acquaintance complained to me recently that he was struggling to afford his medications, which cost him a couple of hundred dollars a month.  I looked at his medication list and saw (among other examples) that he had been prescribed … Continue reading

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November 29, 2012


Reader Question: Diabetic Malingering Part 3


Dr. Kay Haw submitted the following question: “I would like to know your thoughts on the ability to forcibly provide insulin coverage on a diabetic inmate whose sugars are out of control and is refusing blood sugar checks and insulin … Continue reading

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November 21, 2012


Essential Pearls from Essentials


Essentials of Correctional Medicine was held last week in Salt Lake City, Utah and included some great talks.  Today’s post is a list of Pearls I gleaned from the conference speakers. The definition of a “Pearl” is a bit of … Continue reading

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November 13, 2012


A Daring Plan for Discharge Meds!


One of the “systems” problems that all jails have to deal with is what to do with medications when a patient is released from jail.  Prisons deal with this issue as well but tend to have fewer headaches than jails, … Continue reading

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November 5, 2012


The Specialty of Correctional Medicine


I just returned from this year’s NCCHC convention.  It was excellent, as always.  A very important announcement was made at the Society of Correctional Physicians’ meeting on Sunday that deserves more publicity than it is getting. The American Osteopathic Association … Continue reading

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October 27, 2012


Interesting Article of the Week: Gonorrhea, Superbug.


The Emerging Threat of Untreatable Gonnococcal Infection. Bolan GA, Sparling PF, Wasserheit JN N Engl J Med 2012;366(6):485 This article was generated by the CDC and is about the increasing incidence of drug resistance of Neiseria gonorrhoeae, as well as … Continue reading

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October 23, 2012


Dr Foote’s Home Cyclopedia of Popular Medical, Social and Sexual Science


I ran across this topic in the excellent Australian Emergency Medicine blog Life In The Fast Lane.  It was too good not to share.  After reading the advice of Dr. Foote, I’m sure that most of you, like me, will … Continue reading

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October 17, 2012


Diabetic Malingering, Part Two. Scams and Solutions!


My last post introduced the subject of diabetic malingering.  In this post, I present several patients I have encountered in my correctional medicine career and the various scams they have used to manipulate their blood sugars.

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October 10, 2012


Diabetic Malingering: Part One


In corrections, we see an awful lot of malingering, symptom magnification, and outright medical deception.  This comes in many forms, from alleging vomiting when none has occurred, to falsely claiming to be hearing “voices,” to deliberately abrading the skin and … Continue reading

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October 8, 2012


What’s That Skin Lesion? Plus updates.


Before we get to the cool skin lesion quiz, first a couple of updates! Get your flu shot! Influenza shots are here.  Be sure to get yours.  I didn’t get my flu shot last year and subsequently came down with … Continue reading

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October 1, 2012


Price Check! Antipsychotics.


It is a good idea to check on the current price of medications once in a while.  When I do this, I am invariably surprised by price changes since the last time I looked.  On the one hand, once a … Continue reading

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September 24, 2012


Methadone? In a Jail?


The question was raised recently about how to handle inmates who prior to jail,  were enrolled in a methadone or Suboxone program to treat narcotic addiction.  Should they continue the methadone or Suboxone in jail?  Or should they instead be … Continue reading

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September 18, 2012


Obstacles to a Medical Commissary Program


Last week, I counted down the five most popular articles from JailMedicine’s first six months.  This week, I would like to revisit my own personal favorite post.  I don’t have very many really good ideas—but this is one of them:  … Continue reading

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September 13, 2012


Six Months Later–Top Posts


Well, JailMedicine is now over six months old and has been more fun to write and much better received than I had imagined it would be.  JailMedicine has had over 30,000 hits!  Thank you especially to those of you who have … Continue reading

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September 6, 2012


Question of the Week: STD’s–Test or Just Treat?


Reader Question of the Week: How do I go about convincing the management team to allow me to treat inmates for STI’s.  It is common practice to obtain a UA for c/o burning etc per protocol.  But, I am not … Continue reading

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September 4, 2012


Interesting Article of the Week: Prostate Screening?


  SCREENING FOR PROSTATE CANCER: A REVIEW OF THE EVIDENCE FOR THE U.S. PREVENTIVE SERVICES TASK FORCE Chou, R., et al, Ann Intern Med 155:762, 2011. One of my hobbies is that I do Wellness-Fitness examinations of local firefighters.  They … Continue reading

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August 23, 2012


Diuretics for Swollen Legs? Not!


I recently had several women inmates at one of my jails complain that their legs were swollen and request a “water pill” to get rid of the swelling. This happens now and again at the jails and seems to occur … Continue reading

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August 16, 2012


Interesting Study of the Week–“Overactive Bladder”


Shamliyan T, Wyman JF, Ramakrishnan R, Sainfort F, Kane RL. Benefits and harms of pharmacologic treatment for urinary incontinence in women. A systematic review. Ann Intern Med 2012;156:861-874. We have all seen the commercials touting medications for the conditon the advertisements call … Continue reading

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August 10, 2012


Eyeglasses in Corrections: Looking out for Vision Requests


Eyeglasses were partly why I got into correctional medicine in the first place.  16 years ago my local jail was under an ACLU consent decree and was desperate to find someone willing to provide medical care to the jail inmates … Continue reading

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August 6, 2012


Interesting Study of the Week and Updates


Set your TiVos! For those interested in the Bath Salts phenomenon that I wrote about in “Bath Salts,” A Review and Bath Salts Update, CNBC is airing an hour-long program tonight about the “Bath Salts” and “Incense” phenomenon entitled Crime … Continue reading

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August 2, 2012


Reader Question About Antibiotic Use. What’s Your Opinion?


My name is Gabby and I am a ARNP working in  a rural health care setting in southern Washington and newly blessed with a county jail assignment.  I oversee 300 + inmates in a county jail setting and was turned … Continue reading

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July 31, 2012


Interesting Study of the Week–MRSA


Antibacterial drugs and the risk of community-associated methicillin-resistant Staphylococcus aureus in children. Schneider-Lindner, et.al., Arch Pedicatr Adolesc Med, 2011 Dec:165(12):1107-14. This is a great study done in England, where a database of medical treatment for the whole country is available for … Continue reading

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July 24, 2012


Education for Correctional Medicine


One of the challenges I see for those of us who practice Correctional Medicine is that there are too few educational opportunities specifically designed for us. There are a few:  NCCHC has great conferences.  The Society of Correctional Physicians puts … Continue reading

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July 23, 2012


Don’t Get Burned by Serotonin Syndrome (like I did)


A 46 year old man comes to the medical clinic complaining of muscle aches and twitching, which he first noticed two days ago.  He had been booked two weeks ago and his prescribed outside medications were continued:  sertraline 100mg a day, amitriptyline 100mg … Continue reading

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July 18, 2012


Bath Salts Update


Last Monday, July 9th, President Obama signed the Synthetic Drug Abuse Prevention Act of 2012 (found here), which outlaws the Bath Salt ingredients MPVD and mephodrone along with 29 other synthetic chemicals.

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July 15, 2012


Thoughts on an Untreated Type 2 Diabetic


We recently had a 46-year-old male patient booked into our jail who reported a history of diabetes but who had not seen a physician or taken any medications for “years.”  He said he used to take a medication for diabetes … Continue reading

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July 9, 2012


“Bath Salts,” A Review.


It used to be that “Bath Salts” were, well, salts that you would use in a bath.  Not anymore!  Nowadays, “Bath Salts” refers to a designer drug of abuse that is marketed like traditional bath salts to give legitimacy to … Continue reading

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July 2, 2012


Three Cases (and Three Causes) of Rhabdomyolysis


Rhabdomyolysis is one of those diseases, like acute alcohol withdrawal, that I have seen much more commonly in my jails than I ever did when I worked in the emergency department. Rhabdomyolysis occurs when skeletal muscle cells die and rupture, … Continue reading

June 28, 2012


Is This Inmate Gaming Me?


I have seen several patients recently with an unusual complaint. A typical presentation would be this:  a male in his early 30s and without medical history  complains of frequent urination: “I have to get up 10-12 times a night to … Continue reading

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June 23, 2012


What is the Most Cost-Effective Treatment for Genital Warts? The Answer May Surprise You!


Aldo Torrente recently wrote, “Currently I have several patients with genital warts.  In my facility there are three alternatives: podophyline, verruca freeze, and trichloroacetic acid. In all cases, the provider ONLY can apply the topical treatment.  What is the protocol … Continue reading

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June 18, 2012


Quiz Time! Name That Rash!


A patient presents to your clinic with this rash on her arm.  She reports that it began three days ago and has steadily gotten worse.  Now, the rash is weeping and crusting a little bit.  It hurts and itches. She … Continue reading

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June 11, 2012


Tips on How to Say “No!”


One of the many things that make correctional medicine different from “outside” medicine is that we in correctional medicine have to say “No” a lot.  Doctors on the outside do not say “No” very often because they must keep their … Continue reading

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June 6, 2012


What Exactly is a “Mood Stabilizer?”


A mental health professional recently referred a patient to the medical clinic “for consideration of a mood stabilizer.”

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May 31, 2012


A Step By Step Approach to the Hunger Games


So the Detention Deputies call medical and say that there is a certain inmate who has not eaten anything for the last four days.  Not an unusual occurrence in my experience; in fact, we medical providers most often hear about … Continue reading

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May 29, 2012


The Hunger Games–Corrections Style


I have two patients in my jails right now who are not eating.  When I was told about these patients, the term “Hunger Strike” was used, as in “We have a new patient on a hunger strike.”  However, “Hunger Strike” … Continue reading

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May 22, 2012


Where Should the Hydrocodone Go?


My friend Sherry Stoutin, Medical Director of the Nez Perce County Jail in Lewiston, Idaho, shared an interesting case. She sent a patient in her jail to the Emergency Department to be evaluated for chest pain.  He was cleared in … Continue reading

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May 16, 2012


Inappropriate Drugs in Jails and Prisons–Continued!


In my last post on this subject (found here), I mentioned three medications that I think should rarely, if ever, be allowed in correctional institutions.  I would like to expand this list today. In my personal protocol on this subject, … Continue reading

May 14, 2012


Tips for Diagnosing Appendicitis


One of the last remnants of my previous life as an Emergency Physician is that I am still to this day the Medical Director of the local fire department and paramedics.  I also do the fire fighters’ yearly wellness physical … Continue reading

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May 10, 2012


Are There Medications that are Inappropriate for Use in Jails and Prisons?


All medications have side effects and potential complications. Of course we all know this. Whether to prescribe and what to prescribe should involve a careful weighing of the expected benefits vs. the potential harm for each individual patient.  This math—risks … Continue reading

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May 9, 2012


Do You Do Doubles? Don’t!


A frequent complaint in jails comes from inmates who request extra food for various reasons–they are underweight, they are just way hungry, whatever.

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May 2, 2012


Review Articles of the Month–Emphasis Psychiatry


Like most physicians, I subscribe to several medical education and CME sites.  One of my favorites is Primary Care Medical Abstracts.  PCMA chooses 30 papers a month of interest to primary care physicians and then these papers are reviewed by … Continue reading

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April 26, 2012


The Proper Way to Document Study Results!


So let’s say you order a lab test on a patient.  Or an X-ray.  Or let’s say you order old records.  When the results are returned to you, how do you document this?  What I have often seen is the practitioner documenting … Continue reading

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April 24, 2012


Embracing the Placebo Effect of Antidepressants.


I recently ran across this interesting article (found here) which is the latest in a long series over the years comparing antidepressant efficacy to placebos.  I know that this is a controversial subject with some believing that all (or most) of antidepressant … Continue reading

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April 19, 2012


The Concept of a “Hypertensive Urgency” is a Myth


One of my nurses called me recently worried about a patient’s blood pressure.  The patient had just recently arrived at the jail and had no complaints, but when his blood pressure was measured, it was 230/120.  The patient otherwise felt … Continue reading

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April 16, 2012


What Makes Correctional Medicine Different?


I recently read my friend Lorry Schoenley’s excellent article on Correctional Nursing is Different–Research Report which is about the differences between correctional medicine and traditional community medicine. Coincidentally, I also found myself at about the same time hiring a new full-time … Continue reading

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April 10, 2012


Diabetic Snacks: Part Two!


In my previous post on Rethinking Diabetic Snacks for Type 2 Diabetics, I mentioned that there are two theoretical justifications for the practice or prescribing bedtime snacks for type 2 diabetics.  I would like to expound on these two issues … Continue reading

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April 6, 2012


Constipation Case: What Would You Do?


I am looking for some feedback here.  How would you manage this case? A patient in her early 30s states that she has taken a Dulcolax tablet daily for over ten years.  She states she spent most of that time … Continue reading

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April 2, 2012


Constipation: Straight Talk on the Last Taboo Subject


I have decided after many years of dealing with complaints of constipation both in the ER and in correctional facilities that bowel health is the last taboo subject.  We all received “The Talk” (about sex and reproductive health) when we … Continue reading

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March 27, 2012


Is It Possible to Withdraw From both Alcohol and Opiates at the Same Time?


I recently participated in a Webinar entitled “Managing Alcohol Withdrawal in the Correctional Setting.” During the question and answer section of the Webinar, a question was posed about how to manage the patient withdrawing from both alcohol and heroin at the same … Continue reading

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March 23, 2012


Rethinking Bedtime Snacks for Type 2 Diabetics


I had an obese Type 2 diabetic patient at one of my jails recently who wrote a long grievance about not receiving a bedtime snack.  He argued in the grievance that he had received a bedtime snack at previous facilities … Continue reading

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March 20, 2012


Pop Quiz: Medication and Lab Prices


One thing that has long bugged me about how medicine is practiced in the United States is that medical professionals for the most part have no idea how much stuff costs.   Doctors prescribe medications that their patients cannot afford to … Continue reading

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March 15, 2012


Food Allergies: Sorting out Truth From Fiction


In my previous incarnation as an emergency physician (before I discovered “The Way” of correctional medicine), I saw a lot of cases of acute allergic reactions. It is a very common emergency complaint; I have probably seen hundreds in my … Continue reading

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March 12, 2012


Diabetic Case Studies–The Insulin Rules in Action!


People come to jail taking the weirdest insulin regimens.  Often times, I don’t know whether these insulin schems are the result of a practitioner who does not understand insulin dosing well, or whether the patient “tinker” with their insulin dosing, … Continue reading

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March 9, 2012


A Quick-and-Easy Solution to those Pesky “Own Shoes” Requests


Everyone who works in corrections is familiar with inmates wanting medical authorization to wear their own shoes.  A typical case would go something like this:  “I have chronic back pain and walking on these hard concrete floors makes it worse. … Continue reading

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March 6, 2012


Should the Flu Vaccine be Mandatory?


So I caught the flu last week and I have been pretty miserably sick for going on 7 days; fever, achy, cough.  Also cranky, peevish, and insufferable.  My hair hurts!  Is that even possible? I usually get a flu shot, … Continue reading

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March 5, 2012


Patient Weight is a Powerful Diagnostic Tool!


Patient weight is a powerful diagnostic tool that is underutilized in corrections.  The reason for this, probably, is that not much attention is paid to weights in outside medicine.  In a general medical clinic, say, a patient’s weight could be … Continue reading

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March 2, 2012


Insulin Dosing Made Simple


I have found, in my years of practicing correctional medicine, that few practitioners who come to corrections are comfortable with insulin dosing. In my experience, this is especially true for physician assistants and nurse practitioners, but many physicians have problems, … Continue reading

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February 26, 2012


The Ankle Rules–You Don’t Always Have to Get an X-ray!


Back in the days when I worked in the ER, I ordered a lot of unnecessary x-rays.  Ankle x-rays were a particular problem.  Often I was sure that there was no fracture, but I ordered the x-ray anyway because of … Continue reading

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February 24, 2012



The Right Way to Deal with Outside Physicians


Those of us who practice medicine in jails frequently (Frequently? Daily!) run into the thorny issue of our relationship to the doctors who care for our patients outside of the jail. When patients are in our jails, we are responsible for … Continue reading

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February 18, 2012


Tasers and Narcotics


Emergency Medicine News this month had two articles of interest to corrections. The Physiology of Tasers reviewed research into the safety of Tasers including a US Department of Justice study from 2009. I think that those of us who evaluate … Continue reading

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February 16, 2012


Beware the Compliance Trap. It will catch the unwary . . .


I had yet another patient recently who demonstrated what I call the “Compliance Trap” of corrections.  The Compliance Trap is simply this—on the outside of jail, in the real world, most people do not take their medications perfectly.  They miss … Continue reading

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February 15, 2012


Interesting References of the Week!


Self Monitoring of Glucose in Type 2 Diabetics Does Not Work The Cochrane Review did an analysis of 9 studies of self monitoring of blood glucose.  In these studies, There was no beneficial long term effect of self monitoring of … Continue reading

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February 11, 2012


What’s the most cost-effective way to treat scabies? The answer might surprise you . .


All correctional medical people should be able to recognize scabies by sight.  Just to review, scabies is a tiny mite that burrows beneath the skin and causes intensely itchy lesions. Since the mite wanders (as little animals will do), scabies … Continue reading

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February 8, 2012


Is this patient psychotic? Or Delirious?


In my career in corrections, I have seen 4 or 5 cases in which a patient was thought to be acutely psychotic, but actually was suffering from delirium.  A typical case would present like this:  Deputies report that Mr. Jones … Continue reading

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February 6, 2012


An Unusual Case of Cheeking


Like everyone in corrections, I have seen my share of cheeking.  For those who may not know what this is, “cheeking” is the slang term for when inmates pretend to swallow their medications but really secrete the pills in their … Continue reading

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February 4, 2012


A Quick and Easy Solution for Second Mattress Requests!


I have a quick ‘n easy solution for those pesky requests for a second mattress that plague all correctional facilities.  But before I get to that, though, there are two important points to consider in any discussion about second mattresses … Continue reading

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January 31, 2012


“Kite?” Where did that come from?


I am wondering today where the term “kite” came from.  Everybody who works in jails or prisons is familiar with “kite,” which in jails and prisons refers to a written request for something. Inmates can “kite” for anything, but those of us … Continue reading

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January 29, 2012


Interesting Reference of the Week!


The Wall Street Journal published a little debate between two prominent physicians about whether statins are appropriately used to prevent heart disease in patients with no history of heart disease. This is an important question for jails and prisons partly because of the costs of these … Continue reading

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January 27, 2012


You Need a Medical Commissary in Your Facility!


When I was an undergraduate, before I switched to pre-med, I was an economics major.  Maybe because of that training, when I look at jail medical practices, I tend to look at all of the costs of medical practice, not … Continue reading

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January 26, 2012


Evidence Based Use of NSAIDS—Less is More


When we want to do an evidence-based approach to the use of any drug, we have to consider three factors: What beneficial effects do we want the drug to have on our patients? What harm might the drug cause?  How … Continue reading

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Evidence-Based Use of Antibiotics Can Save Your Jail Money!


I suspect that almost every physician in theUnited Stateswould agree that antibiotics are over-prescribed.  Unfortunately, since the total number of antibiotic prescriptions in theUnited Statesgiven to people with “cold” has been estimated at 44 million per year, it would seem … Continue reading

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Don’t Use Antibiotics for Most Cases of Pharyngitis!


I have practiced medicine for over 18 years and have gotten a lot of CMEs over that time. The lectures I have enjoyed the most have tended to be those exposing the myths of modern medical practice.  You probably know … Continue reading

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January 25, 2012


Page 2 of 2

6 thoughts on “Complete Article List

  1. Dr. Keller; could you consider an article on a particular type of offender manipulation – offenders who use medication / treatments etc. to leverage an issue.
    Here are some examples:

    #1
    We typically provide a calculated calorie diet (based upon ideal weight) for all diabetics and have a food restricted commissary. Items that have little to no caloric / carbohydrate value are allowed.
    A diabetic patient will complain, file a grievance and finally ‘refuse’ treatment (medication, testing) if the first few efforts fail.
    NOTE: offenders are fed by trays delivered to their rooms not in a ‘chow hall’ setting so they cannot ‘select’ their diet – if we used a ‘chow hall’ it would be an education issue.

    #2
    An inmate cannot work – on disability in the community – after exam and health history a medical profile and activity restriction is accomplished. The jail has no work position available that fits the profile. The offender is refusing all medications.
    NOTE: Of interest; the diabetic / hypertensive / COPD patient has better glucometer readings, plod pressures and activity level than in community.

    My concerns are:
    First that the patient-offender will cause themselves (medical) harm
    Second the facility will be open to some level of liability
    Third that the offender is turning this into a ‘contest’ (and I’m falling for it).
    Finally, they often say (offenders) that they are ‘willing’ to sign a ‘release’ that frees the jail of any responsibility for their (offenders) choices [Not worth the paper used to write it]

    PS the notes are my personal comments and probably add nothing to the post.

  2. I would love to see your opinions on the Hep C treatments being mandated across the country for the inmate populations. I want to see people get treated, but budgets are not infinite, and say cost is not an excuse but how can we afford to treat hep c when in some cases its more than triple an entire states pharmacy budget.

  3. Jeff,
    How do you handle pregnancy at your jail? None of us carry malpractice insurance that includes OB, and there isn’t an OB in my area that is willing to come to the jail to see a pregnant lady with no prenatal care, or even their own patients for that matter. We have a PA that has had some experience working for an OB and have her see them until 20 weeks and then we try to get them furloughed to see their own OB or transport them there. A community clinic is willing to see them after 20 weeks but they only give us 4 slots a month. I would like to know how other jails are handling this.

    • H John! Is the issue that they won’t take pregnant inmates as new patients at all or is the issue that they won’t come to the jail to see them? In my experience, medical specialists are never willing to come to the jail to see the patient–the patient must be transported to their office. WE also have a formal OB protocol that was developed for us by a local OB that tells us what routine procedures should be done (like blood pressure checks and urinalyses). The protocol specifies when to transport the patient to the OB’s office. The first visit for patients who are doing well is at 20 weeks and increases in frequency as the patient goes along. The key point is that the OB set the protocol.

  4. Question for you (that I didn’t see addressed in the above articles – though please direct me if I’m wrong) –
    My hospital takes care of prisoners (state/federal) when critically ill. Any information you can help me find about medical decision making, especially when patient is unable to make decisions? (DNR/DNI, trach, procedure consent, etc) or about family communication? We never get formal training on this special population – I really appreciate your site for that reason!

    • Hi Scott, The prison systems I have been involved with usually try to contact family members to be involved in such decisions. If no family are available, then the prison medical director typically may make such decisions.

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