Improving the Reputation of Correctional Medicine

A noteworthy event happened last June that you may have missed. For the first time ever, an Emergency Physician was elected as president of the American Medical Association . “So what?” you might ask. Well, not that long ago, Emergency Medicine was not a respected (or even respectable) medical specialty—in fact, it was not a specialty at all. The American College of Emergency Physicians (ACEP) was first established in 1968.

Before then Emergency Rooms were staffed by various members of the medical staff as part of their obligation to the hospital. There would be an orthopedist there one day, a pediatrician the next day and an anesthesiologist the next. If you worked in the ER full-time, other doctors and people in the community looked at you askance. They were thinking, “What’s wrong with you that you’re not working as a ‘real’ doctor, with a ‘real’ practice?”

That attitude persisted well after Emergency Medicine was finally officially recognized as a separate specialty in1979. I encountered it when began my residency in Emergency Medicine in the mid 1980s: “What’s wrong with you that you are training in Emergency Medicine? Couldn’t get into a good residency, eh?” Back then, ER docs were certainly not considered for leadership roles in professional societies, even the local ones, not to mention the AMA.

But the respectability of ER medicine has slowly risen over the years due to relentless hard work by ER physicians to convince the broader medical establishment that Emergency Medicine was legitimate and worthy of respect. The election of an Emergency Physician to the top medical leadership position in the country is the culmination of this effort. ER doctors have arrived! They finally get to sit at the big kids table!

Now it is Correctional Medicine’s turn to become “respectable.”Doctors 3

I came to Correctional Medicine after 25 years of practicing as an Emergency Physician. I did not change career paths because I disliked emergency medicine–to the contrary, I enjoyed those 25 years just fine. But I like being a Correctional Physician even better! In fact, I think I do more overall good working in jails and prisons than I did as an ER doc.

But there is that one thing that can get under my skin and that is, once again “I don’t get no respect” (apologies to Rodney Dangerfield). There seems to be an innate assumption among my fellow physicians and the community at large that, because I work in a jail, there must be something wrong with me; that I must not be good enough to practice “real” medicine.

Of course, the people who have this misconception have no idea, really, what we do in Correctional Medicine. They think of jails and prisons as places where people are sent to be punished and that everyone who works there, including the medical personnel, are there to, well, punish the inmates. Some think that inmates don’t deserve medical care and so we are there to NOT give it to them.
No matter where it comes from, though, I think we would all agree that negative stereotypes regarding our profession exist and it is our job to change them.

However, it is going to be harder for us to do this than it was for Emergency Medicine because we are much more isolated. We do not interact with our fellow medical professionals on a day-to-day basis like ER docs do. When I worked in the ER, I knew all of the other doctors on staff by name. I went to the same staff meetings. I shook their hand when they came to the ER. I joshed with them in the Doctor Lounge. Now that I work in jails, the only time I interact with outside physicians is when I call them about patients in the jail—or when I bump into them in the grocery store!

Because our compatriots never see us, it is easy for them to hang on to their preconceived (and inaccurate) notions of what jail and prison medicine is all about. We have to change that. It seems to me that the very first hurdle we have to overcome in order to rehabilitate our image is to tear down the barriers that isolate us from the larger medical community.

This will take work by our professional groups, and I commend the NCCHC, ACCP, and the ACHSA for what they have accomplished; I am proud of their efforts. But achieving our goal of integration with the medical community is going to take more than this.  It will take individual effort from us individually. That means me and that means you.

In my opinion, the single most important way for those of us in Correctional Medicine to do to help improve our reputation and standing in medicine is for each of us individually to join our local medical society and attend meetings.

Speaking from experience, if you do this, you will be asked questions about what goes on behind the walls—everyone is curious! And when you do go to these medical meetings, your fellow professionals will see that you don’t have two heads with three eyes; instead, you actually are intelligent, hard working and deserving of their respect.  Consider this article your personal challenge  to do this for your profession:  join your local medical society!  Go to the meetings!

The barrier between correctional medicine professionals and outside medicine is large, at least as large as the task emergency physicians faced, but they got the job done. If we Correctional Medical Professionals were all to do this single act: join our local medical societies, attend meetings and maybe even seek out leadership positions, we could also succeed in becoming integrated as our own specialty. I’ll know that we have achieved our goal when a Correctional Physician is elected president of the AMA!

Are you an active member of your local medical society? Have you had any noteworthy interactions with outside medical professionals? Please commentMeeting

11 thoughts on “Improving the Reputation of Correctional Medicine

  1. Congrats Jeffrey, YES “you’ve come a long way baby.” Oops. . . too ironic; 400K deaths DIRECTLY from smoking… OK, not the best dated slogan but you get the point: not a small feat for ED Med. I can very much appreciate & share your delight. I left IM for full time EM in the early 80s then Boarded in 92. Back ERs were the land of the “broken toys.” Like you I simply liked correctional medicine and the positive influence quality practitioners have in this atypical practice milieu.

    IMHO, one of the best tools I’ve seen connecting the isolated Correctional practitioners was the Prison Listserver. I liked the bulletin board format but it got a little crazy at times. I remember some names like Al Chicon from there. This forum does much the same in networking and examining to improving the way we do things. You’ve made a huge difference with this website. I know you don’t need the kudos but take a bow with all those who take the time to share. THANKS!
    Interesting to see the NCCHC now has a certification for physicians (CCHP-P). Who knows, maybe in our lifetime we’ll get ABMS recognition?
    PS. I’ll take you up on your challenge to get more involved locally. I wish there was a way for subscribers to voluntarily share emails. Hope it’s OK to share mine:

    • Currently, the AOA recognizes a certification exam (CAQ) for Correctional Medicine. As a Correctional Medicine fellowship grad, I’m hoping that this will have some impact in garnering better recognition for the profession. Until then, keep pushing!

  2. Good morning Dr. Keller:

    Thank you for a well-written article. I have been practicing general dentistry for over 30 years and
    I get the same “vibes” from dentists in private practice. I work in the Hillsborough County Jail here in Tampa and between treating many patients that are medically compromised and that have difficult extractions I do practice in a real world-with the same standards of care as my colleagues on the outside.” I truly feel like an outsider within my own profession. Perhaps your article is the beginning of a beacon of change!
    Best Regards,
    Mark J. Szarejko, DDS, FAGD

  3. Jeff,

    Thanks so much for your timely and thoughtful article. As an administrator who has been involved in correctional medicine for more years than I can remember, I have seen great clinicians and I have seen the stereotypical clinician. Thankfully, as the years have passed fewer and fewer have been the stereotypical clinician. I congratulate you on providing some guidance to physicians and hope many read this article and take your suggestions to heart.

  4. Hi Dr. Keller,
    I am an NP at the San Francisco County Jail. We are currently revising our opiate narcotic administration and diversion policies. Do you have an written policies on how you handle opiate diversion in your jail? If yes, would you be willing to share them with me?
    thank you so much,
    Elizabeth Marlow, PhD, C-FNP

  5. greetings. i am a medical officer in a jail agency in manila, philippines. i would like to inquire if there are seminars or conferences offered to be attended concerning jail medicine. or if there are training offered. we want to improve our health system in our jails. at the same time we want to be updated on whats new on jail medicine. hope to here your good office.
    thank you
    dr. paul

    • look up There are q 6 mo major, 3 to 5 day conferences on correctional medicine. by the way I’m traveling to Manila in March, would love to meet you one day to see medical care there if you are around.

    • look up There are q 6 mo major, 3 to 5 day conferences on correctional medicine. by the way I’m traveling to Manila in March, would love to meet you one day to see medical care there if you are around.

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