This Patient Needs to Be Seen by Mental Health, But When?

This morning, inmate Gibbs had a visit.  The nurse passing medications in the housing unit noticed that he was not ready when his name was called.  Unusual.  Mr. Gibbs is typically aware of his visits and is up and ready at least five minutes before it’s time to go.  The nurse asked Mr. Gibbs if he was feeling ok.  Mr. Gibbs just shrugged and left the unit for his visit.  Later that day, the nurse noticed that Mr. Gibbs was not out in the day room playing cards with others, like he usually is.  The nurse walked by Mr. Gibbs’ cell and noticed he was just lying on his bunk looking at the ceiling.  The nurse asked again if everything was ok and Mr. Gibbs stated, “Just not my day.  Things aren’t working out for me.  That’s the problem with hope, you always get disappointed.”  “Anything I can do?” the nurse asked.  “No, man.  Thanks.  Just gotta do what I gotta do.”

Every individual who works in a correctional setting has unique experiences with inmates.  Based on your role, your personality, your style of interaction and how others perceive you, you are likely to see and hear things that others do not see and hear.  In the above example, the nurse has a unique perspective on what’s happening with Mr. Gibbs. 

Do not underestimate the value and importance of what you see and hear.

When you notice things are out of the ordinary, ask questions.  If the answers leave you feeling unsure, make a referral. 

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Top 2018 Medical Research Articles for Corrections

One thing I look forward to each day is looking through my medical feeds that keep me up to date with medical research.  Most of this content ranges from bogus to unhelpful (in my opinion), but every once in a while, a truly game-changing article appears.  Over the years, I have noticed that most of the game changing articles are debunking articles.  They show that something that is commonly done in medicine actually has no value.  I love these!  Not only do they improve the medical care of my patients, they also make me more cost-effective.  As I have said before, the main way to save money in Correctional Medicine is to eliminate (and stop paying for) medical practices that have no value—or even worse, are harmful to patients.

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My Thoughts on MAT in Jails

I recently ran across this news article on NPR (found here) about the problem of treating the large number of opioid addicted patients who are coming to our jails. There is a growing movement that all opioid addicted patients should be offered Medication-Assisted Treatment (MAT) while in jail–meaning one or more of three drugs: methadone, Suboxone or Vivitrol. The article does a good job in pointing out that this is a complicated problem. Having been on the front lines of this problem for many years in my own jails (and so having that great teacher–experience), I would like today to present my own thoughts on using MAT in jails. (MAT in prisons is a separate subject that I will address later).

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Get Updated Information Here…

We have added an ‘event’ on our Facebook page for the Essentials of Correctional Medicine Conference.  Make sure to jump over there and join the event for all of the latest information regarding the conference next month. Continue reading

Diabetic Snacks: Part Two!

Full Service Prison Cafeteria

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 here and also comment on another issue that I failed to mention in the first article but that is important:  the non-medical security issues of having diabetic snacks.

Myth:  Four Meals are Better than Three for Type 2 Diabetics

The first justification for diabetic snacks is the idea that if Type 2 diabetics eat several small meals rather than 3 big meals, there will be more even absorption of calories and carbs.  This would cause smaller blood sugar spikes at meals.  In other words, four meals (counting the bedtime snack) is better than three meals. Continue reading