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
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.
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
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).
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 →