Words matter. What we write about our patients in our medical notes to a great degree reflects how we feel about them. Our words also mold our future relationship with our patients. One good example cited by Jayshil Patel, MD in a recent JAMA editorial (found here) is the common phrase “the patient was a poor historian.” There may be many reasons why a patient is not able to answer our questions well, such as dementia, delirium or psychosis. In fact, the inability to present a cogent narrative usually is an important symptom of an underlying condition. “Poor historian” does not reflect this fact. To the contrary, “poor historian” implies that the patient is at fault for my poor documentation, not me! “Poor historian” leaves out that there are other ways for me to get a medical history (medical records, talking to family, etc). “Poor historian” also implies that the patient was deliberately not cooperative—even though perhaps I spent maybe two minutes attempting to get a history.
Many other common medical phrases also subtly disparage patients. Two good examples are the words “denies” and “admits” as in: “The patient denies drinking” or “the patient admits to IV heroin use.” The implication of these words is that we are engaged in something akin to a hostile cross examination where I forced the patient to “admit” (against their will) to drinking and I really don’t believe the patient who “denies drug use.” Words guide how we think about our patients, even if on a subconscious basis. When I use these words, I am saying that my patient and I are not on the same team.
In corrections, perhaps the single best example of a word that negatively influences our relationship with our patients is “inmate.”
I have reviewed hundreds of correctional patient charts and I can confidently say that “inmate” (or the abbreviation “I/M”) is used more than “patient” or the person’s name in correctional medical records. Now I understand that in corrections, our patients are, indeed, inmates. They are incarcerated in a jail or prison and so, by definition, are inmates. I also understand that we learn to use “inmate” in our medical documentation by example and it becomes habitual. No malice is usually intended!
However, “inmate” is usually inappropriate in correctional medical documentation (in my opinion). When inmates are in our medical clinics, they are primarily patients. Yes, they are also inmates, but the fact that they are inmates is irrelevant.
Consider the example of people committed to a psychiatric facility. They are also inmates (by definition) but the medical professionals in state psychiatric facilities do not use the word “inmate” in their documentation. They say “patient” or use the patient’s name. So why do we?
The answer, I think, is that we picked up the term “inmate” (or its prison equivalent “offender”) from our security colleagues. Security is an ever-present concern in jails and prisons in a way that it is not in a psychiatric hospital. We have to go through security to get in and wait to be buzzed through clanging metal doors. We have correctional officers or deputies always about—and we rely on them. They are our friends. The Deputies say “inmate” so we historically have used the term “inmate” until it became habitual.
But our relationship with the inmates in a jail is very different than the relationship that deputies have. When inmates are in our medical clinic, they have become our patients. Using the term “inmate” in our medical documentation misidentifies our relationship. When I used to work both in the ER and the county jail, I commonly would see the same patients in both locales.
“When did you get out of jail?” I’d say at the ER. “Yesterday.”
“When did you get re-arrested?” I’d say to the same person at my next jail clinic. “Yesterday.”
My relationship with that person is the same in both circumstances. They are not an “inmate” in one setting and a “patient” in another. In both places, I am their doctor and they are my patient.
I should finally say that “inmate” is fine in appropriate non-medical contexts. “The inmates just finished rec,” for example, or “How many inmates are in Dorm C?”
But in our medical documentation, let’s please get rid of the term “inmate” and “I/M.” Let’s instead use their name (Mr. Jones) or the general term “patient.”
As always, what I have written here is my opinion based on my experience, training and research. I could be wrong! If you think I am wrong, please say why in comments!
How do you refer to the people in your correctional medical clinic? Please comment!
I realized that about a year ago. Everyone told me in my orientations that we refer to the patients as offenders or inmates but my realization was that they are not inmates they are patients and so all my emails and charting reflects that idea. If there is a witness that is not the patient I may refer to them as an inmate or offender but my patients are my patients. People find it hard to believe that I love my job but I while tired a lot trying to help cover many openings across our state and working many 60+ hours per week in a row I never feel like I don’t want to be there. Others find it hard to overlook what the crimes are but in the hospital I didn’t look up their criminal records because it is not any of my business and two it has no bearing on the care I am giving or going to give. If you hear that someone molested a child or killed their girlfriend and you can’t take care of them like you would a family member corrections might not be a good environment for you to be working in. Several of my coworkers will treat patients as if they are sub human and I am just courteous to all. It doesn’t mean I don’t get called names or have slurs or negativity come my way but overtime I have gained the trust of many of my patients and when I am on duty they know I don’t shell out BS but tell them honestly what I think. It is not my job to punish the patients they are being punished by the court system simply by being my patient. My job is to assess and address their healthcare concerns while they are my patients. It is not a job for everyone and yes you do have to be aware of your surroundings and be on guard against manipulation but it is a very fulling line of work to be involved in and I tell anyone who is interested to come see how they like it. In fact I have liked it so much I know what I want to be pursuing, I want to become a psychiatric nurse practioner and help treat the MH that is so common in our facilities.
Great comment David! Thank you
I totally agree with this! Inmate seems to be so negative when it comes to medical professionals.
Labeling the person as “inmate” infuses an imbalance of power in what should be a normal patient-provider relationship. Calling them “patient” reminds me of their autonomy and agency. For the same reason, I also avoid “refuses” or “non compliant”. Instead, I try to use “declines”, it reminds me that my efforts should be based on collaboration and respect.
Thanks, Amber! I must admit that I use the word “refuses” when inmates don’t come to their scheduled clinic appointments. But you are right that “Declines” is a much better word so I’m going to start using it instead!
I 100% agree with you on this point. I believe changing how you refer to the patients you care for while incacerated is a great step in the right direction of changing the culture of care when individuals are in custody. As a manager of corrections health I saw many many charts with I/M and W/O (women offender) and made a point of instructing all staff to stop using those terms and replace them with patient or client. I believe it has made a difference in the culture of our workplace.
I think it should be called a patient just to be professional. great article btw!
I am a dental professional in a corrections facility. I always prefer the term “patient” while the inmate is in the clinic, that is what they are. Many argue that they are inmates of the facility, that is also correct, however, words do matter! If we call the individual a patient while seated in the dental chair, then we are respecting that individual as the person receiving treatment, which is by all descriptions, a patient.
PS….I also prefer the term “patient napkin” instead of the word “bib.” We are not babies, afterall. Remember that the next time you go to your dentist’s office…take note.
Great article! I’ve only been in corrections for 4 months PRN (my full time is ER) And I say basically the same. I get some hemming and hawing about it from other nurses (not all) and it pisses me off. I’m not a C/O and I’m not a judge. Crime and punishment are not anywhere on the nurse’s creed. I’m there to treat ailments of the body and at times, the mind. This is so refreshing and I’m so glad I found this website!
When I was first hired at a correctional facility, my boss said “they may be inmates, but they are OUR patients”. I couldn’t agree more.