No Firing Patient in Corrections

I remember back in residency there would occasionally be the wild, rude, drug seeking patient that we would have to call security on for threatening the staff when they were told they weren’t getting a bump in their opioid prescription. There were also the patients that would constantly no-show for clinic appointments, were never compliant with any treatment regiment, and when confronted would become verbally abusive. These types of patients had one thing in common. They were fired from clinic. Exiled into the world to find another poor provider never to be allowed in the doors of our clinic again. Conversely, if our patients weren’t happy with our care they could fire us as well, quit the clinic and seek out another provider.

In the correctional environment we are stuck with each other, I can’t fire my patients, and they can’t fire me. It’s like being a doc in some bizarre summer camp, we are all on the same canoe. To illustrate the contrast in this topic between the normal world and the parallel universe that is prison medicine a few recent patient encounters come to mind.

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A Day in Prison

Of the four facilities I currently work at the high security penitentiary is my favorite, and where I spend most of my week. I find the higher security Uber maximum prison to be draining. The inmates are constantly locked down, they have nothing to do most of the day but fester on their problems which often makes their quasi-medical issues become immediately life threatening in their own minds. The inmates at the low security and medium security facilities sometimes don’t realize they are in prison. I often get of mirage of complaints about the wait time for medical, or why they can’t have their turmeric ginger tea shipped in. At the pen the inmates know they are in prison, most are convicts that have been in for the greater part of their life and still have several years to go. The Penn is what you imagine prison to be like. Gangs, fights, drugs, it’s all there. What follows is an average day in my life. Read more

A Day in the Life

I feel that whenever I have a story to share from the chronicles of residency or life it is typically an outlandish outlier from the day to day events of normal life. These patient stories and tales of inpatient medical adventurism are of course entertaining to share with other residents, and useful in doing so to blow off steam. These stories are also typically the traumatic or heart wrenching memories that have a profound shaping effect on our careers and insights as physicians. But, what often gets missed I feel is the mundane days that fill the void between the outrageous tales of crazy and noteworthy patients. I also think we as health care providers get so used to this monotony that we sometimes fail to see just how amazing and equally outlandish our typical normal days have become for better or for worse.
      So I feel justice should be paid to an average day in the life of a resident. One random day while on inpatient medicine I decided to chronicle the entire day. The following is the story of that day. If not for taking note of it, this day would have likely been lost from all memory and would have passed as just another drip of water on my forehead in the endless water torture that is general medical education.

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My Return…

It’s been almost a year since my last blog. Much has happened and in some ways its been a little overwhelming to absorb all the transitions that have unfolded. Although, I suppose that in itself is not special. We all live our own important lives with transitions and adventures in our own way. So in some sense that is no excuse for not finding the time and mental space to keep writing. This blog helps me make sense of the world, the brilliance, and idiocy that surrounds me. Ultimately writing helps me to figure out which one is which. Perhaps I’m shy to write more again as I’m pretty sure I’ll just wind up finding idiocy in my own self perceived brilliance.


In summary over the last twelve months: Read more

The Interview Trail

We walk many lines in life. Sometimes these lines are well structured with clear and concise paths laid out in simple steps. Sometimes they are serendipitous. Most of the time we don’t see the lines for what they are. They are simply lines. Lines that we’ve created by our free will and choice. These lines cut and shape the seemingly gelatinous space that we call our lives to give us an idea of purpose, direction, and ultimately the identity of what we see ourselves to be.  Sometimes in rare glimpses we are allowed the fluke chance of circling back and re-emerging  on a line after a tangential circumnavigation through the life jelly, and in these strange moments we see can see a little more clearly, and we see that defining ourselves solely by the line we walk in life is a bit of a joke. If there are an infinite amount of possibilities in how we cut through the jelly than one singular path cannot possibly be our definition. Our identity that is immutable is the substrate between the lines. How we shape that substrate with these lines and paths through higher education and the carnival of the modern business world is just a byproduct of living in the modern world, and not as meaningful to our real identity as we are trained to think. Read more

We need a new model

It’s common language now to say that we have one of the best health care systems in the world, but some of the worst access to care. In my mind this is true, but it’s missing the point. In thinking about healthcare as a business saying that we have poor access to care is basically saying we have a great product, but our potential customers due to various reasons can’t figure out how to use it. We take a passive approach when we start placing the burden of our failing system on access to care alone. Our model is complacent with the concept that the patient will come to us. We commonly accept the idea that our patient’s will negotiate their own insurance, co-pays, and the myriad of other complexities involved in acquiring and utilizing healthcare. In short, we have the potential to offer a brilliant product, but we over rely on our customer to do all of the work to reach what we are selling, and often through a web of tangled bureaucracy.  Our access to care is indeed terrible, but poor delivery is equal to blame. What are we doing as a medical community to offer new innovative ways that would allow our patients not only quicker and more efficient care, but a delivery mechanism that takes the burden of procuring healthcare off patient and more on the infrastructure?  Read more