I can’t fire my patients

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