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.