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  #1  
Old 12-15-2002, 08:37 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Ask the maximum security prison physician

Well, it's been nine months since I left the practice of medicine in the private sector (after nearly 16 years) to do corrections medicine. It's been quite a time, and a lot of fun, and I plan on continuing my current job deep inside the 1600 bed co-ed maximum security state prison I work at for the forseeable future.

I'm also grateful for the interest and support I've received here at SDMB since announcing my career change and posting various travails. And in the spirit of openness I decided to start this thread.

I won't be naming names, or making diagnoses over the message board, but I'll try to answer any questions I get, when I have the time.

Hopefully,
QtM
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  #2  
Old 12-15-2002, 08:42 PM
Booker57 Booker57 is offline
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Co-ed!?!

Do you live inside when on call or is this a 9 to 5 type gig?
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  #3  
Old 12-15-2002, 08:44 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Strictly 8 to 4, M-F. All call is by phone.

And we have 1570 males and 30 females, give or take a few. Keeping the populations separate is a hassle.
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  #4  
Old 12-15-2002, 10:05 PM
Atreyu Atreyu is offline
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Is there a guard in the room with you at all times while you're with a patient? If I was in your shoes, I'd worry all the time about the possibility of being a hostage.
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  #5  
Old 12-15-2002, 10:08 PM
DoctorJ DoctorJ is offline
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I, of course, am teeming with questions.

Why did you make the switch from private to prison? Was there any specific "last straw"?

While I would never ask for specifics, did the move involve a pay cut? Did your hours go down appreciably?

Do you do all "outpatient" (hee hee) type medicine, or does the prison have an inpatient facility?

What has surprised you the most about the experience?

I'm sure I'll have more later...

Dr. J
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  #6  
Old 12-15-2002, 10:13 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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No, I generally don't have a guard in the room. Only if I request it, or if I'm seeing a patient on the segregation (disciplinary) unit. I have a "panic button" on me, and if I push it, it sends a signal out letting security know exactly where I am, and 20+ security personnel rush in. I hope I never accidentally set it off in the bathroom.

I was worried about the security issue at first myself. However, my nurse, a woman, has been there for over 14 years, and never has needed to call for help. And I feel pretty comfortable now. I am also far more aware of my surroundings, and pay more attention to smaller details, thanks to security training. But I feel safer here than I did working in a lot of big-city ERs. Frankly, here we know who the bad guys are. They all dress in those green or orange outfits. We keep our eyes on them.

In this setting, actions, particularly wrong ones, have rather immediate consequences. Frankly, most of my patients are far more well-mannered and respectful than a lot of those I had previously in private practice. Many are frankly grateful just to get proper attention paid to their genuine medical problems.

And we've never had a significant hostage situation in our institution. But I did have hostage training. What to do when you're a hostage: Whatever your captors tell you to do.
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  #7  
Old 12-15-2002, 10:16 PM
Guinastasia Guinastasia is offline
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Have you ever had to deal with someone who was raped in prison? How common is it?
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  #8  
Old 12-15-2002, 10:21 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Originally posted by DoctorJ
Why did you make the switch from private to prison? Was there any specific "last straw"?
My old organization went bankrupt, and the primary care jobs in my area were scarce, and all pay was based on production, with plenty of incentive to ramp up that coding. My friends were all working 60-70 hours a week to make 3/4 of their previous guaranteed salaries, after the salary guarantees ran out. And the pressures to see patients so you could bill rather than handle things via phone was increasing.

While I would never ask for specifics, did the move involve a pay cut? Did your hours go down appreciably?
Frankly, I get more now than I did in my best years in private practice. Our state docs unionized, and back when competent docs were scarce, the state finally realized it had to offer competitive salary and benefits.

Do you do all "outpatient" (hee hee) type medicine, or does the prison have an inpatient facility?
I do ambulatory. We have an "infirmiry" (think nursing home) for those who need extra care they can't give themselves. We've got dialysis, PT/OT, and X-Ray on site along with a phlebotomist. Most specialist work and inpatient goes to contracted specialists and hospitals outside the prison.

What has surprised you the most about the experience?
How much fun it is, and how I'm more energized and professionally challenged than I've been in years.

QtM
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  #9  
Old 12-15-2002, 10:22 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Quote:
Originally posted by Guinastasia
Have you ever had to deal with someone who was raped in prison? How common is it?
I haven't seen a single one yet. Fights, yes. But not rape. I won't say it doesn't happen, but it's less frequent here than I expected. It does appear however, that there is a lot of "consensual" (read coercive) homosexual sex going on.
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  #10  
Old 12-15-2002, 10:28 PM
DoctorJ DoctorJ is offline
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A few more things I thought of...

How much trouble do you have with malingering? For instance, we have our local "frequent fliers" who know that they can come in and complain of just the right sort of chest pain, and they get admitted and ruled out. Do the prisoners do that sort of thing? Are there any particular ploys they like to use?

How much preventive care gets done? For instance, if a prisoner has a family history of colon cancer, does he get the recommended colonoscopies?

Dr. J
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  #11  
Old 12-15-2002, 10:45 PM
minty green minty green is offline
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What is your opinion of the non-medical prison staff?

To what extent do you find yourself sympatizing with the legal/penal situations of your patients?

How has the experience affected your opinion of our penal system?
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  #12  
Old 12-15-2002, 11:31 PM
Mephisto Mephisto is offline
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Well, let's hope Dr. Qadgop is one of those people who thinks there's no such thing as a stupid question . . .

It's not unusual for a hospital or family doctor to give a patient drugs that can be used to get high . . . seems like my doctor will give me meds containing narcotics for everything from bad coughs to stubbed toes (well, I'm exaggerating a little, but not much). How do you handle giving your patients such medicines in prison? Must the patient come to you for each dose? Does somebody take the drugs to the patients in their cells. Or what? Do you get many people feigning illnesses so that you'll prescribe them drugs with fun side-effects?

Does medical confidentiality disappear for convicts in the American prison system? Who has easy access to your patients' files? What sorts of things, if any, must you notify prison authorities about--you know, medical problems related to drug use, sexual activity, violence, or any other activities that might be frowned upon at your facility.

Any special problems working with such a large population of people living in such close proximity to each other? I'm imagining scenarios where you show up for work one fine morning in the middle of flu season to find that a thousand people got cold chills and diarrhea over night.

What's a Mercotan?

Thank you for considering my questions. Have a great day!
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  #13  
Old 12-15-2002, 11:39 PM
Klaatu Klaatu is offline
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You don't have to name the state or the facility, but a few questions.

You mentioned keeping the female inmates apart from the males to be a hassle.

I don't quite understand this, being a max sec prison. How do they have contact?

Does this facility have a "supermax" or segregated area where the troublemakers, snitches, etc are housed, and is it the 23 hr a day in the cell thing? If so, have you interacted with people who have been isolated by themselves for years, and if so, what is their mental state?
(The reason I asked the above is I understand many supermax prisons almost totally cut off human interaction.)

Do you get searched entering and leaving work?

What kind of attitude do your bosses have re medical care to say, a child molester or rapist. Do they give a shit or (Fuck that baby raper, he can suffer) do you have enough say to give everyone equal treatment?
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  #14  
Old 12-15-2002, 11:46 PM
Fear Itself Fear Itself is offline
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What is the strangest thing your ever extracted from an inmate's rectum?
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  #15  
Old 12-16-2002, 02:27 AM
edwino edwino is offline
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I don't know a politically correct way to ask the question so forgive me if I seem brusque.

How do you feel to be working in one of the two truly socialized universal care health care settings in the US? (The other is the VA for veterans who saw combat.) Do you have any opinions on the fact that these prisoners get far better health care than a significant chunk of the free population? That things like heart transplants (this happened in California) are completely covered for those incarcerated but inaccessible for much of the free country?

Do you have suggestions to fix or change this?

Also, how much HepC, HepB, HIV, and TB do you see? Prisons are supposed notorious breeding ground for these types of things. Also, how do you handle the inevitable outbreaks? Mycoplasma, Norwalk, Adenovirus, etc. are relatively easy to deal with, but is there contingency plans for meningococcus outbreaks and the like?

Do you treat anyone who is sentenced to die?
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  #16  
Old 12-16-2002, 08:19 AM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Originally posted by DoctorJ
How much trouble do you have with malingering? For instance, we have our local "frequent fliers" who know that they can come in and complain of just the right sort of chest pain, and they get admitted and ruled out. Do the prisoners do that sort of thing? Are there any particular ploys they like to use?
It happens, and I don't see a real greater frequency of it here than in private practice. Some of that is situational, as we're the main intake center for the state prison system. Everyone sentenced to prison comes here first, for their evaluation: Medical, vocational, psychiatric, rehab, etc. So the average length of stay is about 3 months, except for our own long-term population, which is 300 inmates.

How much preventive care gets done? For instance, if a prisoner has a family history of colon cancer, does he get the recommended colonoscopies?
Yes, we follow the same guidelines as for the general population
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Old 12-16-2002, 08:24 AM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Originally posted by minty green
[B]What is your opinion of the non-medical prison staff?[\b]
Many are caring professionals. Some are not. 'nuff said.

To what extent do you find yourself sympatizing with the legal/penal situations of your patients?
Frankly I work on disconnecting myself from that part of it. The only facts I have about why they're in prison is from the patient, unless I make the effort to look it up. So whatever story they would tell me will be one-sided. So I tell them I'm there to assist with their medical needs and stick to that. Mental health crises I refer to the psychologists and/or psychiatrists.

How has the experience affected your opinion of our penal system?
Learning the nuts and bolts is interesting. But overall it's a big bureacracy that chews up resources in order to incarcerate people. It does that job, sometimes well, sometimes less than well. We have many dedicated professionals working to make it function right.
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Old 12-16-2002, 08:33 AM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Originally posted by Mephisto
It's not unusual for a hospital or family doctor to give a patient drugs that can be used to get high . . . seems like my doctor will give me meds containing narcotics for everything from bad coughs to stubbed toes (well, I'm exaggerating a little, but not much). How do you handle giving your patients such medicines in prison? Must the patient come to you for each dose? Does somebody take the drugs to the patients in their cells. Or what? Do you get many people feigning illnesses so that you'll prescribe them drugs with fun side-effects?
I'm pretty stingy with narcotics, and use them only when I feel they're needed, for treatment of significant acute pain, or chronic malignant pain. Some medications the inmates keep on their units and can use without supervision, some (especially mood-altering ones) are controlled and distributed by the officers.
And malingering doesn't seem much worse here than other places I've worked. See above comment to Dr. J.

Does medical confidentiality disappear for convicts in the American prison system? Who has easy access to your patients' files? What sorts of things, if any, must you notify prison authorities about--you know, medical problems related to drug use, sexual activity, violence, or any other activities that might be frowned upon at your facility.
Medical record confidentiality is treated pretty much the same way for the inmate as for the free person. But any medical problem that compromises institution security is reported. security comes first ahead of health care. So drug use, violence, etc. is reported.

Any special problems working with such a large population of people living in such close proximity to each other? I'm imagining scenarios where you show up for work one fine morning in the middle of flu season to find that a thousand people got cold chills and diarrhea over night.
So far that's not much different from the general public. In summer, we issue heat warnings and cooling tips, as we are not an air-conditioned institution.

What's a Mercotan?
My alter-ego
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  #19  
Old 12-16-2002, 08:40 AM
plnnr plnnr is offline
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Is there capital punishment in your state? Your facility? Do you support the practice?
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Old 12-16-2002, 08:44 AM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Originally posted by Klaatu
You mentioned keeping the female inmates apart from the males to be a hassle.
I don't quite understand this, being a max sec prison. How do they have contact?

Passing in hallways, sharing waiting areas in the health unit. They are supervised, but raucous behavior can ensue, lots of noise. Extra manpower to supervise

Does this facility have a "supermax" or segregated area where the troublemakers, snitches, etc are housed, and is it the 23 hr a day in the cell thing? If so, have you interacted with people who have been isolated by themselves for years, and if so, what is their mental state?
(The reason I asked the above is I understand many supermax prisons almost totally cut off human interaction.)

We have the segregation unit, for those who break rules. Most stay short times (days or weeks) some do longer. The longer-term ones tend to be the real hard-core cases, associated frequently with mental illness. I've seen and treated them in these units. It is tight supervision 24/7 with few privileges. Many of these guys have a tendency to fling their bodily output about freely. They do get assessed regularly by psychology, psychiatry, and by the medstaff. It ain't pretty but it functions.


Do you get searched entering and leaving work?
Nope. I just go thru 7 access points that have to be opened by an officer, between the parking lot and my office. My ID badge and the fact that they recognize me precludes searches. But any one of them could stop me for search or evaluation.

What kind of attitude do your bosses have re medical care to say, a child molester or rapist. Do they give a shit or (Fuck that baby raper, he can suffer) do you have enough say to give everyone equal treatment?
We are mandated by law to give equal care regardless of what they've done. I personally feel ethically bound to do the same. When the prisoner is on my territory, my orders generally rule. Do the officers respond more slowly and with less enthusiasm to certain individual's perceived needs? It's certainly something to ponder.
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Old 12-16-2002, 08:45 AM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Quote:
Originally posted by Fear Itself
What is the strangest thing your ever extracted from an inmate's rectum?
nothing so far
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  #22  
Old 12-16-2002, 08:52 AM
Qadgop the Mercotan Qadgop the Mercotan is offline
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[QUOTE]Originally posted by edwino
How do you feel to be working in one of the two truly socialized universal care health care settings in the US? (The other is the VA for veterans who saw combat.)
I like it
Do you have any opinions on the fact that these prisoners get far better health care than a significant chunk of the free population? That things like heart transplants (this happened in California) are completely covered for those incarcerated but inaccessible for much of the free country?
I appreciate the irony. I recognize it's a result of our constitution and judicial system, and work on accepting the dichotomy.

Do you have suggestions to fix or change this?
Not really. Not that are workable, anyway.

Also, how much HepC, HepB, HIV, and TB do you see? Prisons are supposed notorious breeding ground for these types of things.
Hep C is all over the place. We have a protocol to see who qualifies for treatment with Interferon and Ribavirin, and most inmates don't meet the criteria (neither do most people out in the real world either). Hep B is here, but not a big problem. HIV patients get specialist care and medications. TB is not an active problem for the most part. Everyone gets screened on admission with a PPD, and many people end up on INH for 9 months as a treatment. These entities don't cause us big contagion problems inside. MRSA (Methicillin resistant staph aureus) is shaping up to be a problem. We're still figuring out what to do.

Also, how do you handle the inevitable outbreaks? Mycoplasma, Norwalk, Adenovirus, etc. are relatively easy to deal with, but is there contingency plans for meningococcus outbreaks and the like?
Case by case so far. If epidemics arise, we use the state epidemiologists to help us figure out the best thing to do.

Do you treat anyone who is sentenced to die?
My state doesn't have capital punishment. For which I am personally grateful. For a host of reasons
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  #23  
Old 12-16-2002, 08:53 AM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Quote:
Originally posted by plnnr
Is there capital punishment in your state? Your facility? Do you support the practice?
See above reply to edwino
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  #24  
Old 12-16-2002, 10:22 AM
Lucretia Lucretia is offline
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I'm going to recieve my BSN in May. I'm aiming to join the AF, but if for some reason that falls through, I've also considered correctional nursing. This may be more of a question for your nurse, but how do you perceive the working conditions for the nursing staff? Do they seem to be more or less satisfied than out in the private sector? How do issues like autonomy and working hours seem to compare?
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Old 12-16-2002, 10:30 AM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Originally posted by Lucretia
I'm going to recieve my BSN in May. I'm aiming to join the AF, but if for some reason that falls through, I've also considered correctional nursing. This may be more of a question for your nurse, but how do you perceive the working conditions for the nursing staff? Do they seem to be more or less satisfied than out in the private sector? How do issues like autonomy and working hours seem to compare?
I'd hesitate to generalize, as each state has its own setup, along with the feds, and there's great variability even from prison to prison. Here the nurses tend to be fairly autonomous, as the original health system in the prison was run by RNs. Pay isn't as hot as the private sector, but the benefits, in terms of health insurance and retirement package tend to be very superior. As state employees and members of a union, they get paid for overtime, and have strong representation at negotiations. But in these days of State Budget deficits, cuts will be made all over, and anticipated raises may not happen (except for the legislators, of course).
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  #26  
Old 12-16-2002, 10:55 AM
Shodan Shodan is offline
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Hi, Qadcop, and thanks for doing this thread -

Do you treat the guards as well as the inmates?

Regards,
Shodan
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  #27  
Old 12-16-2002, 11:14 AM
Ferret Herder Ferret Herder is offline
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How do you feel that your bedside manner has changed - if it has - since switching out of private practice? In other words, does having no 'competition' affect how blunt you are with non-compliant patients, and so forth?
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  #28  
Old 12-16-2002, 11:31 AM
bernse bernse is offline
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Have you run into crooked guards (or other personel)?

Have you run across any inmates that were under the influence of illegal drugs? Have you had to turn them in? How are they handled?

Can an inmate go to a Hospital for treatment that is more specialized than the prision infirmery can handle? Do you have to go with them?

Do you know even know what the inmates are convicted of when you treat them? Is there something like a briefing sheet you get before you see them with all the info on them?
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  #29  
Old 12-16-2002, 11:49 AM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Originally posted by Shodan
Do you treat the guards as well as the inmates?
I treat the guards very well indeed. They may be the ones coming to rescue me. But I don't take care of their medical problems. They've got their own docs and health insurance to do that.
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Old 12-16-2002, 11:56 AM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Originally posted by Ferret Herder
How do you feel that your bedside manner has changed - if it has - since switching out of private practice? In other words, does having no 'competition' affect how blunt you are with non-compliant patients, and so forth?
I tend to be very direct, and don't socialize with the patients, or trade amusing anecdotes with them, or listen to their laments about how they've been misunderstood by society. One gent in particular complained (after proper history is extracted and examination was done) how his shoulder was manhandled by cops, and how I had to contact his lawyer and mother and tell his parole officer it wasn't his fault. I basically told him "What we have is a failure to communicate. This is what's wrong with your shoulder, this is what we need to do about it. Do you understand? Yes? Good! Goodbye."

I don't worry about pleasing the customer, and I certainly don't worry about getting repeat business! I worry about effectively communicating to the patients what they need to know.
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Old 12-16-2002, 01:51 PM
Splanky Splanky is offline
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What do you think of the TV show Oz (on HBO), and are there many suicides/attempted suicides?
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  #32  
Old 12-16-2002, 02:10 PM
Truth Seeker Truth Seeker is offline
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Qadgop

Could you provide links to your "Dr. Qadgop goes to prison" series? I know these were in MPSIMS but it might give people some background . . . also, I'm afraid I may have missed a few!
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Old 12-16-2002, 03:25 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Originally posted by bernse
Have you run into crooked guards (or other personel)?
Not firsthand. I've heard stories, and true reports of personnel getting fired for diverting drugs (to feed their own addictions, not to sell) or having inappropriate relationships with inmates. Oddly, this latter seems more of a problem with female staff and male inmates. I don't know what the attraction is, but some male inmates have really managed to charm their way into the hearts of female staffers. There have been women who left their spouses over inmates. And the inmates take these women for all they can get, as sources of contraband like booze, tobacco, (unearned) money, etc. Then they dump them when they're discharged from prison, or shortly after. I know that employees have been escorted off the premises and terminated for these sorts of behavior.

Have you run across any inmates that were under the influence of illegal drugs? Have you had to turn them in? How are they handled?
Not really. I've suspected they may have hoarded their meds to have a 'party' but it's hard to prove. Security often finds contraband on their routine cell searches, and this is where disciplinary action results. However if my exam showed anything that violated security principles, I would be obliged to report it. So far that means I've reported genital jewelry that made it past security in the first place.

Can an inmate go to a Hospital for treatment that is more specialized than the prision infirmery can handle? Do you have to go with them?
They're sent to local emergency rooms for emergency treatment, with a guard. I don't go along, unless it's a specific extremis situation, which rarely happens. Before leaving in the ambulance, they're subject to strip search and go out in irons.

Do you know even know what the inmates are convicted of when you treat them? Is there something like a briefing sheet you get before you see them with all the info on them?
Sometimes there's a brief description of the law they were convicted under, and their sentence. Often it's not with the chart. I usually don't make it a point to find out why they're in, except when making long-term health care plans. Then I just ask how long the sentence is. I figure the details of their crimes shouldn't matter much to my treatment plan for them, and I don't need the aggravation, or the rationalizations, or the portrayal of themselves as a victim of circumstance or someone else's malice.

Not that I haven't known about some more heinous crimes, and have had to suppress my revulsion for certain people so I could do my job.
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  #34  
Old 12-16-2002, 03:27 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Quote:
Originally posted by Splanky
What do you think of the TV show Oz (on HBO), and are there many suicides/attempted suicides?
I've never seen Oz.

There are regular suicide attempts, some serious, more not. And a few successful suicides. I only get involved in the acute rescue aspect.
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  #35  
Old 12-16-2002, 03:31 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Quote:
Originally posted by Truth Seeker
Qadgop

Could you provide links to your "Dr. Qadgop goes to prison" series? I know these were in MPSIMS but it might give people some background . . . also, I'm afraid I may have missed a few!
I think the best were lost in the Great Collapsing SDMB disaster of early 2002.
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  #36  
Old 12-16-2002, 03:38 PM
Liberal Liberal is offline
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Here is the Boardreader cached version of Qadgop is going to prison.
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  #37  
Old 12-16-2002, 04:11 PM
Ferret Herder Ferret Herder is offline
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Here's a few "tales from prison" stories from QtM (searched in MPSIMS under his username and "prison"):
Epiphany in the Big House
Qadgop, what news from the Big House?
Taking care of a serial killer
A murderer asks me for a consideration
A sex offender doesn't want to suffer
Gollum is my patient
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  #38  
Old 12-16-2002, 05:06 PM
Cervaise Cervaise is offline
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A few questions:

Do your patients know about your "panic button," either in general (you have one) or specifically (what it is and how it works)? I ask only because I wonder whether some desperate type, knowing about it, would try to get it from you in order to prevent your triggering it. Note that I'm not asking what it is, because I assume that information could get passed inside. I'm just curious what if anything the prisoners know about it.

How many of your patients, or the population in general, would you say are mentally ill? (My epidemiologist wife is working on a study of mental illness and recidivism.)

What's the general breakdown of your caseload? What are the proportions for chronic terminal (e.g., lung cancer), acute but not life-threatening (broken leg), and so on?
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  #39  
Old 12-16-2002, 05:13 PM
eunoia eunoia is offline
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Quote:
Originally posted by Qadgop the Mercotan
"What we have is a failure to communicate..."
What's the prison record for eating hard-boiled eggs?

Glad to see you doing great, and thanks for this thread Qadgop, very illuminating.
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  #40  
Old 12-16-2002, 06:59 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Originally posted by Cervaise
Do your patients know about your "panic button"?
Good question. I don't actually know! It's wearable, and just their act of grappling for it would most likely set it off. Also, we work in an area with many people around, so a shout would bring help too.

How many of your patients, or the population in general, would you say are mentally ill? (My epidemiologist wife is working on a study of mental illness and recidivism.)
I'd guess at least a third. Certainly close to 25% are on anti-depressants or anti-psychotics on admission. And it is just a guess, I have not checked actual numbers.

What's the general breakdown of your caseload? What are the proportions for chronic terminal (e.g., lung cancer), acute but not life-threatening (broken leg), and so on?
My personal load is filled with the sicker ones, as my Physician Assistants handle routine care of healthy new admissions. And we average over 100 admissions a week, all of whom need a history and physical. I'd guess and say that 20% of the incoming patients have a chronic physical illness that needs maintenance. This does not count psychiatric illness or chemical dependency.

My own caseload is about 80% chronic illness management, especially diabetes, asthma, heart disease, high blood pressure, HIV, emphysema, Hep C, etc etc. I basically lay the groundwork for their care and get them launched to their final destinations at other prisons. The groundwork can be heavy-duty hard work, because a lot of these people have not been taking care of themselves very well.

The rest is acute care, including colds, tummyaches, and ripping people's toenails off because of ingrown, infected nails (a common problem with young males, who constitute the majority of inmates).

Ripping people's toenails off, even those of convicted felons, is not as rewarding as one might initially think.
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  #41  
Old 12-16-2002, 07:11 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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True anecdote, fresh from today!
Me: What kind of treatment did you have before for your psoriasis?
Patient: I got ultra-violated a number of times.



(ultraviolet light treatments are commonly used for psoriasis)
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  #42  
Old 12-16-2002, 07:36 PM
wring wring is offline
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Quote:
Originally posted by Qadgop the Mercotan
True anecdote, fresh from today!
Me: What kind of treatment did you have before for your psoriasis?
Patient: I got ultra-violated a number of times.
love it. On a form that an inmate filled out for me, under 'ethnic group' he wrote "alcoholic".


He weren't lyin', neither.
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  #43  
Old 12-16-2002, 07:57 PM
Ferret Herder Ferret Herder is offline
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Quote:
Originally posted by Qadgop the Mercotan
True anecdote, fresh from today!
Me: What kind of treatment did you have before for your psoriasis?
Patient: I got ultra-violated a number of times.
I was wondering if he'd watched A Clockwork Orange too much...
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  #44  
Old 12-16-2002, 07:57 PM
Guy Montag Guy Montag is offline
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A fellon chimes in...

I think I can ring in from the other side here: although I was not in prison, I am a convicted felon and spent 267 days locked up.

Qadgop: they know about your panic button. Be sure of that.

Inmates are always happy to see the doc, They are one of the few people who don't (usualy) talk down to you, and at least pretend they care a little about you.

In my own experence, one inmate kept complaining to the COs that he was having chest pains. He was told to lie down--repetedly, and finaly died of a heart attack in his bed. Thankfully, the offending guard was fired.

The toenail thing was pretty common in the facility where I was, there were no nail clippers available. I had one that got so infected that I had to go to the hospital.
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  #45  
Old 12-16-2002, 07:59 PM
MEBuckner MEBuckner is offline
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Moderator's Note: Since this thread hasn't been hijacked into a debate about capital punishment or anything like that, I'm transferring it to IMHO.
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  #46  
Old 12-16-2002, 08:16 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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D'oh! Sorry to make work for you, MEB. I read the felon thread and without thinking posted my thread without heed to the forum I was in. My bad. Seven days in segregation, away from the other threads, for me!
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  #47  
Old 12-16-2002, 08:21 PM
MEBuckner MEBuckner is offline
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It's not a problem. I was just going through the various "Ask the...." threads, scratching my head, and trying to figure out what goes where. Some of the "Ask the..." threads do go in GD (I left the two current "Ask the [adherent to some specific set of religious beliefs]" threads where they were.
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  #48  
Old 12-16-2002, 09:05 PM
StGermain StGermain is offline
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QtM - Why all the ingrown toenails? Ill-fitting shoes? That's just weird. Are you the only physician on staff? How many nurses and PAs do you have working there? Do any inmates work in the infirmary?

StG
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  #49  
Old 12-16-2002, 09:57 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Quote:
Originally posted by StGermain
QtM - Why all the ingrown toenails? Ill-fitting shoes? That's just weird. Are you the only physician on staff? How many nurses and PAs do you have working there? Do any inmates work in the infirmary?StG
Ingrown nails are common in young people in their teens and 20's. This is aggravated by few shoe choices, and lack of nail clippers.

I'm the full-time doc, we've got 4 part-timers, to make up about another 1 and a half full-time docs. A couple of those docs work at other prisons in our system too, to make up their full-time hours. Others float in from other prisons to help out when we're too behind on our physicals. I've one Nurse Practitioner, two Physician Assistants (all fulltime), and we have an opening for another fulltime NP which we haven't been able to fill.

The infirmary position is a full-time one for another doc, we have 54 beds, and no current full-time doc for the slot, so two docs are covering it part-time, leaving us short-staffed in our unit. Inmates help clean and maintain the infirmary and primary care unit (my home) along with some paperwork, but don't do any patient care, other than wheeling some patients places.
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  #50  
Old 12-17-2002, 12:20 AM
Dr_Paprika Dr_Paprika is offline
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How hard is it for prison docs to prescribe methadone in the US? If it is pretty restricted, should it be less so?
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