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.
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.
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.
*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.
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.
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?
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!
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?
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?
*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
*Originally posted by minty green *
**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.
*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.
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.
