nothing so far
[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
See above reply to edwino
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?
*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).
Hi, Qadcop, and thanks for doing this thread -
Do you treat the guards as well as the inmates?
Regards,
Shodan
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?
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?
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.
*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.
What do you think of the TV show Oz (on HBO), and are there many suicides/attempted suicides?
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!
*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.
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.
I think the best were lost in the Great Collapsing SDMB disaster of early 2002.
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
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?
What’s the prison record for eating hard-boiled eggs? 
Glad to see you doing great, and thanks for this thread Qadgop, very illuminating.
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.