I’ve now logged 4 weeks as a full-time doc to convicts in prison. It’s been quite interesting, and actually rather pleasant. Our nurses are quite dedicated to delivering competent health care to the underserved, and in this last month, I’ve treated more AIDS, Hepatitis C, and active tuberculosis than I did in the previous 5 years of practice in the “real world”. And I’m treating twice as many diabetics than before too. And I was treating a hell of a lot of diabetics before.
And I’ve also come to employ another persona here. And I love it! It began when a patient came in complaining of a problem, and I took a history, examined him, then started to tell him what I thought should be done for his non-trivial but non-life or health-threatening concern. He kept interrupting me, complaining about his mistreatment by society, how his PO (parole officer) had it in for him, and how I should call his mother to find out just how badly he’d been treated. Oh, and he had lawsuits pending.
Now this is a guy in for his 6th DUI, so he’s a slow learner. After 5 minutes of gently trying to redirect him, I am suddenly inspired to cut to the chase.
Dr. Q: Be quiet and listen to me! If you want me to help you, you will stop talking and pay attention!
Offender: But doc, you…
Dr. Q: I said, be quiet! This is what I think is wrong with you, this is what I will do about it, this is what you need to do about it. Do you have any questions?
Offender: I want you to call my lawyer and tell…
Dr. Q: What we have here is a failure to communicate. It’s time for you to go away. Now.
It felt wonderful! I finally don’t have to think “the patient is also a customer whom I want to come back to see me again”!
Don’t get me wrong, I will continue to do my best to take care of their legitimate medical concerns, but I will NOT get involved in the games! And my god, they do play them! Games to get narcotics, lower bunks, special mattresses, to avoid work detail, etc. etc. etc.
I find I must start every patient visit with a healthy degree of skepticism. Not cynicism, mind you, but skepticism. Looking at every statement and thinking “is that true? How can I confirm it?” It’s good training for dealing with my own 13 year old.
Further bulletins as events warrent.