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Nova and prison

Discussion in 'Pre-Medical - DO' started by Doctor TRuth, Dec 20, 1999.

  1. Doctor TRuth

    Doctor TRuth Senior Member

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    Would it help to actually go to prison before and prepare for your upcoming rotation?

    Just a thought not a sermon!

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    Khan
     
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  3. DocGibby

    DocGibby Senior Member

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    I guess that would depend on who you had as a roomate while your in there. I'm all about making new friends, but you gotta draw the line somewhere. Right DT?

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    DocGibby
    MSUCOM class of 2004
     
  4. RollTide

    RollTide Senior Member

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    I really think this whole topic is getting out of hand and find it offensive that some of you on these boards either dont understand or could care less that these are human beings that are in need of health care, not caged animals. If those of you making these comments think that it will be your proffession to judge the actions of your future patients, you are wrong! This is the responsibility of law enforcement, and in the end, God. One of the many highlights of the osteopathic proffession is the interest we claim we have in providing healthcare to populations who have been ignored by traditional physicians because of either the remote areas they live in or because of lack of funding. Or for those of you who will claim that this is a training issue, please give me an example of another enviroment where you will come into contact with so many people afflicted with AIDS, Hep-C, Antisocial Personality Disorder ect. ect.? Or will you choose to select your patients by not only thier criminal background but also the disease they present with? Maybe we should start a new specialty that treats only the rich(so that we know they have insurance) and they must have no previous criminal background(for our own safety of course),no symptoms of mental illness(persons with mental illnesses can be unpredictable), and we should all work in nice suburb hospitals so that we know that the undesirables will not have transportation to find us. Grow up people!

    -Joshua
     
  5. seneca

    seneca Junior Member

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    The issue is not entirely about the type of patients that are being treated but the fact SAFETY is an issue that concerns most students who face the possiblity of serving in a prison. I believe if you choose to serve in a prison environment you do so at your own will not because it's a requirement of the school. I am also concerned about women who have to serve in this type of environment, which can be VERY hostile. I know in southern Florida you have the opportunity to see many pathologies without serving in a prison. Also, this is not an issue of class its an issue of safety.
     
  6. RollTide

    RollTide Senior Member

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    I thought some might find the following article interesting....


    Most prisoners rapidly return to the community, so it is only practical to provide adequate health care to this large proportion of the US population. [Infect Med(3):160-161, 1998]


    Serious infections and other health problems in prisoners reflect the health status of the
    communities from which prisoners come, and to which they will eventually return. Prompt
    diagnosis and management at the community standard of care is humane, cost-effective, and rewarding.

    The 1.7 million adults currently incarcerated in the US can be considered "sentinel humans." Their sheer number reflects the social state of the nation's poor. Their health indicates the state of our medical, mental health, and public health infrastructure. Many Europeans, weary
    of criticism of the costs of their social programs, point to our huge and rapidly growing corrections industry. They wonder which is, indeed, the more expensive, and which is the more civilized approach.

    Philosophy aside, why should practicing physicians be interested in treating infections and other health problems in prisoners? One reason, as the more than 630,000 corrections employees know, is that the great majority of our sentinel humans will soon return to the flock. Most jail prisoners serve less than a year, and state prisoners released for the first time in 1995 had served an average of only 2 years. Only about 20% of state prisoners receive a maximum sentence greater than 10 years, and far fewer serve that long.
    Incarceration, albeit brief, is an opportunity to interrupt the cycles of drug use and medical and mental health neglect that pervade the incoming prison population. Through active education and involvement of the prisoners, incarceration can be an opportunity to identify and to begin to control the chronic conditions that can lead to catastrophic illnesses and future costs. The quality of medical care in correctional facilities can have a major impact, positive or negative, on the public health.

    Another pragmatic reason to provide adequate health care to prisoners is that it is the law. Many are startled to learn that prisoners are the only US citizens who have a constitutional right to health care. The Supreme Court has held that deliberate indifference to the serious medical needs of a prisoner violates the Eighth Amendment's prohibition against cruel and unusual punishment. With this foundation, most of the dramatic improvements in correctional health care over the past 25 years can be credited to courts and to fear of courts. Public officials are seldom elected or appointed on a platform of improving prison or jail conditions. However, enlightened officials know that litigation and court-supervised
    improvements are far more expensive and cumbersome than simply doing it right--from the beginning. In litigation, as in medicine, an ounce of prevention is worth a pound of cure. To help sustain and advance improvements in correctional health care delivery, the National Commission on Correctional Health Care and the American Corrections Association offer accreditation of health care services in correctional facilities; and the American Correctional
    Health Services Association and the Society of Correctional Physicians conduct programs
    to foster professionalism among correctional health care staff.

    In this issue of INFECTIONS in MEDICINE, Piliero and colleagues describe approaches to
    managing serious infections in prisoners. The knowledgeable reader will note that the
    diagnostic and treatment methods they outline are also applicable to free citizens in a
    community setting. There is no separate standard of care for prisoners. While the range of health care services to which prisoners are entitled may be limited (eg, cosmetic surgery is excluded), as in public and private health insurance programs, the quality of services provided should be the same as in the community. To do otherwise is to relegate tens of thousands of correctional health care staff to the status of providers of second-rate health care.

    Piliero and associates write from the perspective of physicians at an academic referral center that serves a region of the New York State prison system. Though their summary is instructive for physicians evaluating prisoners in any setting where HIV is prevalent, their experience is certainly colored by the extraordinary rate of HIV infection in the New York system--a prevalence of 14%, compared with the national prison average of 2.3%. The US Justice Department estimated that at the end of 1995, the number of HIV-infected prisoners in the New York State prison system had grown to 9500, more than one third of the nation's
    adult HIV-infected prison inmates.

    While many ill and injured prisoners may be identified and managed entirely in a correctional setting, many physicians in community emergency rooms, urgent care clinics, offices, and inpatient wards will be called upon to see prisoners. In addition to keeping in mind the legal and ethical principles involved, the following very practical principles will make the experience more productive:

    Restraints can and should be temporarily removed when necessary to permit an adequate examination. However, escort officers, who are there to prevent escape and
    to protect you, may need supervisory approval to do so, so be patient.

    Suspicion of malingering may be conveyed by escort officers or by referring
    correctional health care staff. Politely ignore this information, evaluate the patient,and do what your findings indicate.

    Refusal of care may be the last effective means a prisoner has of regaining control. A serious illness may remove the last remnant of personal autonomy from the highly regimented life of a prisoner. Urge the patient to act in his/her own interest, and document your conversation.

    Litigious prisoners exist, but like other patients, they usually sue physicians who fail to communicate effectively with them. Professional and nonaggressive interactions with the prisoner get the best results. Add in good care and documentation, and don't worry about litigation.

    Communication with the corrections health care staff can facilitate your work and theirs. Try to ensure that documentation of your recommendations accompanies the
    prisoner back to the correctional facility.

    Special privileges are often requested by prisoners. Requests for special diets,
    housing, bedding, and clothing should be deferred to the correctional health care
    staff, unless they are clearly necessary. Focus your recommendations on the medically important things.

    About the Author:

    Dr. Hutchinson is a Fellow in the Division of Infectious Diseases and Tropical Medicine at the University of South Florida College of Medicine, Tampa. During his 14 years as a
    correctional physician, he has served as a Staff Internist, Regional Medical Director, and Acting Chief Medical Officer for the Michigan Department of Corrections.
    http://medscape.com/SCP/IIM/1998/v15.n03/m4570.hutc/m4570.hutc.html
     
  7. DocGibby

    DocGibby Senior Member

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    Lighten up RollTide!

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    DocGibby
    MSUCOM class of 2004
     
  8. KimR

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    I know health care professionals who work in prisons and mental hospitals, and I have worked in a regular hospital for 2 1/2 years. At my workplace, I have seen patients that bite, scratch, scream, threaten nurses, and have confrontations with medical personnel as well as family members. Earlier this week a patient bit a nurse-practitioner and defecated all over her room. On the other hand, a nurse who works in one of the area prisons said that prisoners treat her better than any other patients did. She noted that she and the other health care providers are the only people who ever express concern for the prisoners welfare, and they respond to that care with respect and gratefulness.

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    "Every individual matters.
    Every individual has a role to play.
    Every individual makes a difference."
    -Jane Goodall
     
  9. strive

    strive Junior Member

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    RollTide,
    Depite my reluctance to add any more commentary to the correctional medicine "issue", I must commend you for the information and different perspective. (This in spite of my being a Big Orange fan. Go VOLS!)

    To others who seem so reluctant to embrace new opportunities:

    Everyone keeps going back to the safety issue. I agree 100% that it is prudent to seek a safe work environment. However, how do we define safe? I was mugged and beaten, pistol whipped and had a gun cocked in my mouth while I was an undergraduate student at my University. This was while walking in a very well lit, public area with 4 friends in the early evening in an area NOT known for crime. I laid on the ground, half unconcscious while probably 20 people watched and none of them called police as me and my friends were attacked.

    Conversely, my wife spent weeks in correctional medicine rotations at maximum security sites and never even received a foul comment from a prisoner. She never felt threatened, but she was cautious in her comments and actions as a healthcare provider.

    So, how can people who have NO IDEA what it is like to work in a correctional medicine environment question safety? Trust me, nowhere are you perfectly safe. Despite my actual experience with crime, I have not altered my lifestyle or restricted my activities. Therefore, why would a student restrict their opportunities because of the imagined and unproven potential for a problem?

    Live Life. Get rid of your unjustified and uninformed fear of the unknown.
     

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