everything i need to know, i learned in prison

I finished a two month rotation at a prison in rural northern Florida recently. And since i left, there has been a part of me that actually misses working in a prison health care facility. Yes its true, things didn't always run smoothly, sometime people were rude, it took FOREVER to get simple tasks done. But in the end, its what i expected. Unlike working in a top state of the art health care facility, where being treated like crap is not as expected. In prison, your expectations of other people's behavior, including those of the patients (inmates) are different. In the prison, as a doctor my word means something, my opinion means something, and there is no web MD for inmates to browse during their free time. There are no families to delay you getting your work done, and there is no need to be spending extra time dealing with family drama, instead you can actually focus on patient care - where it belongs, and social workers can deal with the family issues. So as stated earlier, in the prison the expectations are lower, but everybody has their role, and the boundaries are more clearly defined. And if you want someone to clarify their position, there are always prison guards eager to 'inform' others of their roles.


Here are some good tips I learned in prison:

1. patients lie! especially when they are 'falsely' convicted felons
2. you got nothing but time, while in prison
- if only they could take that kind of mental energy used to manipulate others for selfish gain, imagine the possibilities, productivity and ingenuity. Anyone that can make a weapon from soap, or devise complicated methods for smuggling contraband - should put his brain to better use
3. patients didn't become inmates for attending church
- at least in prison i know they are dangerous guys, in the real world - they walk around just like everyone else. they don't have 'murderer, rapist or child molester' stamped on their foreheads.
4. don't be shocked by any irrational behavior (ie self harm, swallowing of strange objects) - they like the attention
5. if you want to get something done, there is always someone around to "take care of it"
(ie - you want your patient to be compliant or stop refusing medical care - let other inmates know of your disapproval with his current behavior, the next day you will be amazed at his attitude adjustment)
6. the faster you can learn who to trust, the easier the job
7. trust no one but yourself
8. be grateful everyday you get to walk out the front gates



All in all - my two months were great. I met some nice people, learned a lot of medicine, practiced a lot of procedures and helped people who never had access to health care get treated. Its unfortunate, but here are people who actually have told me - they intentionally broke parole so they would be able to have access to HIV medication, chemotherapy or even surgery.

There is something to be said for not providing - productive members of society with universal health care, while making it a against the constitution (8th amendment) to not provide criminals with health care....

we treat our criminals better than our poor in this country....i am going to be interested to see how things change in the next few years.