I knew immediately that James wasn't like most of my patients. The first thing I noticed was that he had rearranged the exam room so that he was not sitting with his back to the door. He was twitchy and seemed paranoid. He said he'd felt sick just stepping out of his apartment to come to his appointment. When I tried to examine him, he jumped and batted my hand away. My stethoscope flew off my shoulder.
I was startled, though not particularly surprised. James had just been released from 10 years of solitary confinement, and it was the first time in a decade that he'd been touched by another person. If some other provider had seen him, this visit might have ended differently: with frustration, aggression or even a call to the clinic security. But because I was trained to care for patients with a history of incarceration, I gathered my composure and continued on.
Close to 13 million patients return home from correctional facilities in the U.S. each year, often having been exposed to extreme conditions or even, as was reported in a recent New York Times article about Rikers Island, allegations of abuse at the hands of correctional officers. But rarely if ever are these patients seen by a provider trained to care for their special needs. Only 22 primary care residency programs in the U.S. train physicians in how to care for prisoners or people who have been through the correctional system.
The ignorance of medical professionals has serious consequences for these men and women and the health care system at large, especially as many of these patients stand to gain access to health care through the Affordable Care Act. Whether they use it is a particularly significant issue for the mentally ill, who are overrepresented in the prison population, many of them urgently needing treatment once they're released and must also manage medications.
Most health care providers don't know how common incarceration is (one in every 31 adults is in the prison system, according to the Pew Center on the States). They don't know that being released from a correctional facility puts a person at high risk for being hospitalized or dying, or that prisons even operate their own health care systems.
They don't know that many of our most powerless patients have their first exposure to health care as adults in prison, that patients in correctional facilities do not inject their own insulin or manage their own medications, may have to get permission from a correctional officer to see a health care provider and can even be punished with solitary confinement for not taking their medications.
Training medical professionals about the correctional health care system alerts them to the unique health risks of prison and how they might help patients prevent future incarcerations. But perhaps even more important, it creates a space to acknowledge that even physicians have a hard time avoiding the prevalent stereotype of criminals -- black, dangerous and deserving of incarceration -- and this can affect who they treat and how. ..Continued.. by CNN, Emily Wang
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