One might assume that inmates in correctional facilities would not be influenced by big pharma’s direct-to-consumer advertising (DTCA) strategies. After all, their communication channels with the outside world have largely been silenced.However, many do have access to television. And despite an increase in online pharmaceutical marketing, TV remains a common medium for trying to persuade patients to “ask your doctor” about drug X. Inmates also read magazines, another common ...
Jeffrey Knuppel, MD
Physicians who treat inmates are at greater risk of litigation
Most psychiatrists and primary care physicians who work in corrections long enough will end up being named in a lawsuit or having a complaint filed against them with their licensing board. So, from a risk-management standpoint, is it worth the potential hassle?Yes, in most cases I think it is.It is a fact that physicians who treat inmates are at greater risk of litigation. I don’t have specific figures to give ...
A psychiatrist on the compulsion behind running and exercise
I love running.I typically run 3-4 miles a day 5 to 6 days per week. It's only about a half hour of time, and it's well worth it. I get 'in the zone' when I run, and I can tune out the rest of the world and enjoy just being. It feels great physically and mentally each time. It's helped me immensely to stave off the obesity issues that have ...
Where do we draw the line on criminalizing mistakes?
Eric Cropp was a pharmacist who was sent to prison for a mistake that resulted in the death of a child.This was a high profile case, but it was just one of many examples of a disturbing trend I’ve seen in the U.S. in recent years: a person commits a mistake–with no malicious intent and without being under the ...
Aspects of psychiatry this doctor appreciates
Working as a psychiatrist is very rewarding. It’s stressful in a unique way, and some people may look at me strangely for having an unusual job. But overall I really enjoy it. Here are some of the aspects of psychiatry that I really appreciate.1. Being trusted. Psychiatrists meet people when they are at their most vulnerable points, and we are entrusted with extremely ...
When should psychiatrists give advice to patients?
This post was inspired by Dinah, a psychiatrist over at Shrink Rap.She recently described how a psychiatrist friend of hers has been going through some phase-of-life changes. Recently he has regretted some of the advice that he previously had given to patients who were going through the same life changes he’s now going through himself. He realizes that he was not nearly so qualified to give the advice ...
Lotteries in life may have to do with suffering, disability and death
Winning the lottery -- yes, I've heard the horror stories of how people's lives have taken a turn for the worse after it's happened. But, like many others, I still wonder what it would be like. I'd be willing to take my chances with the win!But this post is not about money. Not at all. Actually it's about gratitude.It's about the many 'lotteries' in life that have nothing to do ...
Physicians need to take responsibility for their actions
As the saying goes, when you’ve got a hammer, everything looks like a nail. Send a patient to a surgeon, and he very well might get surgery. Send a patient to a psychiatrist, and he very well may end up on psychotropic medication.As physicians, we need to take responsibility for our own actions. We should not prescribe or perform procedures unnecessarily. However, even if we are responsible for our own ...
Involving a psychiatrist in a patient’s care for the first time
The psychiatrist knocks on the door of the patient’s hospital room.Patient: “Come in.”Psychiatrist: “Good afternoon, Mrs. Jones. I’m Dr. Moodbetter, one of the psychiatrists here. Your doctor asked me to see you. Did he say anything about this?”Patient: “No, he didn’t! You know, I’m not nuts. I didn’t think he believed me. Great. Now he just thinks it’s all in my head.”Psychiatrist: “Well, I don’t think he meant to imply ...
Technology can help your aging parents
One of the most difficult family decisions can be whether to move an aging parent(s) out of their own home and into assisted living or even a nursing home. I’ve seen families face this dilemma numerous times. (After my psychiatry residency, I completed a geriatric psychiatry fellowship and also spent the first few years in practice consulting at nursing homes.)Nobody wants to face this situation.In fact, I’ve seen repeated instances ...
Do all people with disturbing behavior have a psychiatric illness?
“Hey Doc, this guy needs some help.”I’ve heard that statement from countless correctional officers over the years. Its meaning is very simple: Someone is exhibiting thoughts or behaviors that the officers find disturbing and “not normal.”I appreciate the officers expressing concern. Without their input I often would not be aware of cases where I might be able to be of assistance.But, one of the questions that always pops into my ...
Forgiveness shaped by the stories of people’s lives
If you had asked me what I thought forgiveness was when I was a young adult, I probably would have said that it is something you do for others—others who have wronged you in some way, to give them a break and let them know that you are no longer angry or upset with them.As I’ve matured emotionally over the years, my view of forgiveness has evolved significantly. Some of ...
The emotional state of doctors can affect patient care
Great doctors listen to their patients.They start out by asking open-ended questions, and unless patients get too far off-track, they don’t typically interrupt them. Despite having limited time for appointments, they have an unhurried manner. They make eye contact with their patients and do not bury their heads in charts and computer screens. Their patients leave their appointments feeling respected and heard.Of course no doctor is likely to be able ...
3 tips to stick with an exercise program
How many times have you started a new exercise program and been determined that this time would be different? You’d actually keep it up. You wouldn’t quit. But, a few weeks or months later, you’re back to your old ways. You’re busy, and you have lots of “legitimate” excuses for skipping a fitness routine.I think most people who have tried to make regular exercise a part of their lives have ...
Treating intellectual disabilities in patients who can’t talk
Psychiatrists treating patients who can’t talk. Sounds fishy, doesn’t it?Well, I do it 2-3 days per week, and as strange as it may sound, it makes perfect sense.Let me explain.I provide psychiatric consultation services in a facility for people with intellectual and developmental disabilities. (Intellectual disability is the newer term for mental retardation). Some of my patients are short-term admissions from the community, and others are long-term residents of the ...
Oil spill got you down? Here’s what to do about it
As I've watched all of the media reports and videos of the oil uncontrollably gushing into the sea, the decaying marshlands, and the suffering or dead wildlife, the profound sense of sadness, anger, helplessness, and disappointment that I felt after 9/11 returned.I don't feel it all the time—it's not clinical depression. It's just strong negative emotion associated with the fact that both 9/11 and the oil spill were man-made disasters ...
Should prisons require co-pays for inmate health care?
In the U.S., correctional facilities are required by law to provide inmates with access to medical care. As health care costs have spiraled out of control everywhere, jails and prisons have attempted to develop innovative ways of reducing this hefty financial burden while simultaneously meeting their legal obligation to provide care.One approach that has gained significant popularity in recent years is to require inmates to pay a small fee, usually ...
Treating patients in prison for murder
Correctional psychiatrists inevitably treat patients who have been convicted of a broad array of crimes. There is a correlation between the security level of the institutions in which one works and the severity of the crimes of the inmates being housed there.Since I’ve treated inmates of minimum, medium, and maximum custody levels, I’ve had the opportunity to work with people who have been convicted of everything from drug possession to ...
Explaining chronic medical treatment to patients
Although some psychiatric conditions are acute and transient, most are chronic. They may wax and wane, but most of them do not go away. Likewise, psychiatric medications can significantly improve people’s functioning and quality of life, but they manage, not cure, mental illness.It’s therefore not surprising that a common conversation that patients and psychiatrists have revolves around the question, “Do I have to be on this medication ‘forever’?”I’ve previously written ...
Prison affects how children relate to their parents
It’s an unfortunate scenario I’ve seen time and time again:* Parent goes to prison. * Child, who already felt neglected by parent, becomes more upset when parent ends up behind bars. Child either blames the parent for misbehavior that results in parent being taken away from child and/or blames him or herself (as children often do). * Parent tries to have contact with child via phone calls, letters, or visits. * Child decides ...
