As a corrections physician I frequently heard the question, “How can you take care of those people?” I understood what they were asking, after all, I was caring for people convicted of such crimes as murder, rape and child abuse.
And yet I had very little difficulty providing the same care to inmates that I provided to everyone else. In fact, the corrections environment was generally easier to work in and more rewarding than other clinical settings.
It soon became clear to me that the majority of inmates, just like everybody else in the world, had both good and bad qualities. They could be funny, kind, insightful, intelligent and, yes, truly decent human beings. All too often they came from an environment in which criminal behaviors were the norm and frankly, given the desperate situations in which they were raised, the only option they had to survive. I quickly felt sympathy for those in my care.
Yes, there were definitely some bad players. I took care of unrepentant murderers and serial predatory pedophiles, too. Some were manipulative, some were angry. But even these people had their stories and were often damaged at a very young age. I often thought, “Is this a life that anyone would choose if they had not experienced life-altering pain?”
The first lesson you learn when deciding to provide care in a correctional setting is that you are not part of the criminal justice system. The court system decides the fate of your patient, and it is not for you as a health provider to add to or otherwise change the consequences society has imposed. As a simple example, inmates have exactly the same right to appropriate pain management as anybody else. The fact they have committed a crime does not mean they have to live with more pain than anyone else.
The second thing you learn as a correctional physician is that very few people live in correctional facilities for their entire lives. People who commit crimes are an integral part of the society in which we live, yet we labor under the misconception that they are permanent residents of correctional facilities or at least tucked away in “bad neighborhoods.” They are not. They are our neighbors; they are the person in front of us in line at the mini-mart and even the person who stops to help us when we’re stranded on the side of the road. They are also our 10:30 hypertension patient.
The third thing you learn, perhaps the most crucial lesson for a care provider, is that even when you are dealing with a patient whose past behavior challenges your morals, ethics or beliefs, the quality of care you provide is not reflective of whether the patient “deserves” care, but rather reflective of you, the care provider. If, as a correctional physician, I decided that I would not take that last step, order that last test or ensure that the patient was responding to care appropriately who would be shamed? Not the patient. Me as the physician.
This isn’t an issue that we only face in correctional medicine. There can be a negative reaction to patients that we perceive to be wasting health resources. We’re all human, frustration, and fatigue can lead to exasperation and prejudgment. In truth, I have been guilty of this and have seen it in others. But the big lesson is that any failure to treat every patient with the diligence and professionalism required to provide good care is a reflection on the quality of your practice, not the quality of the patient.
Correctional medicine is not for everyone, but practitioners who do follow this path find a rewarding, unique, challenging environment in which to practice. It also provides insights into how human societies function that cannot be gained in any other way, insights inevitably tempered with compassion for people that are rarely seen as having value.
Robert J. Tilley is a palliative care physician and can be reached on Twitter @RTilleyMDMBA.
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