5 Things You Didn't Know About Being a Prison Doctor

Gone are the days when physicians in correctional facilities were those with the worst reputations in the field, whether that was due to news reports of substandard education or malpractice and disciplinary issues. Recent focus on prison health care has helped transform an inadequate system of care into a rapidly improving one, though much depends upon the prison's location -- some states have major prison overcrowding, and this means doctors just don't have enough time or resources to treat everyone. Luckily, this isn't the norm.

So how do nurses, physicians' assistants and physicians find themselves practicing in the correctional health care system? "We stumble into this field," explains Dr. Katina Bonaparte, a family medicine physician practicing at the Cook County Jail in Chicago, Ill. Often, the first introduction to correctional health care practice is during an elective medical residency, and that's all it takes for many doctors to find their calling.

"It's a chance to take care of someone who may have never been taken care of by a physician. We change and save patient lives," continues Bonaparte. "I think it gives people a different perspective on how they want to practice medicine."

According to a report released by the Bureau of Justice Statistics, more than eight out of 10 prisoners reported having had a medical exam or blood test since their incarceration. It's estimated that 44 percent of inmates in state facilities and 39 percent in federal ones report having a medical issue, not counting the common cold or viruses [source: Maruschak]. What do prisoners do when they need medical attention?

Inmates typically have access to a health care professional as often as daily, if needed, and can ask for medical attention by submitting a health services request form, though this process varies from one facility to the next.

"I treat patients as if they're never going to leave," says Bonaparte. "We take the opportunity to educate this captive audience. We run clinics; we bring in specialists. For the majority of patients, the primary care they receive is in the correctional system."

Physicians in private practice often talk about the importance of establishing a relationship with their patients. In that setting, it's not only desirable but also encouraged by both the community and the doctor's office. "When you see patients in jail, you can't approach the situation in the same way," says Bonaparte. "There are patients you bond with, and the relationship is cordial, but you need to be more cautious." Sharing personal information with inmates can be a safety issue, and some inmates may take advantage of such a situation.

Balancing physician safety with patient privacy also complicates health care in the correctional system. Officers are present, often outside the exam room door. Security needs to be close enough to watch, but far enough away not to hear, out of respect for patient confidentiality.

Inmates who act unpredictably may wear shackles when seen by health care professionals, but "patients, for the most part, are courteous and appreciative," says Bonaparte. "We're here to help them, and I think there is that understanding."

Under the Eighth Amendment of the U.S. Constitution, correctional facilities must provide medical care to inmates. It's a right all Americans have when they find themselves in the correctional system.

Essential standards of care in a correctional facility include an initial health assessment, which includes a questionnaire to collect information on prisoners' medical, dental and mental health histories, as well as vital signs, a physical exam, screening for communicable diseases and immunizations [source: NCCHC]. Does this sound more thorough than your own annual physical? It likely is. And because health care is constitutionally mandated for inmates, it's likely they didn't have a co-pay (or bill) or have to wait very long for an appointment.

"People's social situations affect the way people take care of themselves, and I think a lot of people have just been dealt a really bad hand. Sometimes there's no getting out of it," says Bonaparte. "We provide such exceptional care. It's the right thing to do, no matter why they are here."

The most common medical problems treated in correctional facilities aren't necessarily from accidents or fights, as many may think. Rather, they include a variety of both chronic and infectious diseases.

Heart diseases, cancer, liver diseases and AIDS/AIDS-related illnesses are the most common causes of inmate deaths in state correctional facilities. In fact, AIDS rates in the prison population are 2.5 times greater than in the general U.S. population [sources: Mumola; Maruschak]. Outside of the prison population, for comparison, heart diseases and cancer are also the top two causes of death, but they are followed by stroke and respiratory diseases [source: CDC].

"We see a high rate of HIV infections, tuberculosis infections, STDs [sexually transmitted diseases], MRSA [Methicillin-resistant Staphylococcus aureus] -- and substance abuse is very common in the correctional setting," explains Bonaparte. "It's a challenging day-to-day job for many reasons. Not only medical issues, but psychosocial issues, as well."