Experiences in correctional medicine – reflections from a GP Registrar

March 2017

Thanks to Metro West GP Registrar, Dr Georgina East for sharing her experiences in Custodial Health – an extended skills post available in the MCCC GP Training region.

Experiences in correctional medicine

by Georgina East

I’m not entirely sure what I expected walking into Metropolitan Remand Centre (MRC) on my first day in correctional medicine… heavy metal doors slamming behind me, patients in orange jumpsuits shackled, angry violent criminals that I would struggle to examine due to safety concerns or restraints. The nerves of starting in a new job can lead to all sorts of nightmares the night before starting.

But what I was to discover was a challenging, yet fascinating work environment which would, in six months, offer me a wealth of clinical experience that I could not hope to obtain in six years of community practice.

The prison population is a unique population, one where mental health, infectious disease and complex untreated co-morbidities are par for course. Many of the patients I saw had advanced stage disease that had not been picked up due a combination of poor health literacy, difficult access to health care, lack money for medications, addiction issues and homelessness. For some, the prison setting is a stable environment in which health issues can be addressed and care initiated.

Prison medicine is a satisfying mix of general practice and emergency medicine. Traumas are as commonplace as complex medical issues and you must be prepared to deal with both. Rarely a dull moment, there is always something to do or learn. From recognizing an acutely unwell patient from a drowsy withdrawal, what “chicken, points, and g” are, that grouse is a good thing and that shaking a hand goes a long way.

Although there is the odd gem of a patient who will yell and curse at you by in large the prisoner population were respectful and courteous as long as respect was returned. Strong communication skills and a sense of empathy at the frustration they surely face in adjusting to the prison environment is a necessity in this job and one a correctional physician must strive not to lose.

Despite the challenges of the prison environment I feel privileged to have had the opportunity to work at MRC and I would strongly recommend correctional medicine as a career choice. The working day of a prison doctor is unpredictable and a thick skin and unrelenting positive attitude are essential. The job as a prison doctor can be extremely challenging and, at times, frustrating but the small achievements you can make in the health of the prisoners provides immense rewards.