My time in custodial medicine at Metropolitan Remand Centre

I’m not entirely sure what I expected walking into 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.

One of the most difficult things I found in my time at MRC was allocation of resources. We learn about this word ‘justice’ in medical ethics but in the community we rarely have to contemplate it in any real way. I have never had to choose between a mother, child or grandfather getting treatment however, in prison, this has been a frequent struggle for me. With external resources for nine hundred prisoners limited to St Vincent’s Public Hospital and only two transfers out per day, I found myself frequently having to choose between patients. How does a doctor choose between sending the new murmur in the context of IVDU for a much-needed echo versus a newly diagnosed Hodgkin’s lymphoma to see their heamatologist versus the man with an acute head injury to ED? These were choices I never expected to have to make and an issue that I found immensely frustrating and distressing at times.

Despite the challenges of the prison environment I feel privileged to have had the opportunity to work at Metropolitan Remand Centre 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.

Contributed by Georgina East
January 2017

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