Lockup Doc

As correctional health care professionals, there may be times when we are tempted to conduct ourselves in a less than professional manner simply because we can.

We may be able to get away with speaking to our patients rudely, using profanity profusely, or wearing inappropriate clothing. After all, we work in jails and prisons. This culture is far from prim and proper. And, our patients are inmates. Many may tolerate misbehavior from us that patients on the outside would not and should not tolerate.

I’ve previously written about how I’ve found the book, Games Criminals Play, to be an invaluable resource. One key point that I learned is that many inmates, especially those trying to set up and manipulate staff, want to know whether each prison worker is a fellow inmate or “the police.” In other words, do we side with the inmates, or are we professional workers who take our jobs seriously? Read more…

Bupropion (Wellbutrin, Zyban) is a unique but commonly prescribed antidepressant that inhibits the reuptake of dopamine and norepinephrine. It is FDA approved for the treatment of major depressive disorder, seasonal affective disorder, and smoking cessation. It is commonly used off-label for the treatment of attention deficit hyperactivity disorder (ADHD).

Anecdotally there have long been reports of abuse and diversion of bupropion in jails and prisons. In my own personal experience in these settings, I have not seen much evidence of such misuse. Inmates rarely present to me seeking this medication. By contrast, and about which I have previously written, quetiapine (Seroquel) is highly desired medication in corrections.

I conducted a literature search on this topic and Read more…

To be effective and enjoy working as a psychiatrist in any setting requires unique personality traits. Likewise, to be effective and enjoy any type of work in corrections requires unique personality traits. But, working as a psychiatrist AND doing so in jails and prisons narrows down the field even further.

For the right candidate it can be a very rewarding career. For others, frustration and ultimately burnout may result.

Here are a few personality traits that I believe are important:

1. Having a Strong Sense of Independence: One needs to be able to organize and prioritize many different tasks without having to ask for advice and reassurance often.

2. Having Patience: Prisons and jails work on their own schedules. The primary priority is always security. Health care is an ancillary service in corrections, not the primary mission. There will be frequent delays and inconveniences that arise. One must be able to shift gears, adapt, and still make the best use of the time available.

3. Having a Sense of Humility: Psychiatrists make more money than most workers in correctional settings and also must work hard to earn the respect of other staff since those providing “help” in corrections are often seen as enablers. Walking in with an attitude will assure a psychiatrist even higher doses of resentment and passive-aggressive behavior from Read more…