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…

How many times do we condemn or agree before hearing the other side of a story? How many times do we stand accused of not listening carefully? How many times do we misinterpret or misunderstand a gesture, a word, an intention? Why do we assume that we know so much about other people’s lives even though we clearly do not? And, even if we did, why do we think we know what’s best when it comes to how others should live their lives?

Through our cumulative experiences in life, the figurative spectacles through which we see the world become tainted. We, unlike small children, lose the ability to see all things as they are. Instead, we see things through our tainted lenses and think we know best. Read more…

I used to have a more “normal” job.

Early in my career I worked in a large medical center and hospital and rotated through a call schedule. I got called into the ER regularly. I covered the inpatient unit and performed consultations on the medical and surgical units. I did all of the typical work tasks associated with a traditional practice.

Then I left it all.

I started working half-time in correctional psychiatry. I have worked in various other less traditional settings to fill the other half of my schedule over the years, but most of it has been spent working with people with developmental disabilities.

My work life is 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…

You may be surprised to hear that despite being a physician tech enthusiast who has a blog, Twitter and Facebook accounts, and a MacBook, I do not own a smartphone. I’ll tell you why.

I’ve previously described the challenges and rewards of working as a correctional psychiatrist, but I did not go into any detail about electronics in correctional settings. Since the overriding objective of jails and prisons is to maintain a secure environment, all staff members give up certain conveniences that we’ve all grown accustomed to on the outside.

Today, so many electronic gadgets are capable of making phone calls and connecting to the internet. In the hands of  inmates, such devices could allow escapes to be planned, the coordination of gang activity, and the running of illegal businesses from within the prison walls. Because either careless or corrupt actions of staff can result in electronics being possessed by prisoners, staff cannot bring in their own devices.

Cell phones of all types are very high on this list of banned items. In fact, cell phones have become one of the major contraband items in prisons around the world. In “shakedowns” where surprise searches of inmate property are conducted, Read more…

It is a fact that most prison inmates will be released at some point. It therefore would greatly benefit society if those inmates had the opportunity to learn work, coping and life management skills and be physically and mentally healthy upon their release.

While I am in favor of personal responsibility, I also realize from my first-hand experience in corrections that a macho “tough on crime” approach that is purely punitive and does not include such elements is not usually successful in changing bad behavior or in making people more productive citizens. Society, generally speaking, does not appreciate the potential benefit for the greater good that could be realized by investing in treatment programs and clinical research in prisons.

Fortunately there are some researchers who are devoting their careers to solving clinical puzzles in correctional settings. One such person Read more…