** Names and details have been changed to protect patient confidentiality, privacy, and dignity **
Working in a women's correctional facility over the past week has been a very insightful learning experience. In many ways, there are no differences between care on either side of the barbed wire. Patients present for treatment of hypertension, diabetes, GERD, thyroid dysfunction, asthma, irregular menses, UTIs, and general health maintenance. Labs can be ordered on-site, and a relatively large formulary is utilized. Patients attend all appointments and are 100% compliant with medications. As in an "outside" clinic, patients with surgical needs are referred to the hospital. If not for the homogenous uniforms and locking steel doors, one would never know the clinic was in a prison.
I was allowed to examine Monica, a very friendly middle-aged woman following up with several chronic illnesses. Aside from her shackles, she could have been any patient seen in outpatient clinic. As we lightly conversed about the weather and the prison food, I realized that I had been previously acquainted with Monica. Several years earlier, I met her under a front page headline of the daily paper, her smiling mugshot juxtaposed by the grisly details of a cold-blooded murder. Her arrest and subsequent trial had been sensationalized in the media, due to the sheer cruelty and brutality of the crime. Oh yes.
That Monica.
During my first year of medical school, we completed an exercise to identify possible prejudices we may have toward different groups of patients. We discussed the reactions we may have to treating homeless patients, welfare recipients, drug and alcohol abusers, criminals, unmarried mothers, racial supremacists, undocumented immigrants, and other difficult social populations. Through that exercise, I learned that I was uncomfortable with murderers and sex offenders. It seemed rather contradictory to provide love and care for someone who deliberately preyed on vulnerable people, or who ended a life in a planned, methodical manner. Would treating these offenders facilitate them to commit more crimes? This dilemma was discussed, but not resolved. We were advised to be cognizant of our biases, and maintain professionalism.
Personally, I believe the doctor-patient relationship to be the crux of primary healthcare. Forming a bond with a patient is the key to obtaining an exhaustive history, and unearthing previously overlooked details crucial to treatment. How could I connect with a person who committed such a heinous act?
How was I going to effectively serve this patient? Employment of a defense mechanism seemed most appropriate. While I listened to Monica's heart and lungs, I considered my options:
- Denial - believing I had the names confused, and Monica was not the killer I recalled
- Intellectualization - considering the pathophysiology of Monica's chronic diseases
- Conversion - involuntary development of blindness in order to avoid completing the exam
- Reaction formation -becoming overly accommodating and friendly to compensate for my negative feelings
- Idealization - convincing myself of Monica's innocence
- Suppression - curbing my thoughts and focusing on completing the exam
- Rationalization - believing that Monica had a justifiable reason for her crime
- Humor - joking with the patient to circumvent the elephant in the room
While I contemplated this and moved to test Monica's reflexes, she intuitively asked me how I liked working in the prison. "Are you OK with treating all these crazy people in here? That's gotta be hard." Without hesitation, I replied. "It's not so bad. Really, patients need care no matter where they are — hospital, clinic, prison, nursing home, on the street. I love helping folks, and making life a little easier for them". Wow. Where did that answer come from? I have no doubt that divine intervention was in play. How humbled and blessed I felt to realize that the Most High had used Monica to teach me such an important lesson. Monica was no more or no less deserving than any other patient. My calling is to heal and serve, not to judge. As a physician, my role is to provided objective, empathetic care to help my patients live with good quality of life and optimal health. After accepting this call, my objections to treat patients are moot points. It only took a day in prison to facilitate this realization, and correct my attitudes.
Thank you, Monica.
The will of God will never take you,
where the Spirit of God cannot work
through you,
where the wisdom of God cannot teach you,
where the army
of God cannot protect you,
where the hands of God cannot mold you
~ Author Unknown
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