Fred Rottnek, MD, MAHCM, Department of Family and Community Medicine, Saint Louis University

One out of every 32 people in the United States is in jail or prison or on probation or parole, and those who are living in jail or prison have a right that those of us outside of the walls do not have—a constitutional right to health care.¹ Since Estelle vs. Gamble in 1976, the United States Supreme Court has interpreted the eighth amendment as meaning that anyone imprisoned has a constitutional right to health care.

For the past 10 years, this has placed me in a unique position as the contracted medical director for corrections medicine in Saint Louis County, MO. I have the opportunity to provide care to patients who have an unequivocal right to care, both in the adult facility and at juvenile detention. I have had the opportunity to introduce the interprofessional manner of care in our facilities to students and residents from Saint Louis University and other area institutions of health professions training.

In addition to the unfathomable breadth of pathology in correctional health care, from trauma and communicable disease to mental health care and substance abuse, students witness a time in patients’ lives where their day-to-day activities screech to a halt. The many competing priorities in a person’s life abruptly halt when someone finds himself in a cell, with a roommate, a set of scrubs, predetermined meals, and eating, sleeping, showering, and exercising on someone else’s schedule. The medical staff become one of the most consistent resources in an inmate’s life. Suddenly that past memory of high blood sugar, high blood pressure, or hepatitis may become something worth addressing. In our program, if that opportunity presents itself, we do our best to seize it.

Millennial students are a hopeful, if not optimistic, generation. In our program at Saint Louis University, students are hungry for experiences of service learning and community engagement. We faculty would like to think, and we hope to prove, that our increasing numbers of graduates entering family medicine residencies do so not only because of the relationships we seek to cultivate from their early years in our program but because of the opportunities we create and foster for community engagement. Correctional health care offers many opportunities for formation of medical professionals: a socioeconomic and cultural population generally different from the students, a group of people who may lack many resources we take for granted but possess a resiliency we can only admire, and a patient panel that can thrive on almost any caring word or gesture from a professional or student at any level of training.

Life’s lessons in correctional health care are taught with a two by four. My students and I have had days when we have been joyful, depressed, overwhelmed, and/or stunned, but we have never been bored. A day has never passed when we have failed to reexamine our knowledge base, our assumptions and biases, and even our ideas of the individual’s ability to heal, change, and grow as a human being. What is good and bad about our selves, our health care delivery system, and our societal structure and values is on daily display, and our treatment plan generally requires us to step outside of personal comfort zones of diagnoses and prescription.

Every medical student should go to jail, and every jail deserves a family physician. As family physicians, we are in a unique position to bring our skills and our attention to an often out-of-sight, out-of-mind patient population. Consider investigating who provides medical care at your local jails and prisons. Perhaps contracting for these services would fit with your program’s mission statement and departmental goals. Correctional health care isn’t for everyone, but it’s a professional service that is particularly suited for both our specialty and our care of society. You’ll likely find that when your students spend a little time behind bars, they’ll open their eyes to a whole new world.

References
1. Bureau of Justice Statistics.http://bjs.ojp.usdoj.gov/index.cfm?ty=tp&tid=11. Accessed July 15, 2011.