During my 4th year of medical school, I had the privilege of rotating in some very special away electives. One that I was particularly fond of was an adolescent rotation at the Cook County Juvenile Detention Center in the city of Chicago. I was responsible for performing all the physical examinations and initial health assessments after the teenagers were admitted to the jail.
Previously, I had some interactions with prisoners in an ER setting—if they needed to be evaluated after episodes of self-harm while in jail—but those interactions were limited.
However, it wasn’t so much a challenge as an incredible experience I still reflect on to this day.
Positive first impressions
I saw the boys in Cook County Juvenile Detention Center 5 days a week for 1 month. Most were polite, friendly, and some were very funny. Of course, occasionally, one or two were a bit cheeky, but I always felt comfortable in the examination room with them (I was chaperoned at all times). I sometimes felt a bit threatened, however, when I would walk through the halls and they would start yelling at me, screaming profanities, and violently hitting the walls.
I remember one boy, in particular, who had a plaster cast on his arm and was banging his arm on the wall to the point I thought he was trying to break the cast. My attending told that is how he initially broke his arm… banging it on the wall. This behavior saddened me, as it was a blatant plea for help and attention.
I made it a point to provide the best care possible during my medical assessments. I was empathetic and attentive; asked detailed questions about their physical, sexual, and mental health; and always told each patient that I wanted the best for them and their future.
Most of these boys came from underserved communities with limited familial structure. Some were violent, others were in gangs, but it seemed they were all dealt a challenging hand from the moment they were brought into this world.
This rotation opened my eyes and my heart to the individuals who go through the criminal justice system, and I have the utmost respect for healthcare providers who work in correctional facilities.
Lessons from jail
The first lesson I learned during this rotation was that I was not part of the criminal justice system, and it was not my business to ask my patients why they were in juvenile detention. I was responsible for treating these patients the same way I would outside a correctional facility. Some of my patients opened up about their crimes and upbringing, and I would sit and listen. I would usually respond, “Thank you for sharing,” and leave it at that. It was not my place to judge, but it was my duty to provide them with the best care possible.
The second lesson I learned is that these individuals will likely not live in a correctional facility their entire lives. Individuals who commit crimes are part of our society. Yet, we hold unfair misconceptions that those who live in correctional facilities will spend their whole lives there, or that they are tucked away in certain neighborhoods labeled as “bad.” This is far from the truth.
"These individuals are our neighbors; they stand in line with us at the grocery stores, help us with car trouble on the side of the road, and are the patients we see in our clinics."
— Kristen Fuller, MD
The third lesson I learned is that even when our patients challenge our beliefs and morals, the quality of care we provide should not reflect the hardships—the hand they have been dealt. Rather, it is our duty to provide the best quality of care to every single patient, regardless of their background, societal status, criminal history, or beliefs.
We can change the system
I hope every physician has the opportunity to rotate through a correctional facility (as well as work overseas and in an inpatient psychiatric facility, but that’s another story), whether as a medical student, a resident, or a short-term contract as an attending. It is a career-changing and life-changing opportunity.
Unfortunately, our training programs are not set up for these important rotations, as under 15% of residency programs provide education on the care of incarcerated individuals, and only 22% offer clinical experiences in a correctional facility.
"The more medical trainees we rotate through correctional facilities, the more we can start to mitigate the challenges that prisoners face regarding access to quality medical care."
— Kristen Fuller, MD
The more time we spend with these individuals, the more we realize that justice is the bridge that gives reconciliation a chance. As physicians, we can help break the stigma surrounding individuals with a “criminal” background.
Each week in our "Real Talk" series, mental health advocate Kristen Fuller, MD, shares straight talk about situations that affect the mental and emotional health of today's healthcare providers. Each column offers key insights to help you navigate these challenging experiences. We invite you to submit a topic you'd like to see covered.