Taking Care of the Shunned and Vulnerable Patients

Equally is how we, as physicians, view and treat our patients no matter what their socioeconomic status, creed, race or any other background. As physicians, we have the unique privilege of treating all our patients with equality. But there is one group of patients who inherently do not benefit from equal treatment: prisoners.

At our academic institution, we take care of the acute needs of the prison population as the state's only medical prison is in the same city as our institution. In my short time taking care of this unique population, I have witnessed prejudices—whether conscious or unconscious—in taking care of prisoners. In a particular way, the prison population is one of the most vulnerable populations in our health care system. They have been shunned by society and, as members of society, health care providers knowingly or unknowingly are influenced by society in caring for this vulnerable patient population.

Biases can come from being dismissive of complaints for fear of being manipulated by the prisoners. Moreover, taking care of patients with acute needs (e.g., patients having an acute ST-segment elevation myocardial infarction, patients having an acute abdomen, etc.), who are handcuffed to the gurney, can lead to difficulties in providing optimal care. Finally, taking care of patients with terminal cancer or heart failure with two, three or sometimes even four guards in the room can make it difficult to connect and empathize with our patients and discuss end-of-life goals. This type of care would not be tolerated with any other patient population.

We, as medical providers, are not part of the judicial system or the executive system, and therefore, we should not judge or treat prisoners any differently than any other patient for whom we care. We are healers whose first duty is to do no harm, and by treating any patient population differently, we introduce the possibility of harm. We as health care providers need to be cognizant of our own prejudices and actively fight those prejudices as we seek to offer prisoners the same quality of treatment as any other patient.

As physicians early in our careers, we have the unique role, opportunity and obligation to acknowledge the prejudices in our health care system in taking care of the prison population. By actively acknowledging and fighting our own prejudices, we can treat this unique patient population with more equality and, more importantly, in doing so, we serve as role models for trainees (medical students, allied health students, residents and fellows) and for those in the health care team (senior physicians, nurses, medical assistants, technicians, etc.). As Mahatma Gandhi once said, "Be the change you wish to see in the world." We can be the change in the health care system as we take care of this vulnerable patient population.

This article was authored by Ruchit R. Shah, MD, a Fellow in Training at Georgia Regents University.