Incarceration Health in Medical Education Medical Student Perspective

Introduction

At the beginning of medical school, we stood shoulder to shoulder with our classmates, dressed in our brand new white coats and took an oath. We pledged to care for any and every patient, regardless of who they are, where they come from, or what is making them sick. Now, as we consider our next steps to becoming the physicians we promised we would be, our experiences learning from people detained in the Hennepin County Jail stand out as uniquely formative. The people detained in our nation’s correctional facilities make up a patient population that is especially vulnerable, suffers from distinct pathology and disease prevalence, faces daunting socioeconomic barriers, and yet is in no way separate from the general population. They are people we must learn to care for if we want to hold true to our oaths.

Specific Health Needs

Individuals who are incarcerated are at higher risk for HIV, Hepatitis C, and latent tuberculosis.1 In addition, they are at higher risk for sexually transmitted diseases like chlamydia, gonorrhea, and syphilis and are more likely to have chronic health conditions including diabetes, hypertension, substance use, and mental health problems.1,2 Even more, those who are incarcerated have a shortened life expectancy compared to the non-incarcerated population.3 To make matters worse, few correctional facilities offer prevention or treatments for these diseases. Understanding this specific epidemiology, as well as the circumstances before, during, and after an individual is incarcerated is crucial to integrating appropriate care into daily practice as a physician.

Importance and Medical Education

About 600,000 people are released from state and federal prisons each year.4 Therefore, the likelihood that any physician will care for an individual who has been incarcerated is high. Put another way: incarceration health is community health. When medical students are educated on the health risks and needs of those who are or have been incarcerated, we have an opportunity to face our biases early on and learn to provide informed, holistic care for a patient population we must be comfortable working with. Our self-pursued pre-clinical projects, third year elective clerkships, and fellowships allowed both of us to carve out opportunities to teach health literacy classes in the Hennepin County Jail, shadow jail Medicine and OBGYN providers, and work in the jail addiction medicine clinic. But currently, there is very little exposure to incarceration health care as a formal part of the University of Minnesota Medical School curriculum. Pre-clinical curriculum needs to include topics related to incarceration health, including the history of medicine and its impact on marginalized populations, addiction medicine, gender/sexual health, and immigrant and refugee health. Clinical opportunities need to be offered that allow all students to rotate through prison and jail clinics, learning from providers who have a keen understanding of the field. Other schools, like Georgetown University School of Medicine, have already begun to do this.5 Failure to educate medical students on incarceration health risks intensifying the forces keeping these individuals in the carceral system, further perpetuating healthcare injustices.

The Ethics of Learning in Correctional Facilities

As students are given more opportunities to work in incarceration health, it is important to remember that correctional facilities are inherently coercive and dehumanizing environments with a history of medical trauma.6 Any exposure to incarceration health must come in a manner that respects patient autonomy, understands the power dynamics at play, and acknowledges the incarcerated patient’s limited ability to consent to having learners present. For example, a patient who is sick, shackled, and within earshot of a guard may not feel empowered to ask a student to leave the room if they prefer to speak privately with the provider. Done carefully and correctly, the opportunity to learn from incarcerated patients will help a future generation of providers develop the knowledge and skills to address the unique health needs and myriad socioeconomic factors impacting this especially vulnerable patient population.

Noah Sanders, MS4 Kristin Chu, MS3

Sources: 1. Davis DM, Bello JK, Rottnek F. Care of Incarcerated Patients. Am Fam Physician. 2018 Nov 15;98(10:577-583). PMID: 30365288. 2. Workowski KA. Centers for Disease Control and Prevention Sexually

Transmitted Diseases Treatment Guidelines.Clin Infect Dis. 2015;61 Suppl 8:S759-762. 3. Widra, E. (2017, June 26). Incarceration shortens life expectancy. Retrieved

April 12, 2021, from https://www.prisonpolicy.org/blog/2017/06/26/life_expectancy/. 4. Office of The Assistant Secretary for Planning and Evaluation. (2019, July 02). Incarceration & Reentry. https://aspe.hhs.gov/incarceration-reentry. 5. Medical Student Educational Opportunities and Resources | The School of

Medicine & Health Sciences. (n.d.). Smhs.gwu.edu. Retrieved April 18, 2021, from https://smhs.gwu.edu/academics/md-program/curriculum/clinical-public-health/criminal-justice-health-initiative/medical. 6. Johnson, C. G. (2013, July 7). Female inmates sterilized in California prisons without approval. Reveal. https://revealnews.org/article/female-inmates-sterilized-in-california-prisons-without-approval/.

PRACTICE YOUR PASSION AS A U.S. ARMY PHYSICIAN

Physicians on the U.S. Army health care team support our Soldiers and their families. They take pride in the fact that their skills and experience will continue to grow, along with their nation’s gratitude.

To learn more about the U.S. Army and Army Reserve health care team, call 502-314-6548, visit https://qrgo.page.link/U2dsi, or point your smart phone's camera at the QR code and click the pop up link to learn more about Army medicine today!