Monday, June 6, 2011

Criminal or patient?

Shadowing today at the clinic reminded me of a case a few months ago. A prisoner came in from juvenile detention. I thought to myself, "Wow, this guy probably got into some pretty deep stuff there" and proceeded to the exam room at the county health clinic. The patient was described as "high priority" because of the possibility of gang activity in the area and had been brought in earlier than the usual clinic time to maintain privacy. The prison called the previous day, and said the prisoner complained of problems. He claimed he needed to be seen immediately because he was having problems with urination.

There were Waco police officers posted at each door, and I feared what I would find inside. Opening the door, I found a scrawny African American male in his mid-teens sitting on the exam table with tattoos scribbled all over his arms. When his handcuffs came off for the exam, I could have sworn I saw a glimpse of a smirk on his face. The nurse continued to examine him, but he looked generally asymptomatic. Blood tests were drawn, and handcuffs were placed back on his wrists and ankles after the exam. The prisoner left, and the nurses and I discussed whether he really was having problems or just wanted to be free for awhile.

Sure, sometimes problems can come and go, much like taking a car to a mechanic and turning it on-- only to realize that nothing wrong is happening. "I saw it fuming and making noise!" you say, but the mechanic only shakes his head in disbelief. Should we treat the patient fairly and care for him as any other? Or should we have seen him as using his clinic visit as a "get out of jail for a day" card and dismissed him?

Of course I would hope we can all have the mindset of the former, but I myself have my doubts (as I'm sure others do as well). I feel in practice, we must clinically treat every patient the same, regardless of race, socioeconomic status, or even criminal background. The lingering doubt will, of course, always be in my mind, but I know I must control it and treat equally in practice.