What is it like to be a prison doctor

"Boredom never arises here"

The inmates of a prison also get sick one day. Then they need a doctor. Dr. med. Georg Schwarzer is a prison doctor in the Rohrbach correctional facility in Rhineland-Palatinate. This makes him one of the few doctors in Germany who care for prisoners. Because many of the doctor's positions in the penal system are not filled. According to estimates, around a quarter of the positions nationwide should be vacant.

Only a few have the job of prison doctor on the agenda. It certainly offers advantages. For example in the type of employment. There are many design options, according to the Rhineland-Palatinate Ministry of Justice.

Everything is possible: from the civil servant doctor to the employee to the fee. Whether full-time or part-time: You are open and very flexible here. The prerequisite for employment as a prison doctor is a medical license and a completed specialist training. General medicine, internal medicine or surgery are desirable.

Medical check-up upon admission

Every inmate who arrives at the prison is given an entry exam; Here, previous illnesses are documented and a check-up is carried out, reports Georg Schwarzer. "Many only come to us for medical care. Many were not outside the doctor", the prison doctor experiences this again and again during the initial examinations.

The current medication intake is also recorded in the detailed anamnesis. This will be particularly examined. Schwarzer: "We're checking that very carefully." There is also a physical examination and preliminary findings - if available - are also obtained. If indicated, an ultrasound examination of the abdomen is also carried out. In addition, there is also an investigation into possible drug use.

Drug use is a problem

Drug use in prisons is huge. There is hardly anyone who does not consume, according to the prison doctor. Mostly cannabis, amphetamines, cocaine, and opioids. A drug test is therefore standard for newcomers.

The desire for substitution treatment is also being examined. For those who were already in substitution when they entered prison, the substitution would continue. This is carefully controlled and, if necessary, terminated if the prisoner does not follow the rules. "We not only threaten with a raised index finger, but also draw the consequences in the event of repeated incidents. Our rules are clear and nobody can say they did not know." He has already seen several times that attempts have been made to smuggle substitution drugs out of the treatment room.

The physical and work ability of the prisoners is also recorded during the initial examination. For the ability to work, it will be clarified whether the newcomer can cope with the usual workloads within the prison. Work assignments are possible, for example, in the clothing store, housekeeping, in the kitchen and in the factory. Unfortunately, a job is not available for everyone; only about every second person could get such a position.

It will also be clarified whether individual accommodation is necessary. For example, if there is a seizure illness, it is important that a fellow prisoner can make an emergency call. If an acute emergency call comes in, the prison doctor and staff immediately go to the cell from which the emergency call was made. They provide first aid up to and including resuscitation and at the same time call in the emergency services.

Consultation hour behind bars

There are fixed office hours for normal medical care. The prisoners have to register for this. Every prisoner in the Rohrbach prison has the opportunity to see the doctor twice a week. At the appointment, they are picked up in their cell by two prison officers and placed in a waiting room in the practice wing. When it is their turn, they are shown to the doctor who is in the consulting room with a paramedic. Wednesday is also the emergency day; everyone can come with acute problems. Sudden emergencies are of course always associated with access to the doctor.

The consulting room in the prison doesn't look much different from other consulting rooms. However, it is noticeable that there is nothing standing around on the desk or within easy reach. In addition, the windows are barred.

The range of topics is similar to that of a general practitioner’s practice

The consultation hours behind bars correspond to the spectrum of a general medical practice: Colds, gastrointestinal problems, back and joint problems, pain of an unclear nature, infections and cardiovascular complaints. In addition, there are sports and work accidents, reports Dr. Black. In the case of special questions, the inmates are presented to external specialists. A dentist also comes to the prison clinic once a week.

If a hospital admission to a civilian hospital is necessary - for example, if care in the correctional hospital is not possible - the prisoners there are monitored around the clock by two judicial officers.

Sleep problems are also a widespread phenomenon in prisons, according to Schwarzer: In his experience, almost one in two complains about them. "Those affected then immediately ask for sleeping pills," he adds. But he is very reluctant to do so. Because many would also like to sleep during the day and then are no longer tired at night. He also appeals to those affected to exercise more and, for example, to take part in the sports program. Sleeping pills are only given for a week at most. Then it will be looked to get the normal sleep rhythm going again.

Mental health problems are common

And of course many inmates come with mental health problems, too, reports Schwarzer. Schizophrenia, depression, borderline syndrome. That is increasing. "Many come from the outside treated with psychotropic drugs." In such cases, preliminary findings and prior medication are requested.

He knows the living conditions of many of the prisoners. "Sure," says Dr. Georg Schwarzer added, "Dealing with the offenders is not always easy, but the work is still a pleasure." He himself got this job because the former prison doctor asked him if he could take on vacation cover. That was in 2004. Many vacation replacements followed, and since 2014 the occupational physician has been working entirely as a prison doctor in the Rohrbach prison. It is of great benefit to him that he has always been associated with acute medicine. For more than 20 years he has worked regularly in a medical on-call practice and has also represented numerous other practices.

He has come to appreciate his unusual workplace. "You really never get bored here; every day is different," says Schwarzer. That is precisely why he likes doing his job so much. And the advantages for him are obvious: a relatively safe place to work, clear time limits, away from budget pressure, freed from administrative tasks and plenty of time for each individual patient: "The prison doctor says what is needed. His medical assessment counts and applies. "

The sick are generally well cared for with medication. "However, we have our thumbs on it when it comes to pharmacy-only drugs; we have a sense of proportion here," explains the prison doctor. For example, with special skin creams, lotions or shampoos. The inmates usually have to buy these things themselves.

You should bring experience

According to Dr. In Schwarzer's opinion "out of place" in prison. You have to have a broad knowledge of general medicine. It is also helpful if you have a certain tolerance for frustration, because loud insults and insults do occur.

And also as a prison doctor: listen, be open and friendly. That makes the situation in the consulting room a lot easier. Schwarzer: "When a smile comes back from die-hard guys, that's a plus!" Every prison is like a closed microcosm - and the doctor, as Schwarzer sums it up, is right in the middle of it.

This article first appeared in the Ă„rzteblatt Rheinland-Pfalz 10/2018