Custodial health: What’s it like to work as a GP in Australia’s prisons?

Doug Hendrie

10/09/2018 3:08:32 PM

Dr Penny Abbott and Dr Cameron Loy can tell you a story or two.

Dr Penny Abbot and Dr Cameron Loy describe patients in prisons as some of the most vulnerable in Australian society. (Image: AAP)
Dr Penny Abbot and Dr Cameron Loy describe patients in prisons as some of the most vulnerable in Australian society. (Image: AAP)

Sitting before Dr Penny Abbott was a feverish young woman with breathing difficulties. It looked very much like pneumonia. Time to send her to hospital.
But nothing is that simple when you’re working as a GP in a prison.
The prison officers were reluctant. They were low on staff, so to send accompanying officers to the hospital meant putting the prison in lockdown. But Dr Abbott insisted.
So all prisoners returned to their cells, and the young woman went to hospital to get an X-ray.
Soon afterwards, however, Dr Abbott got a call from a worried prison officer. Her patient had done a runner from the hospital.
‘I looked really bad,’ Dr Abbott told newsGP as she laughed at the memory of her first day as a prison GP. The officers thought the prisoner was faking to get a chance to escape.
But, when the X-ray came back, there were the tell-tale signs.
‘She really did have pneumonia,’ Dr Abbott said.
It was an abrupt start, but Dr Abbot was hooked on the challenge. She has since spent more than two decades working in women’s prisons throughout New South Wales.
‘It was an interesting learning curve. But the bottom line is, you still send people out to hospital when you need to,’ she said. ‘To be a good clinician in prison, you have to make those decisions – no matter how inconvenient to everyone else.
Dr Abbott, Chair of the RACGP Custodial Health Specific Interests network, has always been drawn to working with people on the margins of society.
‘I was looking for a job with a difference, so that attracted me,’ she said. ‘You’re working with people who don’t have much access to care. They’re one of the groups in society with high health needs.
‘There’s lots more of almost anything in prisons – chronic or infectious diseases, substance abuse, really complex medical problems – and that’s why it’s good to work there.
‘You really are at the coal face.’

Penny-Abbott-Article-(1).jpgDr Penny Abbott, who has spent two decades in custodial health, has found she is able to make a genuine difference to patients’ lives by addressing their health issues.
Dr Abbott said GPs have a vital role in the prison system, both in treating high-need patients and acting as an advocate for them in the wider healthcare system.
‘The time it takes to get all the investigation done and get them on the waiting lists for surgery – they’re constantly in limbo, waiting for treatment,’ she said.
Despite the common belief that working in prisons is dangerous, Dr Abbott said she feels safer than working in a community setting.
‘There’s really good security. I have never felt in any way threatened,’ she said. ‘The patients are generally highly respectful, just wanting to get care they need.
‘We have an idea on what people in prison are like; we imagine lurid stories from pages of the Daily Telegraph. But they are ordinary people who took a bit of a wrong step. They might have problems with addiction or mental health, and that’s the root cause of their incarceration.
‘That’s why this work is so satisfying; because poor health is one reason why people end up in prison. That means, as a doctor, I can help people stay out of prison.
‘On many occasions, I’ve seen people who came into prison with their life in chaos due to health problems. When they get treatment and develop a good therapeutic relationship, they have experience of what good healthcare can look like.’
Dr Abbott said getting supports in place and good healthcare can reduce the chances of reoffending.
‘Most women in prison are there related to substance misuse and minor crimes, and they often have quite short sentences. They’re often cycling in and out of prison,’ she said.
‘I have patients who I might not have seen since their previous sentence and they say, “When I got out, I didn’t follow up [a health issue], things went pear shaped. But I’m back now and really worried about it and I want to follow-up”.’
Prison work does have its challenges, though. Many health services are not available to prisoners, and there are long public waiting lists for many issues.
‘Prison health is chronically underfunded. But people in prison, when released, will help society more if they’re not unwell,’ Dr Abbott said.  
Overall, Dr Abbott said working in a custodial setting is a satisfying and interesting career that young doctors should consider. Dr Cameron Loy, Chair of RACGP Victoria, can attest to that.
Early on in his career, an older GP gave him a piece of advice that he took to heart.
‘If somebody asks you to do something and you’ve got enough time – give it a go and don’t say no. The more risks you take in your career, the more things you have a go at, the better you’ll be at your job,’ Dr Loy told newsGP.
‘I liked that advice and now give it to my registrars.’
So when a colleague asked Dr Loy if he’d consider working one day a week in a Victorian prison, he took up the offer.
Like Dr Abbott, Dr Loy was soon hooked. After 14 years working regularly inside Victorian prisons, he’s now the Principal Medical Officer at Justice Health.
‘Our job in prisons is to deliver care to a group of people who really need healthcare. The people inside a prison are often some of the most vulnerable in society. A highly skilled GP can really make a difference,’ he said.
In fact, a 2015 Australian Institute of Health and Welfare report on prisoner health found that most prisoners felt their health improved while in jail.
‘It wasn’t uncommon that the fellas coming in and out [of prison] saw me as their regular GP,’ Dr Loy said.
‘When they’re on the outside, there are often a whole lot of other things getting in way of looking after themselves. When they come to prison, we help dry them out, address their health needs, and then they go back out.’
Dr Loy, like Dr Abbott, would recommend working in prisons and other unique settings. 
‘If you’re ever given the opportunity to work in a unique environment, take up the opportunity,’ he said.
‘There’s a lot of personal and professional growth you can gain from working in prisons – and that experience set is only going to help you as you go through your career.’

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