An underserved population being poorly treated.
Pros
As a physician I am privileged to have had the opportunity to serve the patients within the Philadelphia Department of Prisons. The overburdened and under-resourced nature of the work has been challenging and frustrating but also rewarding. Struggling with an antiquated EMR and dealing with the logistical difficulties of the corrections environment harden one like iron to steel from hammer and anvil. The nursing staff has been nothing less than amazing. They are by far the best core crew that I have had the pleasure of working with. They are smart, alert, dedicated and kind to the patients. They have alerted me to numerous emerging crises before a true emergency arose, allowing me to intervene in time to avoid a bad outcome.
Cons
I am, however, concerned about a number of things. First, the EMR, an antiquated Eclinicalworks version 10 (currently on version 15) is truly an impediment to patient management. For instance, prior to my departure, I endeavored to renew all DC infirmary patients medications so that my successor would not have to deal with it right off the bat. Given the infirmary census of about 25 at the time, this should have taken about two hours. Instead it took two full shifts. Data is difficult to locate and many features of the program are broken. The EMR is a danger to the patients and a liability to the organization. Second, it seems that senior medical staff are opposed to patient advocacy. For example, one of our patients had a serious medical condition with only one known therapy. This treatment is recommended as first line treatment by professional organizations and the NIH. When I recommended this I was reprimanded and told that Yescare only orders treatments recommended by outside, directly consulted specialists. This is bad for the patients in light of the extremely limited specialist access and disrespectful to the practitioner attempting to deliver state of the art care to Yescare’s patients. Furthermore this is a danger to the patients and a liability to the organization, especially given the litigious nature of the environment. Thirdly, the organization seems intent on wringing every penny from the system while delivering minimal care. For example, we have a number of paraplegic patients with severe pressure injuries. I attempted to get Clinitron air-fluidized beds, considered first line therapy, only to be met with passive resistance from administrators. I was told by several coworkers that they were opposed to paying for these potentially life-saving devices.
