Sue Kimberly
A resident physician in internal medicine primary care at Massachusetts General Hospital in Boston.
AMA J Ethics. 2017 Sep 1;19(9):885-893. doi: 10.1001/journalofethics.2017.19.9.ecas2-1709.
The United States has the highest incarceration rate of any nation in the world-more than 700 people per 100,000. For this reason alone, clinicians practicing in the US should be aware of the numerous ways in which incarceration adversely affects the health of individuals, their families, and communities. While we clinicians are taught how to discuss ways that culture, religion, or sexuality can affect health outcomes, we are not instructed on how to talk about incarceration history with patients when it might be affecting their health, as highlighted in the case scenario. Here I present a "structural vulnerability" screen, a theoretical approach that clinics or individuals can take to better understand how structures of power (i.e., mass incarceration) directly and indirectly affect our patients. I also offer practical tips on how to talk to patients about incarceration history and why it matters for good health.
美国是世界上监禁率最高的国家——每10万人中有700多人被监禁。仅出于这个原因,在美国执业的临床医生就应该意识到监禁对个人、其家庭和社区健康产生不利影响的多种方式。虽然我们临床医生学习过如何讨论文化、宗教或性取向可能影响健康结果的方式,但正如案例中所强调的,当监禁历史可能影响患者健康时,我们并未得到如何与患者谈论这一问题的指导。在此,我提出一种“结构性脆弱性”筛查方法,这是一种理论方法,诊所或个人可以采用它来更好地理解权力结构(即大规模监禁)如何直接和间接地影响我们的患者。我还提供了一些实用建议,说明如何与患者谈论监禁历史以及为何这对良好健康至关重要。