Indiana University School of Medicine, Indianapolis, Indiana.
Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana`.
J Surg Educ. 2021 Nov-Dec;78(6):e154-e160. doi: 10.1016/j.jsurg.2021.06.009. Epub 2021 Jul 18.
Incarcerated patients represent one of the most vulnerable populations in the United States healthcare system. Studying disparities in care they receive, however, has been difficult due to a history of abuse at the hands of medical researchers rendering this population excluded from most current medical research. Due to incarceration, these patients are frequently maintained in shackles and under constant guard when receiving healthcare. There is a paucity of literature on the influence these measures exert on healthcare workers and the care they provide. Our study aimed to measure surgical trainee's perception of health inequities and disparities in incarcerated individuals undergoing surgical care.
An anonymous cross-sectional survey was administered at our single institution to all general surgery trainees assessing perceptions in delivering care to incarcerated patients within our hospital system. The survey consisted of 10 items, nine of which were yes or no responses, and 1 open-ended text question. Survey results were averaged, and percentages were reported.
Of all current general surgery residents (n = 60), 40 (66%) completed the survey. Almost all respondents (n = 39, 97.5%) have cared for a patient that was incarcerated or in police custody. Most respondents (n = 25, 62.5%) have operated on an incarcerated patient with an armed guard present in the operating room. Similarly, most respondents (n = 26, 65%) have cared for a patient intubated and sedated that was shackled to a bed. The majority of respondents (n = 30, 75%) recalled incidents where a trauma patient was actively questioned by law enforcement during the primary/secondary survey during initial trauma evaluation. At the time of hospital discharge, a quarter (n = 10, 25%) of respondents reported being unable to prescribe all of the medications that a non-imprisoned patient would receive with the same condition. In addition, 18 (45%) respondents felt they were unable to arrange outpatient follow-up with physical or occupational therapy and/or the patient's primary/consulting physician due to patient's incarcerated status. Strikingly, half of respondents (n = 19, 47.5%) believed that the incarcerated patient received substandard care, and the majority of respondents (n = 28, 72%) agreed that the holding areas for incarcerated patients in the emergency room provide substandard patient care.
The current status of caring for incarcerated patients within our system represents an urgent and needed area for quality improvement. Surgical trainees report difficulty caring for these patients, and they perceive these individuals receive substandard care. Though our cross-sectional study did not assess the origin of this disparity, the challenges trainees face in caring for incarcerated patients, from assessment to diagnosis and treatment, as well as in follow-up signals an area requiring further research and study.
被监禁的患者是美国医疗体系中最脆弱的人群之一。然而，由于医疗研究人员的虐待历史，使得这一人群被排除在大多数当前的医学研究之外，因此研究他们所接受的护理方面的差异一直具有挑战性。由于监禁，这些患者在接受医疗保健时经常被铐住并受到持续监视。关于这些措施对医护人员及其提供的护理的影响，文献很少。我们的研究旨在衡量外科实习医生对接受手术护理的被监禁个体中存在的健康不平等和差异的看法。
在我们的单一机构中，对所有普通外科住院医师进行了一项匿名横断面调查，评估他们在我们医院系统内为被监禁患者提供护理的看法。该调查由 10 个项目组成，其中 9 个是是/否的回答，1 个是开放文本问题。对调查结果进行平均，并报告百分比。
在所有现任普通外科住院医师（n=60）中，有 40 人（66%）完成了调查。几乎所有的受访者（n=39，97.5%）都曾照顾过被监禁或被警方拘留的患者。大多数受访者（n=25，62.5%）曾在手术室有武装警卫在场的情况下为被监禁的患者进行手术。同样，大多数受访者（n=26，65%）曾照顾过被插管和镇静的患者，这些患者被铐在床上。大多数受访者（n=30，75%）回忆起在初次/次要检查期间，创伤患者在最初的创伤评估期间被执法人员积极询问的事件。在出院时，有四分之一（n=10，25%）的受访者报告说，他们无法为患有相同疾病的非监禁患者开出所有药物。此外，18 名（45%）受访者表示，由于患者被监禁，他们无法安排门诊随访进行物理治疗或职业治疗和/或患者的初级/会诊医生。引人注目的是，一半的受访者（n=19，47.5%）认为被监禁的患者接受的护理质量不达标，大多数受访者（n=28，72%）认为急诊室中被监禁患者的等候区提供的护理质量不达标。
目前我们系统中为被监禁患者提供护理的现状代表了一个急需改进的质量领域。外科实习医生报告说，照顾这些患者有困难，他们认为这些人接受的护理质量不达标。尽管我们的横断面研究并未评估这种差异的根源，但实习医生在照顾被监禁患者方面面临的挑战，从评估到诊断和治疗，以及在随访方面，都表明这是一个需要进一步研究的领域。
