A 33 year old male patient from a maximum security state prison was admitted to a community hospital with flank pain and hematuria. His INR was discovered to be 8.2 (therapeutic range 2-3). His medical history included deep vein thrombus resulting from Protein S deficiency. A medication error investigation revealed that the patient had been receiving three times the amount…
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Over time, as experience develops, clinical reasoning themes emerge that speed our decision-making for commonly reoccurring scenarios. We begin, for example, to develop rules of thumb and analogies resulting in common pattern recognition that originate from past successes. The formal term for this is heuristics. In fact, clinicians rarely use formal computations to make patient care decisions in day-to-day practice….
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Prison and jail medical units are over-represented by female staff, creating a number of challenges to avoiding unhealthy patient relationships. It is a common saying that incarcerated persons go to medical to ‘enjoy the view’, and in one prison system in which I worked, it was explicitly stated to all orientees, “You cannot have sex with an inmate.” As crass…
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