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E JOB


type effects and causes euphoria. Consequently it is highly valued. Iain outlines the size of the problem: “Out of 25 patients I saw yesterday, six had prolonged discussions with me about their need for pregabalin.” Security and prescription considerations are


manifold: no glass bottles or aerosols as they could be weapons, no gum-based nicotine to make impressions of keys or block locks. No injectables. Iain also has to assess a genuine need for hospitalisation, as most escapes happen in court or in hospital.


refused to go to hospital with paramedics and allowed himself to bleed out until losing consciousness. “There was no DNAR in place due to his


mental fluctuations and IV access was impossible due to previous drug use. We were only able to deliver first aid to him and thought we were going to lose him at one point. At the same time, another prisoner was withdrawing very badly from alcohol and had a series of seizures requiring diazepam followed by a detox script.”


“ We have to be alive to psychiatric diagnosis. I ask patients about suicide several times a day.”


Prison GP, Dr Iain Brew Despite his work environment, Iain says he


rarely feels threatened and there is seldom the need to have prison officers sit in on consultations. “Very occasionally prisoners try to threaten, especially about their desires for medication. The highest risk comes from the mentally unwell.” On occasion, it does get “wild at times”. Says Iain: “Things got hairy recently during an evening reception clinic when a long-term prisoner opened his dialysis fistula with a biro,


While this may sound alarming, Iain adds: “When thinking about safety, I have been in more danger in GP practices than in prison due to the uniformed staff and alarm bell system.” Alongside drug abuse, mental health issues


are also common with half of patients diagnosed with personality disorders. Iain says: “We have to be alive to psychiatric diagnosis. I ask patients about suicide directly several times a day.” What has surprised him most about his


patients? Iain is unequivocal in his response: “Their humanity. When I started out I had a


‘Daily Mail reader’ attitude but prisoners are just people like you and me. They have often been excluded socially from a very young age. “There are some really intelligent people


here. If they had applied themselves within the law they would have been brilliant. So I feel compassion and some sadness for how things could have been different.” Downsides are pressure and intense


scrutiny. While GPs have to deal with endless requests for drugs they also have to ensure patients feel they are properly treated. “For me, examining people well is part of


that,” says Iain, “but any death in custody, even natural-causes deaths, is extremely involved.” First there’s a 48-hour review of clinical care; a police investigation; prison and probation ombudsman statements; a clinical reviewer who will scrutinise records of care; and eventually a coroner’s inquest (with jury) often up to three years after the death. Iain believes the job is challenging but


rewarding and is keen for trainee doctors to find out more. He stresses that prison doctors need to be confident in their assessment and be able to switch off at the end of the day. He would encourage trainees to get


involved. “We have foundation doctors in one day a week as GP attachments, and medical students doing their intercalated BSc,” he says. “Anyone interested should try to contact their local prison. I know prison GPs are keen to encourage that; I certainly am.”


Alison Bird is a freelance writer


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