Monday, January 24, 2011
"What, with these feet?!"
Norman Stanley Fletcher, that perpetual con, trying to blag the prison Doctor into giving him decent shoes in the first episode of Porridge, while simultaneously disavowing homosexuality.
Many a truth is woven within the fabric of comedy, and Fletcher's exchange with the Medical Officer is a classic. Not only as a comedy sketch, but as a reflection of the essentials that form part of our dealings with the MO.
The Medical Officer - nowadays a contracted GP - is one of the few gateways that prisoners can try to exploit in order to gain some small advantage or benefit above the herd.
A new mattress? Wide-fitting shoes? A proper chair? An unusual diet? An excuse from work? All lay within the domain of the MO. And the wordly-wise con will try to blag his way from the first moment. Hence Fletcher's complaints about flat feet as soon as he lands at HMP Slade. His previous experience shows!
Of course, there are those whose complaints and maladies are quite genuine. But any medical condition which leads to some perceived benefit, such as comfier shoes, will doubtless be faked by some chancer.
This places the MO in a difficult position. Is he dealing with a genuine complaint or a faker? The historical method of weeding out the later is to treat every con as if he was lying through his teeth, and see who gives up and who ends up at deaths door.
With the dismemberment of the Prison Medical Service in favour of NHS treatment, we had hoped that this malign and mistrustful view of prisoner-patients would wither. To some extent it has, but not completely.
When you go to see your GP, does she assume you are lying? If you require pain relief, is it prescribed? Because these are pretty fundamental to any medical service worth its name. But despite our healthcare now being provided by the NHS, nurses who are based within prisons find it difficult to avoid being contaminated with the attitudes of the screws - that is, anti-con.
This sometimes shows up in small ways. I recently overheard a nurse phoning a hospital outside regarding two appointments. Both times, she referred to the men as 'prisoners'. Not patients, prisoners. As that's an irrelevant consideration for arranging appointments, that merely reflected how that nurse perceives us -prisoners first, patients second. And prisoners come with baggage - such as an assumption that we are invariably lying.
At the grand age of 45, I have had prescription strength painkillers (i.e., anything above Ibuprofen) issued to me by the MO a total of four times in my adult life. Four. Either I am a medical marvel, obscenely healthy, or prison medics really don't like issuing painkillers. I lean - heavily - towards the latter.
This is one of the difficulties facing the MO. Even if they completely avoid being contaminated by the prisons attitudes of prisoners, they then have two other hurdles to negotiate. Firstly, the attitudes of nurses, the permanent staff in the healthcare wing. It is a regular event that some prescription or other is questioned by nurses, mostly prescriptions for the more effective drugs. "Oh, I don't think the Doctor should have prescribed these...". Cynical as I may be about the Medical Officer, they do have the benefit of 8 years medical school and the letters MD; it's not for nurses to question.
The second hurdle for the GP to navigate around is the Formulary. In brief, there is an official presumption against giving strong medications - especially painkillers - to prisoners. Ibuprofen is King in prison healthcare, and it's a cynical truism that Paracetamol can be used to cure anything up to and including cancer.
Fletcher didn't manage to get his shoes from the MO. And he'd have had as much chance as the rest of us as getting decent painkillers.