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What I Learned As A New Medical Director
By Spencer J. Epps, MD, MBA
Published: 10/04/2010

Doctor police Editor's Note: Reprinted with permission from the Winter 2010 issue of CorrDocs, the quarterly newsletter of the Society of Correctional Physicians (SCP). All rights reserved.

The role of Medical Director of a Department of Correction can be a rewarding experience, with unique opportunities for professional and personal development. It can also present unanticipated, frequent setbacks, and moments of profound discouragement. For the seasoned Medical Director, time, experience and a portfolio of steady achievements can make the business of correctional medicine seem intuitive. For the newly initiated, the daily challenges faced in developing and managing a complex healthcare system can be overwhelming. As a new Medical Director, I have learned that the initial feelings of isolation and doubt are universal. I have also learned they will pass. Any physician dedicated to caring for a vulnerable population can be an effective Medical Director through hard work, a sense of adventure, and a healthy respect for what one does not know. Although there is no manual for how to succeed, there are three common sense tenets that every new Medical Director should remember.

Look Before You Leap

Highly motivated people tend to be problem solvers. They thrive in challenging environments, like correctional medicine, and are not afraid to dive in and get their hands dirty. There can be a tendency, though, for problem solvers to try to “reinvent the wheel” with each challenge. In my zeal to solve the problems inherent to a state correctional medical system, I made the same mistake. I assumed that the challenges I encountered upon first starting the job were either new or complicated problems requiring novel solutions. Although each correctional medical system is unique, and new challenges will always arise, many problems can be solved by connecting with colleagues from other jurisdictions and learning how they approached the issue. This is the value of national organizations such as NCCHC and SCP- they provide formal and informal networks to allow the exchange of information and ideas. CorrDocs, and other correctional medical literature, is equally essential in that it creates an atmosphere of academic rigor and scientific dialogue that gives context to systems solutions. One learns that there are patterns of problems endemic to correctional medicine. This gives insight into solving these problems and also into anticipating them. SCP’s Medical Director Boot Camp was also crucial to orienting me to the field. First, it provided an instant network of colleagues and friends whom I could ask for help and guidance. Second, it helped treat those initial feelings of isolation. The collection of dedicated practitioners the conference represented showed me that I had more resources and support than I had realized. Third, the structure of Boot Camp exposed me to a broad range of issues in correctional medicine and put me face to face with experts working on those issues. I came away from the experience with a sense of perspective on common issues in healthcare systems and a toolbox for how to approach fixing them most effectively.

Patience Is a Virtue

A related, but slightly different tendency among new medical directors is failure to triage. When I first started in my role, I tried to solve every problem that arose, as quickly as possible. I feared every ember would turn into a fire, and thought that my effectiveness was a function of my reactivity to crises. What I eventually realized is that, rather than making me more effective, responsiveness without prioritization actually made me less efficient. I spent time responding to requests for information that changed or evaporated by the end of the day. I spent energy on solving site level details that were better managed by those working at the site level (who, incidentally, solved these issues in innovative ways once I gave them the chance). I got much better at triaging my workload while keeping track of tasks delegated to others, and learned to resist the urge to press “send” within a minute of receiving an email. An extra moment of contemplation is seldom wasted and giving staff and colleagues a chance to work with me as team members helped me be a more effective member of the team. It is important never to underestimate how much one has to learn. Medical directors bring great compassion and clinical training to their work, but there are more than just these moving parts to the clockwork of a healthcare system. Custody and administrative staff often have operational insight or institutional memory that can be invaluable to a new medical director. Agencies, such as the department of public health or the attorney general’s office, are also helpful in developing coordinated solutions to common issues and maximizing effectiveness. The exchange of perspectives among different agencies engenders stability in social programs that are critical to our patients’ good health. Taking the time to gain this perspective can be the difference between a policy that succeeds or fails, and a patient who thrives upon release or recidivates.

Rome Wasn’t Built in a Day

Building and improving a medical system is iterative. With each pass, the root causes of problems ultimately preventing access to high quality health care become more apparent. As one problem is solved, other more fundamental problems can be addressed. As a new Medical Director, I thought that my inability to solve every problem at once meant failure. What I learned, however, is that the process of finding solutions as a team was just as important as the solutions themselves. Sustainable solutions are those not driven by one person alone, but rather those involving the contribution of all stakeholders. A wise mentor of mine once told me that one person can have a great positive impact on a system. What I realized is that she had achieved such change not by the force of her will alone, but by convincing those around her that healthcare for inmates was a noble and necessary pursuit. Making positive change takes time, as nothing worthwhile is done without hard work and dedication. The struggle involved in trying to provide good individual and good public health is part of what makes correctional medicine an important and fascinating field. As a new Medical Director, I have learned to welcome the challenges that come and to see in them opportunities for growth. This process builds clinical and administrative skill-sets, strengthens networks and makes us better advocates for our patients

For more information on SCP view their website at www.corrdocs.org.

Dr. Epps is an SCP member and Medical Director at the Department of Correction, State of Delaware. Readers may contact him at spencer.epps@state.de.us.


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