You Don’t See Me Laughing, Do You?

The patient has a common complaint, musculoskeletal pain of the knee.

“You probably need an MRI. We can put you on the list ... When do you get out?” the prison PA asks.

“2014,” answers the inmate.

“I don’t think we’ll get to you,” says the PA flatly.

The other PA student and I give a chuckle, as does the inmate. Good one.

“You guys are laughing. You don’t see me laughing, do you?” says the PA. “Let’s talk about it Friday. Stay behind the fence until then, okay?”

It turns out the MRI truck comes once, maybe twice, a year--Usually on a weekend. They’ll see seven or eight guys one day from this facility, and seven or eight the next day from the camp down the road. How they decide who gets an exam, I haven’t figured out. Many are called but few are chosen. I am sure not everyone who wants an MRI really needs one. In fact, I’m sure a large percentage of inmates don’t need an MRI. But … if you did need one … then, you’re kind of screwed.

I suppose my only answer at this point is to make sure I do good physical exams and give good patient advice, and refer for an MRI only when I’m sure that’s the appropriate next step. It’s a good rule for any clinician and a good lesson for me as a student.

And I guess I won’t laugh next time either.