“Your Stethoscope, It Could be a Danger to You”: Criminal Stigma and the Clinical Encounter

• In Event: Medical Sociology Section Open Call Paper Session

Abstract

Researchers have studied the provision of healthcare in correctional settings and to formerly incarcerated patients seeking community care. Less work has examined free world hospital care for those presently incarcerated and the unique challenges of this type of healthcare delivery. Drawing upon twenty-five semi-structured interviews with inpatient general internal medicine physicians (“hospitalists”), I explore what tensions arise when medical and carceral logics collide, how physicians manage these tensions, and what role their broader views on the criminal legal system play in shaping these management strategies. I find that criminal stigma, as perceptions of dangerousness and mistrust in the therapeutic alliance, is a principal component of carceral logic that obscures medical reasoning. A subcomponent of this stigma is related to the presence of policing officials in the encounter, who transform the patient-physician dyad into a carceral triad that can undermine medical authority. In response, physicians adopt a variety of strategies to resist or comply with carceral impositions, either passively accepting police presence, physically distancing police from clinical activity, or bypassing detailed information about a patient’s criminal past. These strategies are partially structured by physician beliefs about the roles of race and punitiveness as scaffolds of the criminal legal system. I argue that medical and carceral logics are incommensurable and co-exist in a manner that is universally antithetical to a physician’s oath to do no harm. These findings fill gaps in existing knowledge related to carcerality, physician culture, and medical practice that have clinically relevant implications for the health of incarcerated patients.

Author

• GeorgePatrick Hutchins, Harvard University