Eliciting Medical History

Eliciting Medical History: Genetic Counseling a Prisoner


Andrea E. Harbison, MS, CGC
Board Certified Genetic Counselor
LBJ General Hospital
5656 Kelley St.
Houston, TX 77026
Phone: 713.566.5939
Fax: 713.566.4521
Email: Andrea.Harbison@uth.tmc.edu

As a new counselor just out of school, I started my first job full of excitement for working with a culturally diverse patient community in Houston.  I was an outreach prenatal counselor, traveling to different city and county clinics. I counseled women who as a majority spoke only Spanish, and who were from countries all over South and Central America—Mexico, Guatemala, Honduras, Argentina.  I also saw patients from different countries in Africa and occasionally some patients from Vietnam.  I rarely, if ever, counseled a Northern European/Caucasian patient.  It was just the job I wanted, as I loved learning about different cultures and cultural issues during my training at the University of Cincinnati.  I really felt like I was putting my skills to use and learning new things every day.

After two years in this position, I began working at a prenatal and pediatric position at Lyndon B. Johnson General Hospital, a county hospital in Houston.   My patient population was similar to those at the city and county clinics.  These were the same patients I was used to seeing, except now they were traveling to see me at the hospital, instead of the other way around.  After two years experience as a counselor I felt comfortable with patients from different backgrounds and who spoke different languages.   I was practiced with using an interpreter, with speaking Spanish myself, and with addressing cultural differences and asking patients their beliefs.  However, soon after beginning to work at LBJ I encountered an entirely new culture—prison culture.

I vividly remember my first time counseling a woman who was incarcerated.  She was wearing an orange jumpsuit, the standard prison uniform.  When I went to the waiting room and called her name, she stood up, and I noticed her hands were in handcuffs in front of her.  She slowly began walking towards me, not quite looking me in the eye, and the guard followed her.  Several thoughts began to race through my mind as I felt my heart start to beat faster and I felt myself getting anxious and nervous.  Why is the guard coming with her?  Why does she have to wear the handcuffs inside the hospital?  Why won't she look me in the eye?  What crime did she commit to end up in jail?  What should I say to her during contracting?  Should I ask why she is in prison or is that not important to the session?

We walked towards my office and I tried to say a few general things like I did with all of my patients.  Once at the door, the guard walked right into the room with us.  I was a little surprised, because I knew we would be discussing sensitive personal health information.  Because I was new to working with the prison population, I thought the guard was supposed to be there with us and didn't question it.

Fighting my anxiety, I proceeded with the session and after several minutes found that it was similar to the other patients I saw every day.   She brought up the same types of questions, similar concerns, and similar fears.  The orange jumpsuit and handcuffs did not seem as intimidating and I reminded myself that she was a person first, not just an inmate.  I thought back to my "people first" training in graduate school.  The guard sat there quietly the whole time and after awhile I forgot about him for the most part too.

After our session was done, I took her back to the waiting room for her ultrasound.  I then called my next patient.  As we walked into my office, she walked into the room in front of me and went to take a seat at the table.   Quite suddenly, she looked back at me with wide eyes and surprise written on her face.  When I asked what was wrong she pointed to the chair.  A pair of handcuffs was on the seat of her chair, an extra set accidentally left behind from the guard.  I apologized to her, picked up the handcuffs, and returned them to the guard.  After recovering from her surprise, the rest of the session went well.

My first case of counseling a woman who was incarcerated will always make me laugh for the handcuff moment afterwards---yet I also still remember my acute feelings of fear and anxiety as I wondered how I would relate to my patient.  With many people I see, I feel a connection to them or their situation, or can imagine what it would be like to be in their shoes.  When it comes to jail and prison, I have no personal experience and find it more difficult to imagine what it would be like to be incarcerated.  I have never been inside a jail or prison.  None of my friends or family have ever been in jail or in prison. It feels like a whole different world that I only see on television or the movies.

Over time, I have come to realize and understand that women who are incarcerated are very similar to many other patients I see who are not incarcerated.  They have the same hopes, dreams, and fears as many pregnant women.  They certainly face special challenges and limitations on personal freedoms from being incarcerated, but they are still people.  I usually do not ask why a person is in custody, although sometimes they will bring it up.  Instead, we talk about other things important to all of my patients—how does this information make you feel?  What do you think about the amniocentesis?  How important is it for you to know for sure if your baby has Down syndrome?

Now with two years of experience of working with women who come from our county jail, I have become a much better advocate.  I now know that my patients are entitled to privacy during their counseling sessions.  I have a chair outside my office where the guard can wait for them.   I also make sure that they know they still are able to make some of their own decisions—like whether or not they want the amniocentesis.

Of course, I still make mistakes and learn new things.  Recently a woman I counseled who was in jail saw a jar of candy I have in my office and asked if she could have some.  She said she did not get enough to eat at the jail.  That tugged at my heart—who could deny food to a hungry pregnant woman?  I felt mad that she didn't get enough to eat in jail.  I gave her the jar and she proceeded to eat all the Starbursts inside over the course of our 30 minute meeting.  After the session the guard who was outside saw the large pile of wrappers on my table and told me I am not supposed to give out food.  Lesson learned.  My co-worker also shared with me that one time she handed a follow up ultrasound appointment to an inmate, and learned that we are not allowed to do that either.  Apparently, if inmates know when their next appointment is, they can try to alert a family member to be there at the hospital on that date and time to possibly attempt an escape.  Anytime a patient who is incarcerated needs a follow up appointment we have to give that information to the guard and not to them.

Overall, I have found that counseling women who are incarcerated adds to the cultural diversity I appreciate from working at a county hospital.


Andrea Harbison is a 2005 graduate of the University of Cincinnati Genetic Counseling Graduate Program.  She was board certified in 2007 and currently works at Lyndon B. Johnson General Hospital in Houston, TX.  She is also a clinical supervisor involved with the University of Texas Genetic Counseling Program.


Also, read this article by Cassandra Barrett, PhD, CGC: 
Who have we disappeared? Questions about incarceration for genetic counselors (nsgc.org)

 

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