A Medical Student's Reflection on Ethics and Advocacy while Rotating Through an Urban Jail

This narrative reflection explores the intersection of clinical medicine and carceral constraints through the experience of a fourth-year medical student completing a clinical rotation at the Philadelphia Department of Prisons. By documenting the challenges of managing chronic disease, acute trauma, and substance use disorders within a high-security environment, the author illustrates how incarceration functions as a primary determinant of health. Key themes include the role of physician advocacy in navigating institutional barriers, the ethical complexities of treating patients with criminal backgrounds, and the value of implementing strategies that align with both custodial and medical goals. The piece concludes that despite the restrictive nature of carceral settings, opportunities still exist for longitudinal relationship-building and humanistic care that can mitigate patient mistrust and promote health equity.