Physicians in private practice often talk about the importance of establishing a relationship with their patients. In that setting, it's not only desirable but also encouraged by both the community and the doctor's office. "When you see patients in jail, you can't approach the situation in the same way," says Bonaparte. "There are patients you bond with, and the relationship is cordial, but you need to be more cautious." Sharing personal information with inmates can be a safety issue, and some inmates may take advantage of such a situation.
Balancing physician safety with patient privacy also complicates health care in the correctional system. Officers are present, often outside the exam room door. Security needs to be close enough to watch, but far enough away not to hear, out of respect for patient confidentiality.
Inmates who act unpredictably may wear shackles when seen by health care professionals, but "patients, for the most part, are courteous and appreciative," says Bonaparte. "We're here to help them, and I think there is that understanding."