-55 NPMs ask staff how prisoners can tell the passing of time (and specifically whether or not they have access to a watch). 4.3.7. Role of medical staff Because of the particularly serious effects that solitary confinement has on isolated people, effective monitoring by the medical authorities operating in prisons is of critical importance. Many NPMs stressed that often doctors lack the necessary awareness regarding their role and highlighted the need to strengthen it also through specific training. A first problem relates to the visit of a medical doctor, which should take place prior to isolation to verify whether the detainee is in conditions to be able to cope with it: NPMs found that frequently this visit does not take place. A second issue that needs to be verified by NPMs is whether doctors visit all persons placed in isolation daily. In some cases, NPMs found that this is true only for prisoners who are isolated for disciplinary reasons. If the national legislation does not provide for an obligation to visit all isolated detainees, the NPM may appeal to the basic obligations of medical personnel. Another aspect to be monitored concerns the way the visits are carried out. They should take place inside the cell, and also allow the doctor to assess the living conditions of the person examined. They should not take place outside the accommodation section, e.g. in the infirmary, and not outside the cell, through the steel door. Visits by doctors often take place through the hatch of the door. A meaningful interaction cannot take place through the hatch of the door since it does not guarantee the privacy and confidentiality of the visit and, more generally, it is disrespectful to interact in this way. A further problematic aspect (that may emerge from the study of the medical records of isolated persons and interviews) concerns cases where isolation measures are carried out in so-called smooth cells (bare cells without furniture or only with a mattress often placed on the floor). This form of isolation is prescribed by medical staff as a reaction to acts of self-harm or suicide attempts. It is a totally inadequate reaction, as there Monitoring Solitary Confinement in Prison