41. A number of CoE countries have introduced systematic medical examinations of all persons who are deprived of their liberty by the police, 28 before or during police custody. This is a commendable practice, which could – if properly implemented – serve as an important safeguard against police ill-treatment. These routine examinations are usually carried out by doctors, nurses or paramedics who are directly working at the respective police facility, by visiting doctors, or in public hospitals, where apprehended persons are brought before entering custody. 42. The most important practical shortcoming noticed in almost all countries – whether during medical examinations upon the request of a detainee, or during routine medical examinations – is the complete lack of medical confidentiality. In most cases, police officers are routinely present during medical examinations, which is likely to discourage persons who have been ill-treated from saying so. In practice, how can legitimate security concerns be met while at the same time not rendering the preventive aspect of a medical examination entirely futile? 43. Further, in practice medical examinations are oftentimes done in cursory manner; detected injuries are not documented properly; and medical staff do not report indications or explicit allegations of ill-treatment to a competent authority. These problems appear to arise regardless of whether the medical professionals are private doctors visiting police stations, are employed by the police, or are working in public hospitals. Employing medical staff directly at police custody facilities has advantages and disadvantages. On the one hand, they could be more efficiently trained in documenting signs of ill-treatment and reporting obligations than general medical staff working in public hospitals. On the other hand, police doctors oftentimes lack independence. How could this be solved? In some countries, systematic medical examinations are carried out in a limited number of police establishments. 28 13