TOPICS FOR DISCUSSION A list of topics is provided in the Manual. Methodology: Divide the trainees into small groups and give each group one of the topics to discuss. A reporting back session is important so that all the trainees hear the points raised under both topics. Where possible, facilitators should move around the groups. Points to be highlighted/suggested areas for discussion: 39. – The relationship between the medical officer and the prison director is crucial to the smooth and safe running of the prison; 39. – Tensions are likely to occur because the doctor has considerable independence, unlike other members of the prison staff; 39. – The medical officer has a responsibility to ensure a good standard of health for all prisoners; this might cause difficulty when resources are limited; 39. – The medical officer has a relationship of doctor to patient with prisoners, which means confidentiality, even from the director of the prison; 39. – The medical officer has a duty to advise the director on certain matters; this advice must be taken; 39. – Are there circumstances in which the role of the medical officer can be compromised by prison management procedures? What should be done? CASE STUDIES Methodology: Trainees should be asked to volunteer to join training team members in panel discussions on the three case studies provided. Points to be highlighted/suggested areas for discussion: CASE STUDY 1 39. – Situations like this pose very difficult problems for prison staff. Clearly, the prisoner is behaving unreasonably and the staff are having great difficulty in dealing with him. The doctor is seen as a member of staff and is called on to help resolve the situation. All this seems very reasonable; 39. – The doctor can act only within the confines of his or her professional brief; 39. – The doctor is not allowed to take part in any punishment or forced treatment of prisoners; 39. – The doctor’s decision must be based on the well-being of the prisoner as a patient; 39. – What responsibility does the doctor have for the safety of the prison staff? 73