Dr. Klein's powerful vignette, "The Prison Patient" [1], describes the all-too-human corruption of a medical resident's relationship with an incarcerated patient. The patient is suffering from impotence secondary to a ß-blocker prescribed for post-myocardial infarction management. The physician has inappropriately peeked at the inmate's crime history and has discovered that his patient is imprisoned for child molestation. With this newfound knowledge, the physician's previous compassionate demeanor turns icy. He is transformed from caregiver to judge and jury, deciding that the patient deserves his impotence and should be cowed into accepting it with the threat of imminent death for noncompliance.

As one who has provided medical care in a major urban jail, I can fully understand the conflicting emotions experienced by this young physician. It is for this very reason that medical staff in our system are prohibited from knowing the crimes their patients have been accused or found guilty of. The only exceptions are mental health providers, for whom this information is critical.

What is most telling about this story is the sense of isolation the reader experiences with the young physician as he delivers care alone in the prison. Health care in a prison or jail is best delivered within a supportive health care matrix. The environment of the prison is corrosive to the ethic of health care delivery, and the practitioner needs the support of colleagues who share his values to deal with the emotional and ethical challenges.