Abstract
In cases involving medical issues, the medicolegal consultation, comprising history-taking and examination, supplemented sometimes by tests or investigations and, wherever possible, information from an informant, lies at the heart of the process of assisting the court. It provides the psychiatric expert with the opportunity to use training, skill and experience to explore by effective questioning the subject’s symptoms, in the context of their family, personal and medical history and personality, and, through careful observation of the physical and mental state, to assess their current condition. The consultation requires the highest standards and should be conducted with an awareness and understanding of the potential effects of the proceedings on the subject.
I must say that, as a litigant, I should dread a lawsuit beyond almost anything else, short of sickness or death.
In cases involving medical issues, the medicolegal consultation, comprising history-taking and examination, supplemented sometimes by tests or investigations and, wherever possible, information from an informant, lies at the heart of the process of assisting the court. It provides the psychiatric expert with the opportunity to use training, skill and experience to explore by effective questioning the subject’s symptoms, in the context of their family, personal and medical history and personality, and, through careful observation of the physical and mental state, to assess their current condition. The consultation requires the highest standards and should be conducted with an awareness and understanding of the potential effects of the proceedings on the subject. Without a personal consultation with the subject, you are reliant on the records made by others as to the subject’s history and condition.
The consultation is an important and potentially stressful experience for the subject. The litigation may have dominated their life for years. Their liberty, reputation, career or financial security may be at stake. They may have been waiting for the appointment for some time, have had to travel a long distance and suffered other inconvenience to get to it. If you are seeing a prisoner, they may not be expecting you or they may have been wrongly informed as to who you are and the purpose of the visit. If you are instructed by ‘the other side’, they may be expecting a hostile consultation. It may be the first time that they have seen a psychiatrist. They may have some of the popular misapprehensions of psychiatry. They may resent the psychiatric label or be angry that their solicitors have sent them.
Arrangements for the Consultation
Fix a date for the consultation and send an ‘appointment letter’ (online Appendix 6). The subject needs due notice, although sometimes it is necessary to arrange appointments at short notice. Allow for how far away they live and, where appropriate, their capacity for complicated journeys using different forms of public transport.
The appointment letter should include or enclose:
the nature and purpose of the consultation;
the likely length of the consultation;
who has requested the consultation;
where, when and at what time the consultation will take place;
a request for details of any special requirements (such as a downstairs consulting room, an interpreter);
any requirements as to proof of identity and advising as to whether it is intended to take a photograph for identification or other purposes;
contact details sufficient to enable the appointment to be changed, a warning to be given of late arrival or for directions to be sought en route;
how to complain;
travel directions, details of car-parking arrangements and, if appropriate, information as to how and where refreshments may be obtained.
Online Appendix 7 sets out the information that you could consider providing on your website.
The Essential Ingredients
Courtesy
It is surprising how often subjects report that experts they have seen ‘for the other side’ have treated them unpleasantly, abruptly or condescendingly.
Respect
However distasteful or objectionable the subject’s actual or alleged behaviour, whatever your views about the merits of the litigation, or however appalled you feel about a parent’s alleged behaviour towards their child, the subject is a fellow human. It is not for you to judge them; treat them with respect.
Sympathetic Objectivity
A sympathetic approach helps you to build rapport and elicit a reliable history. The subject wants to know that someone is prepared to listen, to believe them, if they are telling the truth, and to try and understand what it feels like for them. But sympathy must be combined with objectivity. It is not necessary to believe everything they say. It is a forensic investigation; the doctor’s usual therapeutic objectives must almost always take second place to the requirement for evidence that assists in achieving the overriding objectives of justice and fairness.
Patience
Some people find it difficult enough giving their history to any specialist, even more so a psychiatrist and particularly if it is for the first time. A hurried and inaccurate history is not in the subject’s interests, in the interests of justice or in the interests of the expert who may have this failing exposed in the witness box. They need time, patience and often encouragement to tell their story.
The Venue
Your safety is paramount. Aim for a reasonable balance between the safety measures in a hospital emergency consultation room and an environment in which the subject feels as comfortable as possible. Have an agreed method of summoning assistance. If you are consulting outside usual clinic hours, consider whether it is safe to do so or what special precautions are needed.
If the subject is in a prison or a psychiatric facility, ask whether you should see them on their own. You may need to be accompanied or have a personal safety alarm. In prison, ascertain the arrangements for summoning help.
You may decide to hire a room in a hotel or a meeting room in a business centre. Where someone is housebound or unable to travel, a home assessment may be necessary, but ask if the solicitor would see the subject in their home. Consider taking someone with you. Ensure that someone knows the time and location of your consultation. Solicitors are often willing for you to see their client at their offices.
You are advised not to see the subject in your own home. A retired consultant psychiatrist was killed in his home by a former patient. His name was on a gate-post. The patient had been looking for another of his former consultants; fortunately, he had moved.
A formal consulting room allows you to get used to how people respond in that setting. Make it welcoming. Carpet, curtains and fresh flowers help. Have a chair identical to that of the subject or at least sit at the same level. If it is also an office, organise it so that the subject feels that they are your priority, that you were expecting them and you were prepared. Paper tissues are essential. If the subject cannot bring in a hot beverage, there should at least be water available.
If you conduct the assessment by video link, draw attention to how this can limit the assessment of appearance and behaviour and prevent the utilisation of the senses of touch and smell.
Be Prepared
Medical Records
Only exceptionally, conduct the consultation without seeing the subject’s medical records. As Boyle (2016, p. 129) says:
The import of the medical records is huge:
Related posts:
Chapter 3 – Training, Development and the Maintenance of Expertise
Chapter 4 – Business Matters
Chapter 10 – Reports in Cases Involving Capacity Issues
Chapter 11 – Reports for the First-tier Tribunal (Health, Education and Social Care Chamber) Mental Health
Chapter 12 – Reports in Immigration and Asylum Cases
Chapter 17 – Going to Court
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