Finding Confidence and Balance in Medicolegal Psychiatry [Every new medicolegal psychiatrist learns this the hard way]
This is part of a three-part series examining how psychiatrists in medicolegal practice can effectively bridge the gap between clinical complexity and legal clarity.
One of the realities of medicolegal work is that lawyers often want definite answers — even when psychiatry deals mostly in shades of grey. It’s not because they want to pressure or corner us. It’s because their role in litigation is fundamentally different from ours.
For new medicolegal experts, this is where the greatest tension lies. Some fall into the trap of hedging or becoming defensive — fearful of being criticised or of making an error. Others swing to the opposite extreme, agreeing with everything the referrer suggests in an effort to be seen as cooperative or to build a reputation for being “helpful.” Both reactions are understandable — the work is high-stakes, and the scrutiny can be intense — but neither serves the purpose of expert witness work.
The first trap: hedging and defensiveness
This often sounds like:
“It is difficult to say whether the claimant’s symptoms meet full diagnostic criteria for PTSD, as several features overlap with normal stress responses, and it is possible that personality traits also play a role.”
While this may feel safe, it leaves the referrer and the court without a clear opinion. A more useful version would be:
“Although some symptoms overlap with normal stress responses and pre-existing traits, on balance of probabilities, the claimant’s presentation does not meet full diagnostic criteria for PTSD.”
You’ve still acknowledged complexity — but you’ve given an answer.
The second trap: trying to please the referrer
This usually emerges when the expert senses what outcome the lawyer or insurer might prefer. Faced with the question:
“On the balance of probabilities, what is the cause of any diagnosable psychiatric condition?”
A new expert might write:
“Mr X's adjustment disorder was caused by the workplace bullying incident.”
This kind of confident, one-line conclusion may look decisive — but it skips the reasoning that makes it credible. It also risks overstating causation to satisfy perceived expectations. A more balanced answer might read:
“On the balance of probabilities, Mr X developed an adjustment disorder in the context of workplace bullying, which is likely to have been the principal stressor, although pre-existing vulnerabilities, including a strong family history of mood disorders and concurrent life stressors, including his marriage separation, also contributed.”
That’s still a clear answer — but it’s grounded in clinical reasoning, not advocacy.
Our role isn’t advocacy, and it isn’t appeasement. It’s independent opinion grounded in evidence and experience. The court values balance far more than certainty or compliance.
With time and experience, this becomes easier. You start to trust your judgement, recognise patterns, and develop confidence in holding uncertainty without being paralysed by it. Peer review and supervision are invaluable here — not as performance assessments, but as spaces to discuss complex cases, calibrate opinions, and guard against bias.
The best medicolegal experts are those who learn to sit comfortably in that space between science and law — committed to clarity, anchored in evidence, and steady enough to tell the truth, even when it’s not supportive of a claim.
If you’re a new medicolegal psychiatrist or lawyer working with experts, I’d love to hear your thoughts — what makes for the most useful expert opinion, and how can we better support confidence and independence in this field?