What Makes a Good Medicolegal Report?

I recently attended a two day legal conference which was held to mark ten years since the Royal Commission into Institutional responses to Childhood Sexual Abuse. A very powerful and information packed program which gave me a new perspective on my work as a medicolegal expert.

It allowed me to deep dive into what lawyers are actually seeking when they ask the questions they do in their letters of instruction. 

As a non-lawyer the learning curve was super steep, and I was able to come away with a basic understanding of some concepts, which helped me understand how lawyers approach and conduct civil injury claims for compensation. And as part of that I could really reflect on the crucial component I contribute to that, when assessing somebody they are representing. 

It made me realise that my medicolegal report was a key part of guiding and instructing the legal process. From determining the presence or absence of a psychological condition that has arisen from the injury, to guiding the critical process of determining damages, my answers need to be as accurate and as thorough as possible.

One of the key takeaways for me was how lawyers assess claims for damages and why asking me about the impact of abuse on an education or employment trajectory is necessary. They are seeking my opinion as to how a condition can impact this, as well as how the injury or abuse can impact this. In other words, what happened and what could have happened if not for the abuse and/or the subsequent psychiatric condition. They need to know which symptoms impact their client and to what level. 

Answer the actual questions

Being evasive or refusing to answer a question may falsely reassure a medicolegal expert that they would be safe if called to Court is one way to ensure that your services are not requested again. Stating plainly that you do not know or cannot know the answer to a question and why is much more helpful, because that might actually be the case from your perspective, and the legal process will find that much more useful. And if the evidence is insufficient, say so—but explain why.

Avoid jargon and personal constructs

Use plain English wherever you can. Always use established diagnoses as they are stated exactly in either the DSM-V or ICD-11. Don’t invent diagnosis and don’t use symptoms instead of diagnoses. Depression is not a diagnosis, neither is an anxiety disorder. Use current terminology rather than diagnoses from a few DSM’s ago if you wish to look relevant and current. 

And don’t offer personal reflections about aetiology of diagnoses unless others also share this knowledge of aetiology. Anecdotes are unhelpful as are personal constructs. 

Anchor opinions in recognised diagnostic frameworks

The establishment of a diagnosis when you walk the reader why the examinee met the criteria, and which symptoms were elucidated to make that diagnosis. This provides more valuable information than simply a name of a condition. It also substantiates your perspective and explains exactly how the history and symptoms meet (or fail to meet) each criterion. 

Read all of the documents provided

It can be laborious to read through huge historical files but it is critical. We see a person in a moment of time, years after the abuse was alleged to have occurred. Buried inside 500 pages might be a court report or a psychiatric assessment that was conducted at the time the injury was being perpetrated. Symptoms might have been noticed and recorded. A diagnosis might have been made. All of these documents are extremely valuable when substantiating your own diagnosis, and a timeline of symptom onset such as outbursts of anger, or suicidality also crucial when assessing the impact of symptomatology, 

Maintain independence

A medicolegal report is not advocacy. It is an independent professional opinion. A well-structured, transparent, and neutral report serves the court best, even if it doesn’t align neatly with one side’s narrative. 

In short: A good medicolegal report is clear, specific, evidence-based, and trauma-informed. It answers all the questions, avoids jargon, uses proper diagnostic nomenclature, references appropriately, and demonstrates you’ve read and weighed all the available evidence.