Writing a Medicolegal Report and Answering the Three Essential Questions

Overall, with matters involving historical abuse, and an agreement about what is defined as the “subject abuse”, I find it useful to conceptualise the case into three parts:

1. What was the person like before the subject abuse?
2. What was the person like after the abuse and currently?
3. What could the person have been like if not for the subject abuse?

Using this approach assists with apportionment and identification of “premorbid” factors or adversity that may have occurred prior to the abuse. It accounts for genetic factors and the impact of other incidents of abuse that were not part of that which was defined as the “subject abuse”, including neglectful or emotionally damaging environments encountered during infancy.

Providing a thorough depiction of the current predicament of the examinee assists with making diagnoses, as well as providing considered opinions of the impact of the abuse. These include interpersonal and relationship issues, self-identity, and behaviours such as substance use, gambling and increased risk-taking behaviours. Examining for avoidance behaviours, either conscious or subconscious, enables us to validate the impact of the abuse. It also demonstrates a potential limitation on social and recreational activities, as well as other restrictions to enjoying a reasonable quality of life.

And finally, gaining an understanding of the areas pertaining to “what would or could have been” is made easier by thinking about the questions to pose in the first place. Importantly, asking the examinee about their goals or aspirations prior to the incident of subject abuse, then determining whether they were attainable, with regard to interest, aptitude or financial means. Asking about family values or religious or spiritual beliefs within the family of origin may also elicit more evidence for the impact of abuse. For example, a family who did not misuse substances and where this was not modelled or normalised is very significant when examining a person with a long history of substance misuse. Determining the interpersonal and career trajectories of siblings who were not subjected to the subject abuse is also significant when providing opinions about the impact of the subject abuse on career and earning potential, particularly if there is a request for a percentage apportionment.

This approach assists me in planning my assessments so that I have all of the information with as much substantiation as possible before putting pen to paper. The number of questions posed in personal injury cases can be considerable and having as much information at hand before preparing the reports saves valuable time and provides for quality responses that can be backed up if they're to be defended in court.