Writing Expert Reports for IMEs – Considering Best Practice When it Comes to the Purpose of the Report and the Intended Reader
Recently I finished a CPD activity with my peers and it made me think about not only the content of medicolegal reports but also the optimal structure.
We decided to examine a series of de-identified medicolegal reports that we had encountered in our practice. These reports had been provided to us so that we could form opinions about the examiner's findings regarding people we would also assess. We chose reports from extremely skilled and experienced examiners in order to determine best practice outcomes that we could implement to improve our own report writing.
The exercise was for quality improvement, but also served as an educational piece. It's quite common to develop an approach to medicolegal report writing based on what colleagues do, without consideration of best practice. We tend to operate in silos, may have attended lectures and adopted the presenter's style, or drifted between different approaches as we've become more skilled with preparing expert reports.
The exercise also opened up discussion about the intended purpose of the report – and the understanding that it was being provided to guide legal processes and inform the presiding person about the details of a particular matter. Given that the audience was not another psychiatrist, we debated whether we should structure our reports so they are useful and easy to implement during proceedings, or stick to the classic structure and subheadings we were taught to use when presenting clinical cases.
We noted that some colleagues number each fact or item under headings and then refer to these numbers as part of their responses to questions. Although it was easy to locate information in the body of the report using a numbering system, we also discussed the limitations of using these numbers in answers to questions to guide the reader back to a fact, rather than offering an opinion about how or why that fact was relevant to the question. For example, being asked about the impact of childhood abuse on an educational trajectory but answering with a direction to the reader to refer to a particular fact.
We also noted that some reports began with a developmental history. There was variance in the reports regarding what information was placed here. There was a learning from this about adding details pertaining to others, such as children's names and dates of birth, which could be discovered as part of a legal process and its publications. We decided it was prudent not to include names or dates of birth of the examinees' children and noted that our esteemed colleagues refrained from this as well.
We also examined the differences in presentations of mental state examinations. Some were lengthy and thorough with sophisticated descriptors, others more basic and perhaps geared towards the intended audience, which is unlikely to have a psychiatry background. We wondered whether we should present our findings as we have been taught, or for the ease of the reader to understand our findings. Our medical and surgical specialists stick to purist examination findings, and we felt that perhaps we should do the same.
Certainly, this conversation would be enriched by obtaining feedback and opinions from those who instruct us and pose the questions. There is likely no one way, and we did note that the same examiner employed different subheadings and a different order in different reports. It's a useful ongoing discussion, one I would love some feedback about, especially regarding how these reports need to be defended in court.