The following is an excerpt from the article:
A PIG THAT BUILDS WITH BRICKS; (WEEDING OUT JUNK SCIENCE IN THE COURTROOM AND IN PSYCHIATRIC-LEGAL REPORTS
By Medical Malpractice Expert Witness Alberto M. Goldwaser, MD
The tale of the “Three Little Pigs” is used to illustrate how psychiatrists use and misuse evidence. This paper refers to the different approaches of building a case the proverbial Brick House through a forensic psychiatric study. The object is to assist the jurist by presenting a picture of the case, and then intelligently persuade.
To know psychiatry well, is but one, albeit important, element of being an expert (psychiatric) witness. Disconnected from other factors, it may play a very limited and not helpful role in the establishment of a legal decision. The expert ought to know what science is, and what it is not, as well as how to apply it to specific clinical matters under legal scrutiny. It is essential to be familiar with the rules of evidence allowing or proscribing his/her participation in the fact finding process. Lastly, it is vital to clearly differentiate between the forensic and the treating roles and responsibilities of a doctor.
To be prepared and convey “science” in the expert opinion, one should have taken the preparatory steps. First, one should know the boundaries imposed by each professional’s hat: treating psychiatrist and forensic psychiatrist.
The clinical (treating) psychiatrist relies heavily on the patient’s self report of symptoms – what the patient feels, or claims to feel. As the patient’s helper, the clinician accepts such descriptions as existing, and proceeds with the treatment, which consists first on learning more about the condition that brings the patient to the office, and then eliminating those symptoms and perhaps even their cause.
As a clinician, the mental health professional is a believer of his/her patient’s clinical descriptions with the overriding goal of diagnosis and treating an illness, advocating, a priori in the patient’s affliction. There is a pro-patient stance and the utmost adherence to the confidentiality standard. Such adherence to the doctor/patient relationship does not exist in a forensic setting. This allows the forensic doctor an objectivity that is raised to levels commonly not expected from the treating doctor. All this applies to the study of direct (the individual itself) and indirect (collateral) sources of information.
There is also the assumption of worthiness and trust to and from the patient. The doctor uses medical notions and techniques designed for the treatment of such ailment.
The treating doctor runs a risk, in a court, when explaining the origin of the symptoms described by the individual based on the dare of an occurrence. It appears that the clinician is placing those complaints in a time context based on a leap of faith, (expected only of the “treating” expert, not of the “forensic” one). Nonetheless, such connection may not be there.
In the forensic role, the psychiatrist’s neutrality and objectivity is vital for him/her to be acceptable link in the fact finding process, expected to be adhered to in the professional attitude and relationship with the examinee.
Expert witnesses are admitted to testify in courts only because they have knowledge that is beyond that of the average juror. They should also be able to teach (digest) clinical concepts into impressions designed for those not versed to get the picture.
EWN
http://www.witness.net
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