ABSTRACT

The methodology for evaluating a traumatic brain injury (TBI) — whether for treatment purposes or forensic purposes — is equivalent. However, there are distinct differences between a neuropsychiatric examination for treatment purposes and that for use in a legal framework; these are discussed in detail elsewhere (Granacher, 2003). When a physician examines a person for treatment following traumatic brain injury, that physician is unconcerned about issues of causation, potential malingering, financial damages, or any other legal constructs that may have great importance in

a legal setting. Moreover, the rules, standards, and ethics for a forensic examination are very different from those for a treatment examination. The treating physician is at all times to follow the Hippocratic Oath, and to function as his or her patient’s health care advocate. On the other hand, advocacy by a physician is not allowed in an expert witness framework. The examining physician, who is to function as an expert witness, acts as an agent of a third party. In general, the plaintiff lawyer, the defense lawyer, or, at times, the court, to perform an independent evaluation of an injured person’s mental state, hires the physician. This examination is required to be impartial and should be based upon ethical principles guiding forensic medical examinations. For a neuropsychiatric examination, the physician will be a psychiatrist or a psychiatrist/neurologist, in most instances. Thus, the ethical principles of the American Academy of Psychiatry and the Law (2004) will apply here.