FM14.{1,9} | Medico-legal Examination & Reporting of Injuries — Summary & Reflection

KEY TAKEAWAYS

The medico-legal examination follows a structured eight-step protocol: consent → identification → history → general examination → head-to-toe injury survey → clothing examination → ancillary investigations → MLC completion. Patient consent is mandatory and cannot be overridden by police authority. Each injury is documented using the SSSMD format: Site, Size, Shape, Surroundings, Margins/depth. FM14.9 specimen identification covers: contusion (intact skin, blunt force), abrasion (epidermis only), laceration (tissue bridges, blunt force), firearm wounds (entry = smaller/inverted/abraded collar vs exit = larger/everted), burns (Rule of Nines for BSA, depth classification, pattern for mechanism), head injury (lucid interval = extradural haematoma from middle meningeal artery rupture), and fracture (site/type/healing stage). The MLC opinion integrates wound type, BNS category (S115 simple hurt; S118 grievous hurt — specifying the sub-category), weapon class consistency, and circumstantial injury pattern interpretation. Medico-legal language uses 'consistent with' rather than definitive causal statements, and all findings are contemporaneously documented and signed by the examining physician.

REFLECT

You are a house officer on casualty duty at midnight. A 35-year-old man is brought in by a police constable after a road traffic accident. The constable asks you to complete the MLC quickly because 'it's just an accident case.' On examination, you notice, in addition to the road traffic injuries, two oval contusions on the posterior aspect of both arms consistent with grip marks, and a small fresh laceration over the left wrist that has clean margins and a tapering end. The patient is drowsy from pain medication and unable to give a clear history. How does your approach to this MLC change — and what additional steps do you take — given findings that may not be consistent with the alleged mechanism? Consider both your clinical responsibilities and your professional duties under the law.