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The challenge of assessing alleged assault
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One of the really difficult challenges of rural and remote practice occurs when asked to assist the police in the examination of an alleged assault victim. Invariably the assault is genuine but rarely the victim may present with a bogus claim. This will usually be in the setting of a secondary gain (e.g. financial) but may also occur when the patient has some form of psychiatric illness.
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‘Maddy’, aged 17, was brought in by the police with a claim that she was allegedly assaulted by a man with a ‘stay-sharp’ knife (Kille, 1986; 1991). On examination there was an unusual pattern of superficial wounds on the chest and legs.
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DISCUSSION AND LESSONS LEARNED
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When faced with the responsibility of examination of victims of physical and sexual abuse it is most appropriate to have basic training in forensic medicine and have the appropriate equipment.
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The account of the assault and examination findings should be carefully documented. Photographs are beneficial. Additionally, the patient’s social, family and psychiatric history may be useful in gaining a better understanding of their situation and subsequent management.
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While listening to and noting the victim’s claims and providing caring empathetic support it is also appropriate to keep an open mind should you have suspicion of unusual behaviour or injuries that are unusual and do not ‘add up’. Keep in mind that you may be asked to provide a report on the injuries (only with the patient’s consent) and to testify in a court of law.
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The picture of ‘Maddy’ shows some typical features of injuries that are self-inflicted namely:
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all of similar depth
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(usually) all accessible from the dominant hand (right in this case)
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avoidance of vital or very sensitive area such as eyes, mouth, nipples
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not consistent with the type of weapon used or the fact that she said she was clothed when slashed (no marking on clothing)
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wounds clustered together in specific body areas with many of the incisions crossing each other
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no ‘defence wounds’.
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The man who cried wolf!
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Only two months after starting country practice I had a phone call from the local police requesting help in an emergency at a nearby farmhouse. Public servants and a constable had been serving legal documents on a man when he suddenly retreated to the house and began threatening everyone with a shotgun.
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I knew about Jim, a 49-year-old widowed farmer and a legend in the district. A war hero, he was awarded for bravery as a pilot of Lancaster bombers over Germany but about 1944 he suffered a ‘nervous breakdown’. He developed paranoid schizophrenia ...