Symptoms appearing after personal injury may or may not be attributable to that injury. All too often, consulting physicians pronounce on causation based on patient report, without reviewing the contemporaneous clinical records. Revisionist memory, while not usually malingered, is generally self-serving and unreliable, and must be tested against what was recorded at the time.

Though they appear de novo, post-traumatic complaints may yet represent a new episode in a pre-existing pattern. The injury may have been neither necessary nor sufficient, and the pre-injury records must be reviewed.

Even truly new complaints contemporaneously documented shortly after injury must be viewed against not a blank screen of symptomless health and well-being but the rate of "spontaneous" occurrence of complaints in the population. Various patterns of bowel symptoms recur in up to 20% of the normal population and frequently first occur after uncomplicated abdominal and pelvic surgery. Various other symptoms are surprisingly common^{1, 2, 3, 4}.

As recently highlighted, the litigation process itself generates symptoms and even syndromes. Dr Paul Lees-Haley continues to build a body of literature on the psychological aspects of personal injury. He has recently pointed out⁵ that Personal Injury claimants without head trauma or toxic exposure complain of more neuropsychological or neurotoxic symptoms than nonlitigants with such injuries. Neuropsychologists should be required to report their medicolegal assessments not in comparison with the normal population but against the background rates of symptoms for litigants with unrelated injuries.

Copyright © 2008 Electronic Handbook of Legal Medicine