Dr. Wortzel is Director of Neuropsychiatric Consultation Services for the Rocky Mountain Mental Illness Research, Education and Clinical Center at the Rocky Mountain Regional Medical Center, Aurora, CO, and Michael K. Cooper Professor of Neurocognitive Disease at the University of Colorado School of Medicine, Aurora, CO.
J Am Acad Psychiatry Law. 2024 Jun 4;52(2):149-152. doi: 10.29158/JAAPL.240023-24.
There is a clear need for experts with the requisite knowledge and experience to offer medicolegal opinions pertaining to various neuropsychiatric conditions. There is also an important distinction between clinical and medicolegal roles, and the need for training and expertise applicable to forensic assessment. But there remain few available experts with credentials spanning neuropsychiatry and forensic assessment. This creates a dilemma whereby parties involved in litigation featuring neuropsychiatric illness or injury are frequently forced to choose between experts with either knowledge and skills applicable to neuropsychiatric conditions or experts with skills and experience applicable to forensic assessment. Either choice introduces risk. Whether flawed medicolegal opinions are a consequence of deficient medical knowledge or an inadequate forensic evaluation process, the result remains the same, with triers of fact potentially being exposed to problematic testimony. There is, however, a more fundamental problem that implicates patient care more broadly: spurious dichotomies created by the historical segregation of psychiatry and neurology. Optimizing clinical care for patients with neuropsychiatric conditions, improving medical education in support of such care, and enabling forensic neuropsychiatric assessment must then start with more proactive efforts to reintegrate psychiatry and neurology.
对于具备相关知识和经验的专家来说,提供与各种神经精神状况相关的法医鉴定意见显然是必要的。临床和法医角色之间存在着重要的区别,需要进行专门的培训和具备法医评估的专业知识。但是,具备神经精神病学和法医评估资质的专家仍然很少。这造成了一种困境,即涉及神经精神疾病或损伤的诉讼当事方经常被迫在具备神经精神病学知识和技能的专家或具备法医评估知识和经验的专家之间做出选择。无论选择哪一方,都会存在风险。无论是法医鉴定意见存在缺陷是因为医学知识不足还是法医评估过程不充分,结果都是一样的,事实裁决者可能会面临有问题的证词。然而,还有一个更根本的问题,更广泛地涉及到患者护理:精神病学和神经病学的历史分离造成了虚假的二分法。为了优化神经精神疾病患者的临床护理,支持此类护理的医学教育,并能够进行法医神经精神病学评估,那么必须更加积极地努力重新整合精神病学和神经病学。