I must say that, as a litigant, I should dread a lawsuit beyond almost anything else, short of sickness or death. (Judge Learned Hand, quoted by Shapiro, 1993, p. 304)

In legal cases where medical issues arise, the medico-legal consultation lies at the heart of the process of assisting the court in the resolution of disputes and the administration of justice. It provides the psychiatrist with the opportunity to use her training, skill and experience to explore the subject's psychological complaints in the context of the family history, personal history, personality and medical history and to assess current mental state. Where the report is to be prepared without a personal consultation with the subject, the psychiatrist is reliant on the records made by others as to the subject's history and mental state.

The medico-legal consultation is an important and potentially stressful experience for subjects. It is very likely that the litigation itself is a major stress in their life. It may have dominated their life not just for weeks or months but sometimes for years. Their liberty, reputation, career or financial security may be at stake. They may have been waiting for the appointment for some time. They may have had to travel a long distance and suffered other inconvenience to get to the appointment. If you are seeing a prisoner in custody, however carefully your arrangements have been made, they may not be expecting you or they may have been wrongly informed as to who you are and the purpose of the visit. If you are instructed by ‘the other side’, they may be expecting a hostile consultation because they have been told to expect this, often by friends rather than their solicitor, or because they have seen another expert instructed by ‘the other side’ who has been abrupt or unsympathetic. It may be the first time that they have seen a psychiatrist. They may have various inappropriate expectations arising out of the popular misunderstanding of such practices as psychoanalysis, so-called ‘sectioning’ and electroconvulsive therapy (ECT). They may be afraid of the psychiatric label or angry that their solicitors have suggested that a psychiatric opinion is needed.