Intended for healthcare professionals

Careers

History taking after torture: the experiences of doctors who document the impact of torture

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6135 (Published 22 October 2014) Cite this as: BMJ 2014;349:g6135
  1. Abi Rimmer
  1. 1BMJ Careers

Abstract

Abi Rimmer hears from doctors who document the effects of torture about the new skills they have learnt during the course of their work

Last year, over 1200 victims of torture from 80 countries across the world were referred to the UK charity Freedom from Torture. The charity helps treat people who have been tortured, and among the volunteers the charity relies on are a team of doctors who write medicolegal reports documenting the effects of torture.

During the production of a medicolegal report, the doctors examine scars and injuries, such as badly healed fractures, lacerations and burns, damaged ligaments, or chronic bone infection. The reports also document evidence of psychological distress.

These reports are either submitted to the Home Office, to support torture survivors’ asylum claims, or are presented as expert testimony in court at an appeal if the person’s application has previously been turned down. Survivors of torture are most often referred to the charity by general practitioners, lawyers, other charities, and agencies supporting asylum seekers and refugees.

The training provided by the charity in writing medicolegal reports means that volunteers develop new skills in the course of the work. Elizabeth Zachariah, one of the doctors who volunteers for the charity and a retired anaesthesiologist, says that working for Freedom from Torture is stimulating and rewarding. “Many of the clients I see will have cognitive difficulties and trauma which may impair their memory,” she says. “I have to carefully craft my questions in order to establish the narrative and match it to the scarring on their bodies.”

She adds, “I’ve found that learning the new discipline of writing medicolegal documents has been really intellectually stimulating, and delving into forensic medicine has definitely expanded my mind and my knowledge. It’s like following a trail and piecing together the story—it really is fascinating work.”

Anna Livingstone is a general practitioner from an inner city London practice who also volunteers for Freedom from Torture. She says that working for the charity helps her to practise a wide range of skills. “General medical skills in sensitive history taking, examination, and the ability to formulate problems, review and summarise materials and reach conclusions are important. Record keeping and good keyboard skills are essential for the process,” she says. “I think active listening is an important and transferable skill from general practice in particular.”

Livingstone says that, because the person writing the medicolegal document reports to the solicitor not the client, this means that she has had to develop a new set of skills in this area. “I’ve learnt about work where the prime purpose is not treatment but the production of an analytic but descriptive report,” she says. “This is a situation where empathy remains important but the report must be produced with detachment.”

John Gilmurray, a retired emergency medicine specialist, is one of the doctors who volunteers for the charity and writes the medicolegal reports. He says that, when producing a medicolegal report for Freedom from Torture, doctors must “document scars and other lesions, assess their consistency with the client’s history, and carry out a mental health assessment—bearing in mind that the two commonest psychological effects of torture are depression and post-traumatic stress disorder.”

Gilmurray says that all volunteers attend an induction course in writing medicolegal reports. “They will also sit in on consultations with a doctor experienced in this work before they start seeing individual clients themselves,” he adds. “This training is ongoing via study days, seminars, and regular monthly doctors’ meetings.”

Angela Burnett, lead doctor at Freedom from Torture, says that most of the 35 doctors who currently work with the charity are general practitioners but that specialists in psychiatry, paediatrics, gynaecology, otolaryngology, and general surgery have also volunteered. She says that the charity is looking to recruit between five and 10 more doctors with full General Medical Council registration and considerable clinical experience.

“Our volunteers need to be able to give us a regular time commitment, ideally once a week for at least a year,” she says. “Doctors can be attached to any of our five centres in London, Manchester, Birmingham, Glasgow, or Newcastle.”

Footnotes

  • Competing interests: I have read and understood BMJ’s policy on declaration of interests and have no relevant interests to declare.