Doctor – Patient Relationship in Clinical Legal – Medicine Practice

"Introduction. In Romania legal medicine suppose professional activities as forensic pathologist and legal doctor are facing victims that request documenting traumatic lesions if any or sexual abuses, prejudices, working capacity, malpraxis, etc. Objective. The objective of our work is to determine the special kind of doctor-patient relationship in clinical legal medicine and to analyze the ethical influences. Material and methods. More than 1500 cases of medico-legal examinations are performed in the National Institute of Legal Medicine Mina Minovici in Bucharest each year. Most of them are domestic violence requests or car accidents. Discussions. In the late 30 years (Ezechiel JE, Linda LE, JAMA 1992) found out 4 different relationship models that may be applied in medical practice; the paternalistic model (the patient accepts his doctor as his legal and moral representative), informative model (the patient expresses his autonomy), interpretative model (the doctor is a good friend in need) and the deliberative model of self-construction of the knowledge that the patient must have in order to have a voluntary decision. Conclusions. In clinical legal medicine the patient is not only a patient but a victim also. Therefore, the relationship is double folded. With his patient the legal doctor develops initially an informative model, then an interpretative model. With his victim the doctor develops initially a paternalistic approach (passive character type) or an informative one (active character type), usually an interpretative model as most highly requested (What would you do if you were I?) or the deliberative model when evaluating prejudices, etc. "

SEXUAL ASSAULTS AND MEDICAL APPROACH

Sexual abuse can be accompanied with physical force, threatening, horrifying, drugging and / or misuse of the consents such as the unable ones to give consent because of their underage and / or mental disease. It is a major problem in all over the world as well as our country. Most of the sexual assault victims are actually also child abuse cases. This study aims to contribute to the solution of these abuses and assaults as well as to increase the awareness of the clinical examiners. We designed this study to present the data and increase the benefit for to prevent these abuses. 154 cases had been evaluated at our department in between the dates of October 2012 and January 2014. The ages varied as in groups such as 0-12, 12-15, 15-18 and over the age of 18. The majority of the cases (46.7%) were in the 12 – 15 age group. 25.9% were aged as 15 – 18 and 15.6% were over the age of 18. Only 11.8% were under 12 years of age. The youngest victim was seven years old while the oldest one was 27 years old. 135 cases (87.7%) were female and only 19 of the cases (12.3%) were male. 66 cases (42.8%) had been examined for second time while 88 cases (57.2%) had come to our unit for the first time. 60 cases (39%) have been abused repetitively. 94 cases (61%) defined that they have been abused for the first time. Way of the abuse is evaluated via history taken from victim and demand letter sent to us by facilities. It is claimed that 94 cases (61%) had been abused vaginally while 40 cases (26%) had been abused anally, and 20 cases (13%) had been abused both vaginally and anally. When we analyze the abusers’ profiles in majority of the cases (87%), the victim knows the perpetrator long before the event happens. Violent findings accompanied with sexual abuse in 14 cases (9.1%). The sexual assault victims should not be traumatized repeatedly by clinicians as well as the official authorities. The major point should be the victim’s higher benefit and it should always be protected. Key words: Sexual Abuse, Examination, Clinical Legal Medicine