Clinical Assessment of Interviewee

The previous chapter on Fitness to be Detained should be read.
Physical Illness
Any detainee who is suffering from a specific physical illness should be stable before interview
takes place. It is difficult to be specific. For example the hypertensive does not have to be
normotensive, only preferably so. Some hypertensive patients are stable at a theoretically
hypertensive level. It behoves the clinician to establish, if possible, the "normal" state for that
patient, if a higher blood pressure reading than expected is obtained. This, of course, can be a
difficult or even impossible task in the middle of the night, in which case the clinical judgement of
the FME must be exercised. A similar approach can also be taken towards other conditions such as
diabetes mellitus. In the latter case no clinical appraisal should be considered complete without a
blood sugar estimation.
If a patient is on medication then the treatment protocol should be ratified and
written up on whatever is the accepted format for care instructions for detainees (see Appendix 3c
for the example of the Greater Manchester Police form).
The detainee who is injured or suffering from a musculoskeletal disorder needs assessing and any
appropriate analgesia given. If serious injury is considered they should have that condition assessed
and treated before interview. The British National Formulary (BNF) describes both Aspirin and
Paracetamol as particularly useful for musculoskeletal pain and pyrexia. The former can be used (if
not contra-indicated in the individual) where anti-inflammatory action is required. The BNF points
out that any combined analgesic, containing an opioid, has no substantiated benefit over the simple
drug, if the dose is low, and carries all the side effects of the opioid if containing a higher dose.
Visceral pain is however more responsive to opioid analgesics.
Care must be taken not to give an opioid analgesia in a dose which may cause drowsiness, during
the interview, in a patient unused to strong drugs.
In police surgeon practice the above example infrequently presents. The specific case of drug
addicts is dealt with below.
Examination
The examination should include:-
1. A full medical history including family, social, and past medical/surgery/ (obstetric) histories.
2. Medication details including any alcohol or illicit drugs used.
2.1 For illicit drugs it is of help to use the regional data base forms as part of the medical
record (see Chapter 3 Section and Appendices 3a & b).
2.2 It is worthwhile remembering the availability of legal "herbal" highs.
2.3 The history should include habitual use as well as intake in the last 24 hours.
3. Nutrition
3.1 General condition, and
3.2 Food intake—when and what?
4. Full clinical examination with particular reference to stigmata of drug abuse and/or withdrawal.
4.1 Does the patient normally wear spectacles (or contact lenses)?, or
4.2 Have a hearing deficit? (important if going to be interviewed or asked to sign anything).
5. The CNS examination should include.
5.1 Locomotor function.
5.2 Co-ordination.
5.3 Temporo-spatial orientation.