Declaring Fabrication (MLC)
Declaring Fabrication (MLC)
This is important post. I have seen many post of young doctors asking about fabrication . This made me write another post about it. Declaring fabrication of a wound is not an easy task. Read carefully and while reading this post stop texting your "love" ones 
😁. (Hum nai chahatay ap ye post tab perho jab aqal ghas chernay gai ho 
😜).
😁. (Hum nai chahatay ap ye post tab perho jab aqal ghas chernay gai ho 😜).
Keep in mind that when you declare an mlc fabricated, it will get challenged. Why it usually get challenged? Its because fabrication is itself a crime. The opponent party will get a very strong case if you declare fabrication. So the party against whom you just declared fabrication will challenge you MLC.
This means you should not declare fabrication in simple case of sections A-1, F1 or L-2 even though it looks like fabrication. The reason is these section are negligible and no case will register on these. That is why do not "apnay paon per kulhari marna" in these sections by saying they are fabricated.
This means you should not declare fabrication in simple case of sections A-1, F1 or L-2 even though it looks like fabrication. The reason is these section are negligible and no case will register on these. That is why do not "apnay paon per kulhari marna" in these sections by saying they are fabricated.
As for higher sections like A2 and above or F2 and above etc you should declare fabrication if it is fabricated. This will discourage fabrications and no innocent will be put behind bars because of you. It is a heavy burden. Be honest with yourself. But there are few precautions you should take before declaring fabrication.
1. Involve other departments like surgery, radiology etc and get their expert opinions if you gonna declare a wound fabricated. Do not declare it fabricated unless the investigation and expert opinions are back. Keep it KUO (kept under observation). The reason behind it is that sometimes you see a bullet wound on forearm and bullet is inside. You advise xray and declare it not fabricated. But when xray comes back the bullet is seen on bone and it clearly looks like someone inserted the bullet there surgicaly. So you realize after seeing the xray that it is fabricated bullet injury but you have already declared it not fabricated. If now you change your not fabricated to fabricated (which you can change) the party will say that you took money and changed your opinion on fabrication. This will cause inquiry and lots of headache. Similar things happen when you send xray of a perfectly simple A-1 for formality and it comes back with displaced fracture of skull. Your clinical findings does not match with xray clearly showing that either they made the fracture after mlc or they give money to xray tech for fake xray. So always wait for all investigations before declaring fabrication.
1. Involve other departments like surgery, radiology etc and get their expert opinions if you gonna declare a wound fabricated. Do not declare it fabricated unless the investigation and expert opinions are back. Keep it KUO (kept under observation). The reason behind it is that sometimes you see a bullet wound on forearm and bullet is inside. You advise xray and declare it not fabricated. But when xray comes back the bullet is seen on bone and it clearly looks like someone inserted the bullet there surgicaly. So you realize after seeing the xray that it is fabricated bullet injury but you have already declared it not fabricated. If now you change your not fabricated to fabricated (which you can change) the party will say that you took money and changed your opinion on fabrication. This will cause inquiry and lots of headache. Similar things happen when you send xray of a perfectly simple A-1 for formality and it comes back with displaced fracture of skull. Your clinical findings does not match with xray clearly showing that either they made the fracture after mlc or they give money to xray tech for fake xray. So always wait for all investigations before declaring fabrication.
2. Also do ask for expert opinions if you have made your mind on fabrication. This involves other specialty like surgeon, dentist, radiologist etc. In inquiry if you have taken expert opinions then responsibility is shared. And it also becomes highly unlikely that you took money for declaring a fabrication(The party will always challenge it saying you took money). Wait for written response from specialists on fabrication before you declare fabrication. Reasons are same as in investigations. Keep it KUO till then.
Do not listen to any senior, dispensar, DC, CEO or prime Minister of pakistan when it comes to Medicolegal cases. Because when it comes to inquiry, only you are responsible. Others will not come for your help. You will be on your own. No one can make you do anything in mlc. They are empty threats. The consequences of declaring a false mlc is far worse to what CEO or any other authority can do to you. So do what seems right to you.
You should be able to defend your fabrication. Write details when you write description of wound why you feel its fabricated. For example it patient is saying he is hit by a brick, but wound is incised (sharp weapon like knife or blade) then mention it in description that weapon described by patient and the wound does not match. This will help you remember why you declared it fabricated later. Also the board examining your mlc in inquiry will know immediately that you saw the patient in detail. Usually they do not ask you to come in inquiry if your mlc is self explanatory.
You should be able to defend your fabrication. Write details when you write description of wound why you feel its fabricated. For example it patient is saying he is hit by a brick, but wound is incised (sharp weapon like knife or blade) then mention it in description that weapon described by patient and the wound does not match. This will help you remember why you declared it fabricated later. Also the board examining your mlc in inquiry will know immediately that you saw the patient in detail. Usually they do not ask you to come in inquiry if your mlc is self explanatory.
Hopefully this will help you guys amd girls in mlc.
Regards : Admin in cheif
PS: I took Medicolegal training from PFSA and discussed in detail about MLC and postmortem with surgeon medicolegal and HOD forensic medicine KE. Although you may do whatever you think suits you. Its for new doctors. Experienced people use their own methods
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