Handling Medicolegal Cases: A Practical Guide for Physicians in Internal Medicine

Dr Neeraj Manikath , claude.ai
Keywords: Medicolegal cases, medical documentation, chain of custody, forensic medicine, physician responsibilities

Abstract

Medicolegal cases (MLCs) represent a critical intersection of clinical medicine and the legal system, requiring physicians to balance therapeutic duties with legal obligations. This review provides a comprehensive framework for internal medicine physicians managing MLCs, emphasizing the primacy of patient care, principles of objective documentation, proper evidence handling, and accurate certification. Understanding these principles protects both patients and physicians while ensuring the integrity of the medico-legal process.

Introduction

A medicolegal case is defined as any medical condition with potential legal implications, requiring documentation for judicial purposes. These include cases of assault, poisoning, road traffic accidents, burns, sexual assault, suspected homicide, suicide attempts, industrial accidents, and cases brought by police for examination. For the internist, MLCs present unique challenges that extend beyond routine clinical management.

The estimated prevalence of MLCs in emergency departments ranges from 8-15% of total admissions, with significant regional variation. Despite their frequency, surveys reveal that only 42% of physicians feel adequately trained in MLC documentation, highlighting a critical gap in medical education. This review aims to address this deficiency by providing evidence-based guidance on MLC management.

Your Role is Not of an Investigator: The Duty to Provide Medical Care First and Foremost

The Primacy of Clinical Care

The fundamental principle governing physician conduct in MLCs is unequivocal: the physician's primary duty is to provide medical care, not to investigate crimes. This principle is enshrined in medical ethics codes worldwide, including the World Medical Association's Declaration of Geneva, which states that "the health of my patient will be my first consideration."

When a patient with an MLC presents to your department, they arrive first and foremost as a patient requiring medical attention. The legal dimension, while important, is secondary. This hierarchy has several practical implications:

Immediate Stabilization Takes Precedence: Life-threatening conditions must be addressed immediately, even if this means delaying forensic documentation or evidence collection. The ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure) applies universally, regardless of legal status.

Consent for Treatment: Emergency medical treatment does not require consent when the patient is unconscious or unable to consent. This principle applies to MLCs as it does to all emergency situations. However, once stabilized, the usual rules of informed consent apply for non-emergency procedures.

No Discrimination: Patients in MLCs—whether alleged victims or perpetrators—deserve the same standard of care. A patient brought by police as a suspect in a crime has identical rights to medical care as a crime victim.

Pearl: The "Golden Hour" Applies to Medicine, Not Investigation

In trauma care, we speak of the "golden hour"—the critical period when interventions have maximum impact on survival. This concept should guide your priorities. Spending 30 minutes obtaining a detailed medicolegal history while a patient bleeds internally represents a fundamental failure of medical duty. Document what you observe during treatment, but never delay treatment for documentation.

The Physician's Non-Investigative Role

Physicians are not detectives, judges, or prosecutors. Your role involves:

Observing and documenting injuries or medical conditions
Providing objective clinical opinions based on medical findings
Treating the patient's medical needs

Your role does NOT involve:

Determining guilt or innocence
Establishing causation in legal terms
Cross-examining patients to verify their accounts
Making value judgments about the morality of events

The distinction between medical and legal causation is crucial. A physician may document that a patient has a subdural hematoma consistent with blunt head trauma, but determining whether that trauma resulted from assault, accident, or other causes is a legal determination requiring investigation by appropriate authorities.

Hack: The "Two-Hat" Pitfall

Never wear "two hats" simultaneously. You cannot be both the treating physician and the investigating officer. If asked by police to "help investigate" while providing care, politely but firmly decline: "My role is to provide medical care. I will document my findings accurately, but the investigation is your responsibility." This protects you from conflicts of interest and potential legal complications.

Managing Difficult Situations

Scenario 1: Police Pressure for Information
Police may request immediate detailed statements or attempt to question patients during treatment. Your response should be professional but firm: "I need to focus on medical care right now. Once the patient is stable, we can discuss the necessary documentation."

Scenario 2: Patient Refuses Care Due to Legal Fears
Some patients fear that seeking medical care will trigger legal consequences. Reassure them that your duty is medical care, and while certain cases must be reported to authorities, treatment remains your priority. Build trust through transparency about the process.

Oyster: The Exception – Mandatory Reporting

While your role is not investigative, physicians have legal obligations to report certain conditions to authorities. These typically include:

Gunshot wounds and stab injuries (in most jurisdictions)
Suspected child abuse or neglect
Elder abuse in vulnerable populations
Communicable diseases of public health significance
Deaths (natural, unnatural, or suspicious)

Know your local jurisdiction's specific reporting requirements. These obligations exist to protect public health and vulnerable populations, not to transform you into an investigator. Report as required, document objectively, and continue providing care.

Accurate and Objective Documentation in MLCs: Sticking to Facts and Observations

The Foundation: Objective Documentation

Documentation in MLCs serves dual purposes: clinical management and legal evidence. The medical record may be scrutinized years after the event by lawyers, judges, and expert witnesses. Poor documentation can undermine justice, expose you to liability, and fail your patient.

The Cardinal Rule: Describe, Don't Conclude

The most common error in MLC documentation is recording conclusions rather than observations. Your documentation should enable any reasonable person to visualize the findings without imposing your interpretation.

Incorrect: "Patient assaulted with a blunt weapon"
Correct: "3 cm oblique laceration over left parietal scalp with surrounding ecchymosis measuring 5 × 4 cm"

Incorrect: "Victim of road traffic accident"
Correct: "Multiple abrasions over bilateral knees and palms, linear pattern, with embedded gravel particles"

Incorrect: "Sexual assault"
Correct: "Genital examination reveals 2 cm laceration at 6 o'clock position of posterior fourchette with active bleeding"

The correct documentation provides objective facts that can support various interpretations. The court, not the physician, determines what these facts mean in legal context.

Essential Elements of Documentation

1. Patient Identification
Complete demographic details including name, age, sex, address, and identification documents (if available). In unidentified patients, document distinguishing features: height (estimated), build, complexion, identifying marks, tattoos, or scars.

2. Temporal Documentation

Date and time of examination (not just admission)
Alleged date and time of incident (as stated by patient or accompanying persons)
Any delay between incident and examination

Time is crucial in forensic interpretation. A fresh injury examined 30 minutes post-incident differs significantly from the same injury examined 48 hours later.

3. History
Document the history in the patient's own words or those of accompanying persons, using quotation marks where appropriate. Record who provided the history.

Example: Patient states, "I was hit on the head with a stick by my neighbor around 3 PM today." (History provided by patient)

Avoid editorial comments or expressions of disbelief. If the history seems inconsistent with findings, note this objectively: "Stated history of minor fall does not correlate with pattern and severity of injuries observed."

4. Detailed Physical Examination

Each injury should be described with seven key parameters:

Type: Abrasion, laceration, contusion, fracture, burn, etc.
Site: Anatomical location with precision (e.g., "medial aspect of right forearm, 5 cm below the elbow joint")
Size: Measured in centimeters using a ruler (length × width, depth if applicable)
Shape: Linear, stellate, circular, oval, irregular
Direction: Orientation relative to body landmarks (e.g., "oblique laceration from superomedial to inferolateral")
Edges and margins: Sharp/clean-cut, irregular/crushed, undermined, inverted
Associated features: Bleeding, discharge, foreign bodies, surrounding ecchymosis, swelling

Pearl: The Injury Diagram

Supplement written descriptions with body diagrams marking injury locations. These visual aids are invaluable in court and help refresh memory years later. Many institutions use pre-printed body maps. If unavailable, create a simple diagram. Never rely solely on photographs; written descriptions remain primary documentation.

5. Color Documentation

For contusions and bruises, document color accurately:

Red/Red-blue: Recent (0-2 days)
Blue-purple: 2-5 days
Green: 5-7 days
Yellow-brown: 7-10 days
Resolution: 10-14+ days

These are approximate ranges with significant individual variation. Never definitively date an injury by color alone; state "consistent with" rather than "exactly" when giving timeframes.

6. Investigations and Interventions

Document all investigations performed (radiographs, CT scans, laboratory tests) and their findings relevant to the MLC. Record all therapeutic interventions, surgical procedures, and their indications.

7. Clinical Opinion

Based on your findings, provide:

Nature of injuries: Grievous/serious/simple (using local legal definitions)
Probable causative agent: "Injuries consistent with impact from blunt object" NOT "caused by wooden stick"
Age of injuries: "Appear recent, consistent with stated timeframe" or "appear old, showing healing changes"

Hack: The "Photograph, Measure, Describe" Sequence

When documenting injuries:

Photograph with and without a scale ruler (with patient consent)
Measure precisely using a ruler
Describe in writing

This trinity ensures comprehensive documentation. Photographs can be lost or corrupted; measurements provide objective data; descriptions capture details photographs may miss (depth, texture, tenderness).

Common Documentation Pitfalls to Avoid

Pitfall 1: Vague Descriptions
"Multiple injuries" or "several bruises" tells us nothing. Quantify and specify.

Pitfall 2: Medical Jargon Without Clarification
While technical terms are acceptable, ensure clarity. "Ecchymosis" should be followed by "bruising" in parentheses for non-medical readers of the document.

Pitfall 3: Premature Conclusions
Avoid statements like "due to assault" or "caused by negligence." Stick to medical observations; let legal authorities determine causation.

Pitfall 4: Illegible Handwriting
In MLCs, illegibility can be devastating. Write clearly or use typed/electronic records. If handwritten, use block letters for critical information.

Pitfall 5: Alterations and Overwriting
Never use correction fluid or erase entries. Strike through errors with a single line, write "error" above, initial and date the correction, then write the correct information. This maintains document integrity.

Oyster: The "Negative Finding" is a Finding

Document absence of injuries in relevant areas as meticulously as you document their presence. "No injuries seen on exposed body parts" or "No defensive injuries on forearms and hands" can be as legally significant as positive findings. This is particularly important in alleged assault or sexual assault cases.

Electronic Health Records (EHR) Considerations

Modern EHRs offer advantages (legibility, accessibility, timestamping) but also challenges:

Use free-text fields for detailed injury descriptions rather than checkbox templates
Avoid copy-paste from previous notes; each examination is unique
Ensure photographs are integrated into the record with appropriate consent
Understand your system's audit trail capabilities
Print hard copies for police documentation when required

The Chain of Custody for Evidence: Proper Handling and Handing Over of Biological Samples, Bullets, or Other Foreign Bodies

Understanding Chain of Custody

The chain of custody is a legal concept ensuring that evidence presented in court is the same evidence collected from the patient, unaltered and uncontaminated. Every transfer of evidence must be documented, creating an unbroken chain from collection to courtroom. A broken chain of custody can render evidence inadmissible, potentially undermining justice.

For physicians, this means meticulous attention to how we collect, store, label, and transfer physical evidence obtained during medical care.

Types of Evidence Encountered

1. Biological Evidence

Blood samples (for toxicology, DNA, alcohol levels)
Urine samples (drugs, toxins, pregnancy)
Gastric aspirate/vomitus (poisoning cases)
Vaginal/anal swabs (sexual assault)
Nail clippings (DNA from assailant)
Hair samples (toxicology, comparison)

2. Foreign Bodies

Bullets and pellets
Knife fragments or weapons
Glass shards
Fibrous material or cloth pieces
Any object removed during treatment

3. Patient Belongings

Clothing (blood-stained, torn, burned)
Personal effects possibly relevant to the case

Principles of Evidence Collection

1. Medical Care Supersedes Evidence Collection

Evidence collection should never compromise patient care. If removing a bullet requires a complex surgical procedure with risks, and the bullet is not medically necessary to remove, defer to the surgical team's clinical judgment. Document the bullet's presence radiologically; its location is evidence itself.

However, when evidence collection aligns with medical care (drawing blood for clinical purposes also serves forensic needs), collect and preserve appropriately.

2. Minimize Contamination

Use clean, preferably sterile, technique
Wear gloves and change them between evidence items
Use separate, clean instruments for each sample
Avoid touching evidence with bare hands
Prevent cross-contamination between different samples

3. Proper Labeling

Every evidence container must be labeled with:

Patient's name and hospital ID
Date and time of collection
Type of specimen/evidence
Location (if anatomical)
Collector's name and signature
Case number (if assigned)

Use indelible ink or pre-printed labels. Labels should be affixed to the container itself, not just the lid.

Pearl: The "Two-Identifier" Rule

Use at least two patient identifiers on every evidence label (name and ID number, or name and date of birth). This prevents mix-ups in busy clinical environments.

Specific Evidence Handling Protocols

Blood Samples:

Collect in appropriate tubes (EDTA for DNA, fluoride-oxalate for alcohol)
Fill tubes adequately but avoid overfilling
Invert gently to mix with preservatives
Refrigerate until transfer (typically 2-8°C)
Never freeze whole blood for alcohol analysis (causes hemolysis)

Biological Fluids:

Use sterile, leak-proof containers
For gastric lavage in poisoning: save the first aliquot (highest toxin concentration)
Refrigerate promptly
Label as biohazardous

Bullets and Metallic Foreign Bodies:

Handle gently to preserve rifling marks and striations
Place in a gauze pad or soft container (never in rigid containers that can scratch)
Do NOT mark the bullet itself
Describe location and appearance in notes before removal
Hand over directly to police with documentation

Clothing:

Handle minimally and with gloves
If wet with blood, allow to air-dry before packaging (moisture promotes bacterial growth)
Place in clean paper bags (never plastic, which retains moisture)
Do NOT shake or fold excessively
Preserve cut edges (if you must cut clothing for resuscitation, cut away from existing tears/defects)

Hack: The "Photograph Before Removal" Protocol

Before removing any foreign body, photograph it in situ (with patient consent and as clinically appropriate). This documents its original location and orientation, information that cannot be recovered once removed. Use a sterile ruler in the photograph for scale.

Documentation of Evidence

Create a separate evidence log documenting:

Item description and unique identifier
Date and time collected
Collected by (name and designation)
Received by (name, designation, and ID of police officer)
Signatures of both parties
Purpose of collection

This log becomes part of both the medical record and the legal record.

Sample Documentation:

"One deformed metallic projectile, approximately 0.9 cm in length, removed from right posterior chest wall during exploratory thoracotomy, placed in sterile gauze in sealed container labeled 'Projectile-001-Date-Time.' Handed over to Constable Rajesh Kumar, Badge #4567, City Police Station, on [Date] at [Time]. Both parties signed evidence transfer form. Photograph taken before removal (Image #MLC-045)."

Storage and Transfer

Storage:

Secure locked cabinet or refrigerator designated for evidence
Limited access (document who has keys/access)
Temperature-appropriate storage
Separate from regular clinical specimens

Transfer:

Hand over directly to designated police officer (not left at nursing station)
Obtain written receipt with officer's identification
Retain copy of transfer documentation in medical record
If police cannot collect immediately, store securely and document storage location

Oyster: The Refusal to Accept Evidence

Sometimes police refuse or delay collecting evidence. Document this: "Attempted to hand over evidence to [Station Name] on [Date/Time]. Officer [Name] stated they would collect 'later.' Evidence remains in secure storage, location [specify], temperature [specify]." Continue attempting transfer and documenting. Your duty is to offer proper transfer; you're not indefinitely responsible for storage.

Special Consideration: Sexual Assault Evidence

Sexual assault cases require specialized evidence collection kits and procedures beyond the scope of routine internal medicine practice. If your institution receives such cases:

Use standardized sexual assault evidence collection kits
Ideally, trained forensic examiners should collect evidence
If this expertise is unavailable, follow kit instructions meticulously
Maintain chain of custody scrupulously
Preserve patient dignity and provide trauma-informed care throughout

In many jurisdictions, Sexual Assault Nurse Examiners (SANEs) or forensic medicine specialists handle these cases. Know your local resources and referral pathways.

Legal Protections for Physicians

Courts generally recognize that physicians are evidence collectors, not custodians. Your responsibility is reasonable care in collection, documentation, and transfer. You are not liable for:

Police failure to collect evidence promptly
Evidence degradation beyond your control
Loss of evidence after proper transfer to authorities

However, negligence in handling (contamination, loss before transfer, failure to document) can expose you to legal criticism.

Issuing Medicolegal Certificates: Your Responsibility for the Accuracy of Facts Recorded

The Weight of the Certificate

A medicolegal certificate is a legal document, not a medical record. It may be the primary evidence in criminal or civil proceedings, affecting life, liberty, and property. The physician's signature on this document attests to the accuracy of its contents. False certification, whether intentional or negligent, constitutes a criminal offense under laws such as Section 197 of the Indian Penal Code (giving false certificate) and can lead to professional sanctions.

The gravity of this responsibility cannot be overstated: your certificate may help convict the guilty or exonerate the innocent.

Types of Medicolegal Certificates

1. Injury Report/Certificate: Describes injuries sustained, their nature and severity, and medical opinion on causation and age.

2. Fitness Certificate: Attests to a person's fitness for police custody, judicial custody, or travel.

3. Death Certificate (Medicolegal): In cases of unnatural, suspicious, or sudden unexplained death.

4. Disability Certificate: Documents permanent or temporary disability resulting from injury or disease.

5. Age Estimation Certificate: Based on clinical and radiological examination (though reliability is limited).

Principles of Issuing MLC Certificates

1. Personal Examination Mandatory

Issue certificates ONLY for patients you have personally examined. Never certify based on:

Another physician's notes (unless co-signing as supervisor)
Patient's verbal account without examination
Radiographs or reports alone without clinical correlation

Hack: If asked to certify a patient you haven't examined, the correct response is: "I need to examine the patient personally before issuing any certificate." If the patient has been discharged, offer to re-examine if they return.

2. Contemporaneous Examination

Certificates should reflect findings at the time of examination. If you examined a patient yesterday but are issuing the certificate today, state: "Based on examination conducted on [date/time]."

For delayed certification (patient returns weeks later requesting a certificate for an old injury), examine currently but clarify: "Current examination shows healed scar measuring X cm at [location]. Patient states injury occurred on [date], but current examination cannot verify the age of injury as claimed."

3. Stick to Your Expertise

Issue opinions only within your scope of competence. An internist can describe a laceration but should defer to a neurosurgeon for definitive opinions on intracranial injuries. State: "Recommend specialist evaluation for definitive opinion" when appropriate.

4. Qualify Opinions Appropriately

Use appropriate qualifiers:

"Consistent with" (not "caused by")
"Likely" or "Probable" (not "Certainly")
"In my opinion" (acknowledges professional judgment)
"Based on available information" (acknowledges limitations)

Avoid absolute statements you cannot prove beyond doubt.

Structure of a Medicolegal Certificate

Header:

Institution name and letterhead
"Medicolegal Certificate" or "Injury Report" clearly stated
Serial number (for institutional records)

Patient Identification:

Complete demographic details
Hospital ID number
Date and time of examination

History: As recorded, with attribution ("Patient states..." or "Police records indicate...")

Examination Findings: Objective description of all relevant findings (injuries, vital signs, consciousness level, systemic examination as relevant)

Investigation Findings: Results of relevant investigations (imaging, laboratory)

Medical Opinion: This section contains your professional assessment:

Nature of injury: Simple/Grievous as per legal definitions (know your jurisdiction's classifications)
- Simple hurt: Does not endanger life or cause permanent damage
- Grievous hurt: Endangers life, causes permanent disability, severe fracture, or disfigurement
Probable weapon/causative agent: "Injuries consistent with blunt object impact" (not "caused by wooden rod")
Age of injury: "Appears recent, consistent with timeframe stated" or "Shows healing changes suggestive of 5-7 days old" (use ranges)
Other relevant medical opinions: Degree of force (mild, moderate, severe), effect on daily activities, prognosis

Pearl: The Grievous Hurt Criteria

Memorize the legal definition of grievous hurt in your jurisdiction. In many systems based on common law, grievous hurt includes:

Emasculation
Permanent loss of sight
Permanent loss of hearing
Loss of any limb or joint
Destruction or permanent impairment of any limb or joint
Permanent disfigurement of face
Fracture or dislocation of bone or tooth
Any hurt endangering life

A simple fracture of a metacarpal bone, though requiring treatment, may still constitute grievous hurt due to "bone fracture" criterion.

Conclusion/Summary: Brief statement summarizing key findings.

Treating Physician's Certification: "I certify that the above facts are true and correct to the best of my knowledge and belief, based on my personal examination of the patient."

Signature, Name, Registration Number, Date: With official seal/stamp.

Common Errors in Certification

Error 1: Backdating Certificates Never backdate a certificate to a date you didn't examine the patient. This constitutes false certification. Date reflects when the certificate was issued; specify examination date separately.

Error 2: Copying Patient's Version as Fact Patient states he was "beaten with an iron rod." Your certificate should NOT state "beaten with iron rod" as fact. State: "Patient claims assault with iron rod. Examination reveals [objective findings]."

Error 3: Over-interpretation "Fracture caused by assault" is over-interpretation. "Fracture of right radius, consistent with fall on outstretched hand or direct blow" is appropriate.

Error 4: Providing Prognosis as Certainty Avoid: "Will make complete recovery." Use: "Prognosis for recovery appears good with appropriate treatment."

Error 5: Issuing Certificates Under Duress Police or patients may pressure you to word certificates in particular ways. Stand firm. Your duty is to truth and accuracy, not to any party's preferred narrative. Politely decline: "I can only certify what I have objectively observed and can medically support."

Oyster: The Provisional Certificate

In complex cases where definitive opinions require specialist consultation, imaging, or time, issue a provisional certificate documenting current findings and stating: "Final opinion pending further evaluation/specialist consultation." This satisfies immediate legal requirements while protecting accuracy. Issue a final certificate once complete information is available.

Corrections and Amendments

If you discover an error after issuing a certificate:

Do NOT issue a new certificate with a different version
Issue a "Supplementary/Amended Certificate" clearly marked as such
Explain the error and correction
Reference the original certificate
Do NOT destroy the original

Transparency about errors is legally and ethically preferable to cover-ups, which suggest dishonesty.

Legal Implications of False Certification

False certification can lead to:

Criminal prosecution (perjury, false evidence)
Professional misconduct charges by medical councils
Civil liability if harm results
Loss of medical license
Imprisonment in serious cases

"False" includes not just intentional lies but also reckless statements without adequate basis. Exercise due diligence.

The Courtroom: When Certificates Lead to Testimony

Your certificate may summon you to court as a witness years later. Some practical points:

Before Court:

Review the certificate and medical records thoroughly
Refresh your memory (legally permissible)
Do NOT discuss testimony with involved parties
Understand you're a professional witness, not an advocate

In Court:

Answer only what is asked; don't volunteer information
Admit if you don't know or don't remember
Never guess or speculate
Maintain professional demeanor regardless of aggressive questioning
You may refer to your certificate and records while testifying

Hack: The "Certificate File" Maintain a personal file (or secure digital folder) of copies of all medicolegal certificates you issue, with relevant clinical notes. Years later when summoned to court, this file is invaluable for memory refreshment. Ensure patient confidentiality in storage.

Practical Pearls and Hacks: Summary

The Golden Hour Pearl: Medical care always precedes documentation. Never delay life-saving treatment for paperwork.
The Two-Hat Hack: Never act as both clinician and investigator. Your role is medical care and objective documentation, not determining legal guilt or innocence.
The Description Trinity: Photograph (with consent), measure, and describe in writing. This triple documentation ensures comprehensive evidence.
The Negative Finding Pearl: Document absence of injuries in relevant areas as carefully as their presence. "No defensive injuries on forearms" is significant evidence.
The Two-Identifier Rule: Label all evidence with at least two patient identifiers to prevent potentially catastrophic mix-ups.
The Photograph-Before-Removal Protocol: Photograph foreign bodies in situ before removal when clinically appropriate. Original location matters forensically.
The Provisional Certificate Hack: When full assessment requires time or specialists, issue a provisional certificate documenting current findings, with final certification to follow.
The Personal Certificate File: Maintain copies of all MLC certificates you issue. Years later in court, you'll thank yourself.
The Qualifier Wisdom: Use "consistent with" rather than "caused by," "likely" rather than "certainly," and "in my opinion" to appropriately qualify statements.
The Stand-Firm Principle: When pressured to alter documentation or certification, politely but firmly refuse. Your professional integrity is non-negotiable.

Institutional Protocols and Training

Healthcare institutions should establish clear MLC protocols covering:

Identification and registration procedures
Documentation templates and standards
Evidence collection and storage facilities
Police notification procedures
Certificate issuance workflows
Legal support for physicians

Regular training in medicolegal documentation should be mandatory for all clinical staff, with particular emphasis during residency training. Simulation exercises and case-based discussions enhance competence and confidence.

Conclusion

Handling medicolegal cases requires physicians to balance competing demands: urgent medical care, meticulous documentation, evidence preservation, and accurate certification. The principles outlined in this review—prioritizing patient care, maintaining objectivity, preserving chain of custody, and ensuring certification accuracy—protect both patients and physicians while serving justice.

The internist's role in MLCs, while complex, is fundamentally an extension of core medical duties: careful observation, accurate documentation, and ethical practice. By mastering these principles, physicians contribute not only to individual patient outcomes but also to the broader societal goal of justice through medicine.

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Disclosure Statement: The authors report no conflicts of interest.