Questions docs ask in rape cases that journalists need to know
Five pointers for reporters to get accurate medical information
In general, doctors follow a pattern of history-taking before diagnosing and treating any patient.
They start with the personal details of the patient and then go on to ask about chief complaints, ‘history of presenting illness’ (HOPI), past history, family history, and ‘differential diagnosis’ or ‘DDx’ (a systematic way of arriving at a diagnosis by eliminating other possibilities). They perform a clinical examination of the patient, and run tests where necessary.
This pattern is followed in rape investigations as well, and right from forensic medicine classes as students, medics are trained to take the history of rape victims in a particular format. There are separate forms to use for females and males, which, once filled-in, become confidential medical history and cannot be shared without the consent of the victim.
On the form for females, there is a column for doctors to note whether the female victim is ‘used to or not used to act (sic) like that of sexual intercourse’. This is usually left blank, said Dr Farman Ali, a Bangalore-based general and minimal invasive surgeon, as “neither virginity nor promiscuity is relevant to a rape investigation”. Investigation forms for male victims do not offer doctors a corresponding option.
There is one other medical form that doctors need to fill during a rape investigation. This one is for the accused, who should be examined with minimum time-lag.
These investigation forms provide some pointers for journalists on what to look for from medics when reporting on a sexual assault case. Below are five questions that would provide reporters insightful information:
1. How much delay was there before the victim was medically examined?
“Examination of the victim without delay is of profuse importance and the exact time and date of examination must be noted,” said Dr Praveen Athani. Dr Athani, a professor of forensic medicine and toxicology at the M V J Medical College, said that prior to the medical evaluation, doctors check if the victim has changed clothing, washed or taken a shower, or brushed their teeth, as these may destroy evidence. Also, certain evidences like the swelling of the vulva might disappear after a few hours. It is hence important for the journalist to know how far after the incident the examination took place.
2. Has the accused been examined (and how quickly)?
Examination of the accused is needed for semen analysis, to match with samples collected from the victim. Further, it allows medics to find evidence in terms of fingerprints, bite-marks, and other injuries or evidence that could be matched with that found on the victim. When examining the accused, medics also look at the development of genital organs, physical power (to determine the possibility of overpowering victim), and mental state and general behaviour. All this is required to confirm wrong-doing, and, in some cases, to counter fictitious allegations of sexual assault.
3. Did the victim use a spokesperson during the medical examination?
In most cases, the victim is greatly traumatised and unwilling to talk to the medical examiner or police authorities. If the doctor has spoken directly to the survivor, there is likely to be a clearer picture in the medical report. For instance, details of the location, date, or the chain of events that took place before the incident allow the doctor to arrive at a more accurate profile of the victim’s psychological state. The protocol for examination includes taking a written consent from the victim, unless the victim is below 12 years of age or is mentally unsound. In such cases, consent must be taken from the parent or guardian.
4. Were there any injuries other than the ones that were sexually inflicted?
It is imperative to differentiate between sexually inflicted injuries and other injuries. Indications of strangulation marks (ligature marks on the neck), stab wounds, firearm injuries, etc could indicate a homicidal attempt. Doctors routinely look for this. Other marks of violence, such as scratches and bruises are also looked for, as these indicate the extent of the struggle. The nature and situation of these injuries are useful to corroborate the victim’s description of the assault.
5. Who was the medic or female police official present during the examination?
A female victim is examined by a female doctor, or under the supervision of a female medic. A female police official may also be present in some instances. Tracking down the examiner, or the female police official present will provide medically rigorous insights into the incident, leaving less room for speculation. While medics are ethically and legally bound not to reveal the identity of a rape victim, or confidential details of any patient, it is possible that an examiner might be willing to speak about the nature of the crime in select incidents.
— With inputs from Spurthi V
