But medication history is evidence to interpret, not a shortcut to diagnosis. A prescription does not prove that a claimant took the medicine, that it worked or even that it was prescribed for the condition being considered.
The expert should use medication history as part of the wider clinical chronology.
Start before the accident
A medication review should not begin on the date of the index accident.
Pre-accident prescribing may be highly relevant to causation. Regular analgesia could indicate an established musculoskeletal problem. Antidepressants or anxiolytics may provide evidence of earlier psychological symptoms. Migraine treatment, sleeping tablets or neuropathic pain medication may also help establish the claimant’s baseline.
None of this automatically defeats an accident-related claim.
A claimant taking antidepressant medication before an accident may still develop a new psychiatric condition or suffer a material aggravation of an existing one. Someone previously prescribed analgesia for back pain may sustain a distinct neck injury.
The purpose of reviewing the medication history is to establish what existed beforehand and whether treatment changed afterwards.
That distinction is especially important where the claimant reports being entirely symptom-free before the accident, but the records show continuing prescriptions for medication commonly associated with similar complaints. The discrepancy requires exploration rather than an automatic conclusion that the claimant is unreliable.
A prescription is not a diagnosis
Medication can provide clues, but the expert should resist reverse diagnosis.
A prescription for an antidepressant does not prove depression. Some antidepressants are prescribed for anxiety, neuropathic pain, migraine prevention or other conditions. Medicines commonly regarded as painkillers may have been prescribed for unrelated problems. The indication should therefore be established from the surrounding records where possible.
The same caution applies to medication strength. A claimant taking stronger analgesia may have experienced substantial symptoms, but prescribing practice varies. Conversely, someone using only simple analgesia may still have significant pain but may avoid stronger medication because of side effects, personal preference or medical contraindications.
CPR Practice Direction 35 requires experts to consider all material facts, including those that may detract from their opinions, and to state when insufficient information prevents a definite conclusion.
Medication history should be treated in precisely that way: as one material fact among several.
Changes after the accident may be informative
A clear change in prescribing after an accident can support the chronology of symptoms.
A claimant who previously took no analgesia may begin regular medication shortly afterwards. An antidepressant dosage may be increased. Sleeping medication may be introduced. A GP may trial several treatments because symptoms remain uncontrolled.
These developments can provide useful contemporaneous support, particularly where the claimant’s later recollection of dates is uncertain.
The pattern may also assist with severity and duration. Repeated medication reviews, changes because of inadequate response and documented side effects may support an account of continuing difficulties, yet escalation should not automatically be interpreted as worsening injury.
Medication can change for many reasons. A claimant may change GP. A new clinician may favour a different treatment. A drug may be stopped because of intolerance rather than recovery. Medication prescribed after the accident may relate to an entirely different medical condition. The expert should read the prescribing history alongside the consultation entries rather than presenting it as an isolated timeline.
What happened to the medication matters
The prescription record shows what was prescribed. The claimant’s history should establish what happened next.
Did they take it? For how long? Did it help? Were there side effects? Why was it stopped?
NICE guidance on medicines adherence recognises that people do not always take medicines exactly as prescribed and recommends exploring the reasons for non-adherence rather than making assumptions. Concerns about side effects, doubts about necessity and practical difficulties can all influence medication use, medico-legally this is relevant.
A report should not state that treatment “failed” simply because a drug appears in the records and symptoms continued. The claimant may have taken only a few doses because of severe drowsiness. Equally, a claimant may report that medication provided no benefit despite continuing to request it for a prolonged period.
Those apparent inconsistencies should be explored.
Non-adherence may also affect prognosis. If a reasonable treatment was prescribed but never properly attempted, it may be premature to say that conservative treatment has been exhausted. That opinion should still take account of why the claimant did not take the medicine.
Medication may affect function
Side effects can themselves become medico-legally relevant.
Sedation, dizziness, impaired concentration or gastrointestinal problems may affect driving, work and everyday activity. If a claimant attributes reduced function entirely to the original injury, the expert should consider whether medication contributed.
This can be particularly important where the claimant works with machinery, drives professionally or performs safety-sensitive tasks.
Again, the report should avoid assumptions. The fact that a medicine can cause drowsiness does not establish that it did so in this claimant. There should be a reported or documented effect before it is incorporated into the functional analysis.
Medication may also interact with other health conditions or treatments. Where the pharmacological issues become complex, the expert should remain within their own competence and recommend appropriate clinical review rather than offering detailed prescribing advice outside their expertise.
The GMC requires experts to provide accurate, objective evidence, take reasonable steps to check relevant information and make the limits of their knowledge clear.
Psychological injury requires particular care
Medication history can be useful when assessing anxiety, depression, sleep disturbance or accident-related psychological symptoms.
Pre-accident prescriptions may establish earlier mental health treatment. Post-accident changes may support deterioration. However, the medication itself does not establish the psychiatric diagnosis or its cause.
A claimant may have received antidepressants from their GP without formal psychiatric assessment. Medication could also have been prescribed for longstanding symptoms that happened to continue after the accident.
The expert should therefore consider medication alongside consultation notes, previous diagnoses, therapy records and the claimant’s reported function.
Where psychological causation is disputed, the difference between a new prescription and an increased dose of long-standing treatment may be significant.
Medication history should influence prognosis
Current medication also helps place the claimant’s present position in context; Is treatment stable? Is medication gradually reducing? Are repeated changes still being made because symptoms remain uncontrolled? Has the claimant become dependent on regular symptom relief while activity remains restricted?
These questions may affect whether further treatment, medication review or specialist referral is appropriate.
Experts should nevertheless avoid equating medication cessation with recovery. Claimants stop medicines because they improve, but also because treatment does not work, causes side effects or is simply disliked.
The reason matters more than the fact of stopping.
Medication history should therefore do more in a medico-legal report than populate a table of drug names. Properly used, it can help establish the pre-accident baseline, test chronology, assess treatment response, explain functional restrictions and inform prognosis.
Improperly used, it can create misleading conclusions from prescribing information that was never investigated.
The expert should ask four questions throughout: what was prescribed, why was it prescribed, was it actually taken and what happened as a result?
That turns a medication list into evidence.
