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The paper presents an audit of admission physical examinations performed in the settings of medium security. Documentation regarding 16 key items of the admission physical examination was assessed. During the first audit, 51 admission physical examinations were assessed, and 50 were assessed on repeat audit. The standard of documentation of the physical examination was poor, and remained poor on re‐audit. Significant improvement was noted only in the recording of temperature, which had improved from 4 out of 51 (8%) to 13 out of 50 (26%) in audit 2 (Yates‐corrected ‐2 =4.72, d.f.=1, p<0.05). Of particular concern are ongoing omissions in the neurological examination and poor recording of marks, bruises and injuries.

This case report highlights initial difficulties in identifying poor effort and malingering in relation to memory, cognitive deficits and mental disorder. We provide information on the outcome for a man charged with murder who was found to be unable to stand trial as a result of poor memory. After being sentenced by way of a hospital and restriction order, he was found upon inpatient assessment to be malingering and was remitted back to prison in order to continue his murder trial. We comment on the psychological tests, physical investigations and inpatient assessment required to confirm the presence of memory malingering.