I work with drug users and requests around fitness to appear in court are very common from my patient group. I am a little concerned that the example of the patient wanting to leave the ward (to attend court) does  not allow for the answer I would consider most patient centred: That is, offer to contact the patient's solicitor and provide a letter stating this man is currently an inpatient requiring drainage of an abscess and therefore is unfit to attend court that day. THe answers provided all take a very biomedical approach. THis man's social priorities are currently taking precedence over his health needs, as might be expected, given that failure to appear in court may result in  him receiving a custodial instead of a community sentence, or considerably longer in prison, as he woudl be judged as being in contempt of court

Dr JP Fisher, Whitehouse Centre, Huddersfield.