Dr.V.V.Pillay's letter (24th Jan 2011) sent to MCI

To,
Dr SK Sarin
Chairperson, Board of Governors
Medical Council of India             
Pocket - 14, Sector - 8
Dwarka Phase - 1
New Delhi – 110077
Phones: 011-25367033, 25367035,
                   25367036,25367037

24 Jan 2011

Dear Sir,
    I am writing this letter in the capacity of Professor of Forensic Medicine and Chief of Poison Control Centre at Amrita Institute of Medical Sciences & Research, Cochin, Kerala.
    This is with reference to the proposed new curriculum for undergraduate medical education as outlined in the document “Vision 2015” (posted in the MCI website at the following URL: http://www.mciindia.org/MediaRoom/Announcements.aspx).
    It is my feeling that the document is seriously flawed and can adversely impact the teaching of forensic medicine and toxicology to undergraduate medical students. The following are issues of great concern, which must preclude the document from being implemented in its present form:
1. The Committee which drafted the document (VISION 2015) does not represent all stake holders of UG or PG medical curriculum. It is unacceptable for a small team of individuals, however distinguished and accomplished they may be in their respective fields to analyse what is wrong with the entire medical curriculum, without first taking the views of a large cross section of medical professionals belonging to various specialities from across the country. Even the annexures to the main document were not accessible until after the deadline for feedback was over, which necessitates extension of the previous deadline.
2. The head of the committee which drafted the document is incidentally the head of an institute where forensic medicine was never taught as a separate speciality, and in fact came under severe criticism for this from several quarters, after which one student was recently deputed to a private medical college for MD training in forensic medicine! Is it then surprising that the document attempts to undermine the importance of forensic medicine completely?
3. The committee appears to have modelled the document on Western lines, without bothering to conduct a survey first in India with regard to the practical situation here. When 60 to 70% of medicolegal work (including autopsies, clinical forensics, toxicology) in India is undertaken at present by MBBS doctors or non-forensic specialists, how can the MCI do away with the teaching of the subject altogether from the UG curriculum? Even with the basic kind of exposure that exists at present, most such doctors are all at sea when it comes to medicolegal work, and end up panicking when confronted with such cases, or furnish reports that are atrocious, leading to serious miscarriage of justice. So, isnt the MCI aggravating the situation by making these doctors even more inept and incapable by doing away with forensic medicine?
4. I am sure that the committee is well aware of the terrible scenario with regard to poisoning and drug overdose in our country, the incidence of which is among the highest in the world. For long, the subject of toxicology has been neglected at the UG level, as a result of which a basic doctor with an MBBS degree has very little idea about practical aspects (clinical and forensic) of management of such cases. The problem is compounded further at the PG level, since toxicology is not a significant component of either general medicine, pharmacology or forensic medicine. So, even at specialist level, a physician has very little inkling about effective handling and management of poisoning cases, leading to high mortality (the highest in the world), as well as miscarriage of justice in fatal cases with criminal overtones. The document “Vision 2015” will further dilute the importance of this speciality among students and faculty of medicine leading to even more neglect.
  
    In view of the above, I feel (just as many others do) that the subjects of forensic medicine & toxicology must actually be strengthened (and not weakened), and must be taught along with clinical subjects in the clinical phase of MBBS course. There should be a full-fledged university examination for these subjects with two separate papers. It is inappropriate to include these subjects in the para-clinical phase along with pathology, microbiology, etc., because unlike the latter, neither forensic medicine nor toxicology falls in the category of basic medical sciences.
    Teaching of forensic medicine and toxicology must be comprehensive with emphasis on clinical, pathological, analytical, and forensic aspects. For this purpose, there must be an integrated approach with relevant departments (clinical medicine, emergency medicine, surgery, gynaecology, biochemistry, pharmacology, etc). The coordinating department should be forensic medicine, since we are talking of cases which are medicolegal in nature, with substantial forensic implications.
    The practical aspects of forensic medicine must include autopsy training (common cases), clinical forensics (examination of victim/accused in cases of drunkenness, assault, sexual assault, etc), and toxicology must include case-taking in poisoning/overdose, along with basic analytical exercises, and forensic autopsy exposure.
    The broad speciality of forensic medicine must have 2 papers (with equal weightage of marks):
    Paper 1 – Medical Jurisprudence (including Medical Ethics) & Forensic Pathology
    Paper 2 – Clinical Forensic Medicine & Toxicology

With regards,
Yours sincerely,

Dr V V Pillay, MD, DCL
Professor, Forensic Medicine & Toxicology
Chief, Poison Control Centre
Head, Analytical Toxicology
Amrita Institute of Medical Sciences & Research
Cochin, Kerala

Copies: 

Dr. Sita Naik
J-708, Wembley Estate
Rosewood City, Sector-50
Gurgaon 122001

Prof RN Salhan
C-1/1233, Vasant Kunj
New Delhi 110070

Dr Devi Prasad Shetty
Narayana, 393, 3rd Block
Koramangala, Bangalore – 34

Prof Gautam Sen
51, Jupiter Apartments
Cuffe Parade, Mumbai 400005