Teaching in forensic medicine is woefully lacking at undergraduate level and this has serious implications for us all
Forensic medicine is the medical specialty that links medicine with the law, incorporating forensic pathology (a subspecialty of histopathology) and clinical forensic medicine. Over the past 50 years forensic medicine as an academic subject has been in slow (some would say terminal) decline.
Imagine a newly qualified doctor probably start practising without having received even a basic grounding in medicolegal matters. In today's increasingly litigious society, this is a serious matter.
Forensic medicine is in the danger of losing out to other subjects in the “overcrowded curriculum” that are of no practical use to students once they qualified. Medicolegal problems, however, will be encountered by junior doctors, whatever branch of medicine they choose to specialise in.
Medicolegal procedures include examination of assault victims (including sexual assault), certification of death, reporting a suspicious death to police, writing medicolegal reports, and giving evidence in courts. Unfortunately, concerns have been raised on several occasions about doctors' ability to complete death certificates correctly and deal with medicolegal matters in general. Embarrassingly, we cannot even describe wounds correctly when documenting and treating them at the casualty.
Many experts link the decline in the teaching of forensic medicine at undergraduate level to the attempts at reducing or removal of the subject from final qualifying examinations at medical school and the loss of status that this can produced. Other subjects have mushroomed and the “service requirements” of forensic departments has caused private medical colleges and universities to question the idea of spending money in setting up mortuaries which prove to be a waste of investment when it come to their ultimate motive of profiteering from medical education business . It’s an open and well know fact that many of these private medical colleges do not want to invest or fund the setting up and running of forensic medicine facilities in their colleges because forensic medicine departments are not income generating departments. The private managements would be glad if they can manage to convince the MCI and get the subject removed from the undergraduate medical curriculum once and for all.
As every citizen in India dreams of getting private medical care because of its quality compared to government hospitals, the same holds true when availing forensic services, provided the general population are appraised of the benefits of such facilities in private set up on a nominal charge. I see no reason why the loved once would deny their deceased kith and kin the benefit of quality forensic investigations when affected from ever more rising crime in our country. The onus of involving the private medical college managements in a dialog about the quality of forensic services and the benefits that can be offered to general public by charging a nominal fee or approaching the concerned stake holders in the government to fund or partly fund the setting up and maintenance of forensic medicine departments has to be take up on a war footing to turn them on our side in fight for due recognition of this subject.
The medicolegal knowledge the medical undergraduates should be familiar with
- What to do with a dead body (and what not to do when suspicions have been aroused of unnatural causes of death)
- Certification and disposal of the dead
- The role of the courts and other investigative departments and which deaths must be reported
- The preparation of medicolegal reports and the giving of evidence
- The aims of civil litigation and compensation
- The interpretation of injuries
- Sexual assault victim examination
- Principles of medical ethics
- Principles of poisons recognition and treatment
The modern medical undergraduate curriculum does attempt to cover medical ethics thoroughly, and most students receive very little instruction in the completion of a death certificate. “Practising within a legal framework,” however, and the role of the courts and the giving of evidence, are well covered. If the decline of forensic medicine at undergraduate level is allowed to become complete the medical profession is bound to come under more intense public scrutiny. The knock-on effect on justice of our inability to deal with medicolegal issues should not be underestimated. If we do nothing, our failings will surely be added to that increasing list of things that the media “bash” us with. Two such examples making national headlines are the Arushi Talwar case in the capital and the Scarlet Keeling rape and murder case in Goa.
Dr K.P. Shubhakar MB BS MD DNBFM MFFLM
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