The Board of Governors
Medical Council of India.
Subject: suggestions in view of VISION 2015, regarding Forensic Medicine as a compulsory subject in Undergraduate curriculum
Respected BOG,
- The recent changes proposed by the Hon’ble BOG, MCI is a questionable and unacceptable effort by a group of erudite medical fraternity who though have held plum appointments and have a broad based but not in-depth knowledge of the ground realities and services delivered by the various specialties.
- Let us evaluate the BOG and its decisions. It is constituted of the following:
a. Gynecologists : 3
b. Surgeon : 2
c. Anatomist : 1
d. Radiologist : 1
e. Educational Technologist : 1
3. The very constitution of BOG is questionable as it does not have representation from all the medical specialties. How can eight doctors decide by a stroke of pen the fate of medical education. The issue of such a magnitude should have a national debate and a consensus of the majority of the medical fraternity before any change is recommended. To err is human, but to turn a blind eye to an error which can have crucial ramifications on the nation is criminal.The way to reforms in medicine should be paved in a democratic manner. It is apparent that by virtue of the power vested in the hands of the BOG, it makes an autocratic decision of doing away with a lot of subjects which form the backbone of the medical education. They should not forget that they themselves are a progeny of the same system they are trying to modify. Redundancy in the medical education stream needs to be weeded out. We need to have a quality medical education program, which delivers well trained doctors who address the health care problems of the country. The present doctor patient ratio of 1:1700 cannot be improved without the revamping the present medical education system. The efforts of the BOG are welcome, but the proposals still need a lot of deliberations. Of late it has become a practice in our dear nation that Autocracy rules over democracy. Let it not reflect in this exercise also. A policy decision of such a magnitude, which has far reaching effects on the community and the nation should be taken with consensus of all the stakeholders.
4. The healthcare needs of the nation cannot be fulfilled by the 35,000 medical graduates which are generated by the medical colleges every year. We need to double the same to fill the void (as reflected by the BOG in VISION 2015). The existing system is not flawless. Absence of clinical exposure for the students for the initial 2 years definitely needs to be addressed. Lack of clinical exposure and practice for the students during UG years, reflects in their inability to handle cases independently after completion of the basic MBBS degree. The need to streamline the same has been deftly highlighted by the Hon’ble BOG.
5. Despite all the good intentions why is it that the BOG’s decisions are not welcomed by all? The biggest procedural fallacy is the absence of representation of all the specialties in drafting “VISION 2015”. With due respect to the well intended proposals of the hon’ble BOG, lack of representation of all the specialties would handicap the decision making process. God forbid, if the well intended change proposed by the BOG backfires, we will end up with medical graduates who will not be good enough.
6. The subject of Forensic Medicine has evolved over a period of time. The necessity of introducing the subject was rightly felt by the various committees as mentioned below:
a. 1958- Constitution of Central Medicolegal Advisory Committee, Ministry of Health, Government of India): Creation of separate department of Forensic Medicine which otherwise was looked after by Medical Superintendents / Civil Surgeons/ Pathologists.
b. 1962- Mudliar Committee on Health Reforms: Reinforced the separate creation of cadre of medical jurist as well as recommended for need of establishing Central and State Medicolegal Institutes for taking the complicated and controversial cases.
c. 1973-Ministry of Home Affairs: Recommended staff pattern for medicolegal autopsies i.e. 2 doctors for conduction of initial 100 autopsies/year and one thereafter for every additional 100 autopsies in addition to other associated paramedical and technical staff.
d. 1983-DGHS Committee Recommendation: staff pattern as well as every hospital having 100 beds will have mandatory mortuary attached with it with facilities for medicolegal autopsies
e. 1999- MCI guidelines dt. 30 Mar. regarding teaching strength in forensic medicine
7. Though the hon’ble BOG MCI have painstakingly tried to formulate a reformative plan for Medical Education in India , but the very document is full of flaws. It does not clearly state which are the subjects identified for keeping in the noncore group. The graphical representations and algorithms are choicely drafted, but they fail to elaborate the plan in detail. It is reiterated that a plan of such a magnitude has to be detailed to the core and should leave no margin for error, as the healthcare plan of the whole nation is at stake. But the “VISION 2015” is flawed, and appears to be planned with some vested interests.
8. Now let us evaluate the various medicolegal duties performed by medical officers/basic doctors apart from the routine duties :
a. Attending to Medico-legal cases coming to Primary health centers, Govt. dispensaries, casualty at Public and pvt. hospitals.
b. Maintenance of medical and medicolegal records.
c. Appearing in the court as expert witness.
d. Conduct of Medicolegal postmortems.
e. Examination of victims of assault.
f. Examination of a rape victim.
g. Examination of an alcoholic
h. Examination for assessment of age.
9. In view that the medical officer/basic doctor is supposed to perform the above quoted medicolegal duties apart from his numerous clinical duties, he should be trained in medicolegal work, which has been till date, very deftly done by the Departments of Forensic Medicine at various medical colleges.
10. Diluting the significance of the subject of Forensic medicine in the Undergraduate medical curricula will create an abyss of chaos and confusion among the judicial and medical fraternity. Numerous instances have occurred where an unwilling and inexperienced medical Officer deputed for conduct of Medicolegal Postmortem has faltered leading to the hon’ble courts passing a stricture against the M.O. The need for proper training of the undergraduate students cannot be negated as some of them will be holding appointments as, Incharge at the Peripheral centers and performing Medico-legal postmortems.
11. Issues of medical negligence and malpractice have been mushrooming every day. The of doctors pledging to follow the “Medical Code of Conduct and Ethics” has been in place since the time of Hippocrates. The very core of medical ethics is being introduced to the medical students all over the country by the Forensic Medicine fraternity. A doctor lacking clinical skills is detrimental to the patients, but a doctor lacking medico-legal skills will be detrimental to the Judiciary, law enforcement agencies, Medical fraternity and the society. How can the importance of such a subject not be felt by the hon’ble BOG, is beyond comprehension.
12. We request the hon’ble BOG, MCI to reconsider their decision in the light of above quoted facts and strongly recommend that Forensic Medicine should be compulsorily taught as a core subject in Group ‘A’ or Group ‘B’.
Yours Sincerely,
Dept. of Forensic Medicine
RMC, Loni
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