I am happy to note that more and more of you are taking the bull (MCI) by the horns. Let us hope that on account of all this concerted effort, Vision 2015 will be reviewed and modified. However, please do not slacken your efforts. Continue with the bombardment of the MCI battlements!
But while anticipating that everything will work out to our satisfaction eventually, I got to thinking about our own role in the creation of this mess. And I have come to certain hard truths. You may or may not agree with me. But I have put these thoughts in the form of a letter which I propose to post to all the FMT heads across the country. The letter analyses the various reasons for the current imbroglio in an objective and candid manner, and offers solutions for the future (so that no more nightmarish "visions" threaten our speciality again).
Do go through the letter and give me your own thoughts about it. Until I get a majority view that the points expressed are valid, I will not be sending out the hard copy of the letter to anybody.
Regards,
From
Dr. V.V. Pillay MD, DCL
Chief, Poison Control Centre
Head, Analytical Toxicology & Forensic Biotechnology
Professor, Forensic Medicine & Toxicology
Amrita Institute of Medical Sciences & Research
Cochin, Kerala 682041
Phones: 0484-4008056 (direct)
0484-4001234: Extn - 6034 (PCC), 8096 (Tox Lab), 8190 (DNA Lab)
8056 (Forensic Medicine & Medical Toxicology)
Fax: 0484-2802020
Emails: toxicology@aims.amrita.edu
14.01.2011
Greetings from Poison Control Centre & PG Dept of Forensic Medicine & Toxicology, AIMS, Cochin!
I trust this letter reaches you and your departmental colleagues (and PG students, if there are any) in the best of health. I am deliberately leaving out the latter part of the salutation (“and spirits”) because I do not think that any of us in the forensic medical fraternity can be expected to be in the best of spirits (unless one is referring to something else) in these troubling times when the fate of the specialty itself hangs precariously at the edge of an abyss of uncertainty. I am of course referring to the proposed fragmentation of our specialty and the consequent, inevitable dilution of its importance in the MBBS curriculum if the so called “Vision 2015” of the Medical Council of India is implemented. Let us hope that this will not happen. Because of a concerted and well-sustained campaign by our fraternity against this ill-conceived document prepared by well-meaning but badly misinformed individuals, there is a distinct possibility that the document will be modified before it is finalized.
Be that as it may, let us introspect a little in complete honesty as to what exactly went wrong, whereby a medical specialty as important as forensic medicine (including toxicology) was deemed by a select group of medical professionals to be relatively insignificant for the undergraduate medical curriculum. Granted that part of the reason is lack of knowledge on the part of the committee that drafted the document about ground realities pertaining to the utility of forensic medicine in the Indian scenario. Granted also that part of the reason may be because the committee did not bother to interact with the stake-holders concerned from each department before framing the document. There may also be several other reasons that we can lay at the door of the committee and blame the “experts” for coming to the erroneous conclusion that forensic medicine need not be a mandatory subject in the UG curriculum. But the fact remains, however bitter the truth may be to us all, that we of the forensic community ourselves contributed to such a perception having gained ground over a period of time that forensic medicine is relatively unimportant from a practical stand-point, and that a student needs to only get a “pass” in the subject somehow and move on to more important subjects. In fact, it is common knowledge, that an average student devotes only a fraction of the time even in the para-clinical phase to our subject, while he/she concentrates mainly on pathology, microbiology and pharmacology. And once the student has cleared the para-clinical phase, he/she may cast aside the book of forensic medicine, which itself may be nothing more than a “guide” prepared by some of our “eminent” colleagues, or a book that is so full of incorrect, outdated or irrelevant information that it ceases to be of practical utility the moment the university examination is over. Can any one among us dispute this bitter truth?
No amount of shouting from the rooftops about the importance of forensic medicine for basic doctors is going to make any difference, unless we actually convince everybody that the subject as it is being taught in most medical colleges in India is really helpful in practical situations. The sad reality is that while the subject itself is indisputably vital to a basic doctor, our whole approach in ensuring that he/she feels confident in handling medicolegal cases or issues has been flawed, inappropriate or inadequate. Unless the teaching of a subject is made effective, however important it may be, its importance will greatly diminish in the eyes of the student if it fails to help him in practical situations after he graduates. So while we may blame basic doctors for not having devoted enough time to grasp the basics of forensic medicine when they were in the para-clinical phase, we cannot escape from the fact that we have been teaching the subject in such a way that important and useful aspects have been glossed over, while redundant or obsolete aspects have been over-emphasized.
In short, we have reduced the dynamic and vast specialty of forensic medicine comprising medical jurisprudence, clinical forensics, toxicology, biotechnology and pathology into just forensic pathology alone, with overloading of information pertaining to thanatology that has resulted in confinement of this glorious specialty within the four walls of a mortuary – solitary confinement! We have been thrusting loads and loads of such information, much of it intricately mired in superfluous minutiae down the students’ throats, as though it is crucial to his very survival as a doctor; so much so that we have finally lost track of most other areas of the specialty. Sadly it is these very areas (clinical forensic medicine, ethics, toxicology and perhaps even biotechnology) that are more relevant to doctors today, regardless of whatever specialty they may finally choose later on, or even if they prefer to be basic doctors, than the excruciating details of forensic pathology.
Please do not get me wrong. I am not putting down forensic pathology. That would be foolish, since we all know that it is the cornerstone of forensic medicine, and every basic doctor must be familiar and competent enough to undertake at least uncomplicated medicolegal autopsies when the need arises. But my point is just that. It is necessary that only the fundamentals of forensic pathology are taught to UG students, with focus mainly on common cases and situations. However, a line must be drawn somewhere, and equal attention must also be devoted to other areas such as clinical forensic medicine, medical jurisprudence and toxicology. This is where we went wrong. This is what we did not do. In our obsession with forensic pathology and our frantic efforts at making basic doctors expert forensic pathologists, we completely neglected all the other vital components of forensic medicine. And today we find ourselves in the unenviable situation of fighting for our very survival.
But if one looks at this issue in the right perspective, is it not fitting in some bizarre though pathetic way, that forensic pathology has over a period of time become a Frankenstein turning against its own creators and propagators, while the main lifeline that we could have used to extricate ourselves (clinical forensics, toxicology and jurisprudence) has withered to a point where it does not have the strength to pull us from the brink?
While I talked and wrote about this very issue in many forums over the past few years arising out of a sense of apprehensive premonition, many of my own peers and colleagues who were immersed in pathology, treated my lectures and writings with derision and contempt. Some of them went as far as to actively campaign against toxicology and biotechnology, branding them as unimportant, and reduced lecture hours and marks drastically for these components in their respective universities and institutes. But I persevered with my own convictions despite criticism which sometimes bordered on the vitriolic, and I feel a sense of accomplishment that today, here in AIMS Cochin, we have the complete specialty in place: forensic pathology, clinical forensic medicine, toxicology, and biotechnology. Meanwhile, as you know only too well by now, the Medical Council of India, while not removing forensic medicine totally from the UG curriculum, has eliminated forensic pathology completely. In Vision 2015, only clinical forensic medicine, medical jurisprudence and toxicology are mentioned. This however does not make me feel triumphant or vindicated. I just feel saddened that during all this time that we had to develop these components (together with forensic pathology), most of us just refused to do so, either out of stubbornness, ignorant arrogance, or indifferent lethargy.
Let me emphasize once again that I have nothing against forensic pathology, and instead feel that it is the fulcrum on which the entire specialty of forensic medicine rests; it must be reinstated in the UG curriculum without question. And we must all fight resolutely and in unison for its retention. At the same time, let us also understand once and for all, that forensic medicine is much more than just pathology. We need to urgently develop the entire specialty as a complete entity. Only then can we ever rest in peace. Otherwise, even if “Vision 2015” is given the burial that it deserves (in its present form), we can still never be sure that some other kind of “vision” may not rear its ugly head once again in the future, determined to make this cherished specialty “rest in pieces.”
Do introspect on all that I have written in an objective manner and decide as to whether there is at least some truth in what I have stated, however bitter it may be. You may curse me or abuse me, but I will keep reiterating that the only way of making forensic medicine immortal in India is by making it a complete specialty, and not an extension of general pathology.
In other words, be whole or be in a hole!
Best wishes,
Yours sincerely,
go ahead,u r perfectly all right.
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