Centres of excellence are needed for clinical forensic medicine

BMJ 2000; 320 doi: http://dx.doi.org/10.1136/bmj.320.7235.650/b (Published 04 March 2000) Cite this as: BMJ 2000;320:650
  1. John Gall (johngall{at}bigpond.com), consultant forensic physician
  1. Australian Forensic and Medico-Legal Consultants, Cambwell 3124, Victoria, Australia

    EDITOR—In their editorial Norfolk and Stark express concern about the privatisation of clinical forensic medical services.1 Certainly, if this is poorly implemented without suitable safeguards, particularly for the doctors, it can greatly reduce the quality and independence of the medical service to the detriment of all concerned. On the other hand, privatisation can be beneficial.

    Irrespective of how clinical forensic medical services are provided, procedures must be in place to ensure the competence and independence of the doctor and that the medical service is provided in a professional manner. As with any medical service, it must be of a high quality. No one would expect a recent medical graduate or practising doctor not trained in the field to perform complex surgery on patients regularly. So too it is inappropriate for doctors untrained in clinical forensic medicine to practise in this field.

    As Norfolk and Stark point out, training for clinical forensic medicine requires far more than a two day course. Clinical forensic medicine requires, in addition to an extensive knowledge of general medicine, a detailed knowledge of forensic principles and their limitations and an understanding of ethics and the law well beyond that encountered in general medical courses and specialised medical fields. In addition, it requires a knowledge of the custodial system and of how to medically manage detainees in that system, and a self confidence to ensure that the principles of medical ethics and the law are upheld. To achieve this, the doctor must receive appropriate supervised training and accreditation and engage in ongoing education and peer review.

    It is surprising that in the United Kingdom, which has a well established system of police surgeons of high quality, the state has failed to understand the need for fully funded centres of excellence (academic departments) in clinical forensic medicine. No one would doubt the value of university departments of medicine, surgery, forensic pathology, etc, to maintain and extend practitioners' knowledge in these fields. Clinical forensic medicine isn't any different. The courts are becoming more demanding of doctors and of forensic practitioners in particular. Failure to introduce an academic department or departments of clinical forensic medicine will eventually result in a decline in the quality and knowledge of forensic services and become an injustice to all.


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