Becoming a police surgeonBMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7515.sgp95-a (Published 03 September 2005) Cite this as: BMJ 2005;331:gp95
Peter Crouch is a general practitioner and principal police surgeon for Wiltshire. He discusses his role as a forensic physician and how it has improved the quality of his working life
Twelve years ago I was looking to broaden my career horizons and explore a relatively new and rapidly evolving medical specialty. Like general practice, forensic medicine spans many disciplines and encompasses aspects of law, medical management, and forensic science, providing direct patient care to some of the most challenging, needy, and often vulnerable members of society.
Most police surgeons are general practitioners but a certificate of prescribed (or acquired) experience in general practice, although helpful, is not a requirement for this role. In fact, any suitably experienced and trained registered medical practitioner can perform duties as a forensic physician. Historically, police surgeons did everything, but as with most areas of modern medicine, it's increasingly the case that although some “specialist generalists” will do everything, most will focus on a single general area, like custody medicine, and some forensic physicians will perform their duties in one narrow but specialist arena, like forensic gynaecology.
What is a typical shift like and how does it work?
I find that the main advantage is that I can return home between calls. I am not required to be at the station when it's quiet and there's no work to do—this can be a great bonus during less busy shifts although these are becoming less frequent. Unlike general practice, since the new GP contract, most police surgeons continue to work at night. I do work with some police surgeons who undertake only daytime work but this is rare, particularly in rural areas. The law says that those detained in police custody have the right to see an appropriate healthcare professional and they don't need a reason to request one. So if anyone reading this is thinking that stern telephone triage might reduce much of what is inevitable night-time work—please think again
Box 1 gives the details of a typical 18 hour period when I was on call last summer. It started at 1 pm on Saturday and ended at 7 am on Sunday morning. Although this shift didn't include an example, it is not unusual to be called on to provide an opinion as to the suspiciousness of the situation confronting officers who are called to the scene of a sudden or unexpected death—particularly if out of hours—as the patient's own GP is very unlikely to be contactable.
Box 1: Example of a typical on-call shift
1305—Police station A—Fit for detention/fit for interview?
1325—Police station B—Fit for detention/fit for interview?
1406—Police station A—Fit for detention/fit for interview?
1540—Home—Fit for detention/fit for interview?
1606—Telephone advice—Police station A—permission to give medication
1838—Police station A—Fit for detention/fit for interview?
1955—Home—Ate dinner (rather quickly)
2103—Police station A—Fit for detention/fit for interview?
2239—District general hospital—“Intimate” samples from an alleged perpetrator of rape (male)
2304—Police station A—Two patients—Fit for detention/fit for interview?
2315—Police station A—Two patients—Head injury? Permission to give medication
2345—District general hospital—Blood sample (unconscious driver)
0040—Police station A—Fit for detention?—documentation of injuries
0050—Police station A—Head injury—Glasgow Coma Scale 8 (admitted to hospital)
01:02—Police station A—See 14 year old boy. Alcohol and Ecstasy (admitted to hospital)
0250—The Sanctuary—Examination of a complainant of sexual assault (female)
0700—Home—End Shift—slept late thankfully, as it was now Sunday
There are two main forms of payment for forensic services—retainer and item of service. Although the nationally negotiated and “recommended” fee structure is published in Medeconomics (http://www.medeconomics.co.uk) each of the 43 police authorities and police forces in the country can negotiate their own local pay rates. The levels of remuneration available for forensic physicians are, in my view, reasonably commensurate with the level of expertise and responsibility required. Certainly the increase in pay rates that followed the shift of out of hours responsibility from GPs to primary care trusts has served to create a more competitive approach towards the structure of remuneration schedules for police surgeons. For example, I would have earned £900 for the shift in Box 1.
Box 2: Ten steps to becoming a forensic physician
Research the role first—this avoids daft questions during the “ride along” (Further Information)
Contact your local constabulary and ask who your local forensic physicians are; explain that you are interested in finding out more about their role
Contact a local forensic physician (in most areas they are still called police surgeons) and politely ask to meet and explore whether they would be prepared to have you “ride alongside” for part of a shift. Please remember they are under no obligation to do so—so please put your happy face and charm hat on! This will give you a chance to meet the police officers and experience the working environment at first hand
Join the Association of Forensic Physicians (AFP)
Attend courses and conferences (see AFP website for details)
Introductory Custody Medicine course
Introductory Sexual Assault/Forensic Gynaecology examination course
Initially work alongside an existing experienced forensic physician
Work independently (initially with telephone advice available from a senior police surgeon)
Develop evidential credibility by virtue of experience and continuing professional development, and by studying for a higher forensic qualification, for example, the Diploma of Medical Jurisprudence
Looking back over the past 10 years I have spent as a police surgeon, as daunting as it seemed at the time, I'm very glad I took the plunge and discovered an intellectually challenging and financially rewarding area of medicine that adds further variety to my working day. ■
The Association of Forensic Physicians' website—http://www.afpweb.org.uk—is excellent. The publications section is particularly good and will give you an understanding of the role of a forensic physician and what is considered to be good practice in terms of delivery at the coalface.
Stark MM. A physician's guide to clinical forensic medicine. Humana Press, 2000. ISBN 0896037428.
McLay WDS. Clinical forensic medicine. Greenwich Medical Media, 1996. ISBN 1900151200.
Robinson SP, Roberts R, Knowlson T, Evans V. Principles of forensic medicine. Greenwich Medical Media, 1996. ISBN 1900151359.
Any of these texts will give readers an in-depth appreciation of the role of the forensic physician
Legal and ethical issues—BMA guidance for forensic physicians
Healthcare of detainees in police stations. 2nd ed, 2004—available from the BMA website (www.bma.org.uk) as a pdf—www.bma.org.uk/ap.nsf/Content/Detainees/$file/Detainees.pdf
The Council for the Registration of Forensic Practitioners website is well worth a look, as registration with them will become very important for forensic practitioners. Check their website at www.crfp.org.uk