Working within the law

THE role of forensic physician is becoming an increasingly popular choice amongst GPs. The work is varied and challenging and brings doctors into contact with some of society’s most demanding patients. General practice training is ideal for forensic work due to the varied skills and patient types involved.

The bulk of a forensic physician’s workload will concern the care of people who are detained in police custody where a doctor is required to determine fitness to be detained or fitness to be interviewed. It often means dealing with people who have drink or drug addiction problems.

Along with this standard custodial work, forensic physicians (FPs) will be expected to develop expertise in the documentation and interpretation of injury. They will be called upon to examine and provide medical treatment to victims of assault and those individuals who find themselves in police custody. Many FPs in the UK practise clinical forensic medicine part-time, in addition to normal general practice, and much of it is based around a duty system that often involves anti-social hours.

The job is not for the faint-hearted as FPs will inevitably find themselves giving evidence in court as a professional witness, writing statements and carrying out examinations on vulnerable patients including victims of sexual assault.

Training

The new Faculty of Forensic and Legal Medicine (FFLM), part of the Royal College of Physicians, has a remit to set minimum standards for forensic practice in the UK, which still vary significantly.

No prior experience or formal training is required to apply for a post as forensic physician, but competition is fierce so you will have to be persistent. Training usually involves shadowing and attendance at a recognised in-house training course such as the twiceyearly residential course in Durham run by the NPIA (National Police Improvement Agency). Bear in mind if you are full time, you will improve skills in some areas, but won’t be doing much in other specialties such as paediatrics or gynaecology.

Last year the government announced plans to close the publically funded Forensic Science Service and for the work to be carried out by private forensics companies from March 2012. Under these new arrangements, it is likely that doctors will need a postgraduate qualification for their area(s) of work, but currently that is not the case.

The FFLM can provide more in-depth information to doctors who are interested in working within the specialty.

In practice

To do this work a non-judgmental attitude is a must – you will come into contact with the most vulnerable and sometimes the most challenging patients in society. The work can be demanding as it will inevitably mean attendance at magistrate’s, crown and/ or coroner’s/sheriff court, but with a bit of experience the nerves should settle.

You may be challenged by patients, doctors, police or solicitors so you will need to feel comfortable explaining and giving opinions, whether it is a normal day at work or in a legal setting. Statement writing is a regular part of the workload, so being organised and timely with deadlines is important. An interest in mental health, substance misuse or ethics is beneficial but not essential.

Clinical forensic work encompasses many areas including custody work where FPs, formerly known as police surgeons, carry out sexual offences examinations (for victims), visit prisons and treat patients with substance misuse problems.

Typically, around 85 per cent of a forensic physician’s workload concerns custodial work and shifts are usually 12 hours, involving out-of-hours work. Over the last five or so years, provision has been shifting from the public to the private sector and now almost all police forces have outsourced custody work to private providers, so terms and conditions of employment will vary.

On shift you cover a ‘patch’ and will be expected to travel between police custody suites, with occasional visits to A&E or private residences. A typical day might include treating those withdrawing from drink or drugs, documenting bodily injuries, assessing fitness for interview, advising police on a detainee’s medication and taking blood samples for drink drive offences. But even when you are confronted with the task of assessing the most intoxicated, aggressive patient it is usually fairly straightforward due to the proximity of police officers. Provided you exercise some common sense in these situations, your safety is unlikely to be at risk. While this all sounds tough to deal with, there is usually friendly banter with police officers and custody nurses.

FPs can also carry out prison work, which follows normal working hours. You would be the only GP onsite (caring for 1,200 inmates), and would be accompanied by a nurse during consultations. Prisoners tend not to take good care of themselves so there is plenty of disease to diagnose and chronic conditions to manage. A typical day can present a mix of patients: one who is grateful for simply having his eczema sorted out while the next may be disengaged with authority figures and having poorly controlled epilepsy. No prior training is required, however, the RCGP has a working group for Secure Environments and offers a certificate in Substance Misuse. Work can be found through locum agencies, or ask your health board/PCT.

As a career option, forensic medicine does have its downsides - shifts are not very family-friendly, training can be patchy and independence can sometimes feel like isolation. But it also offers interesting, independent, flexible working and there’s scope to do as much or as little as you like. Your communication skills will be developed to the maximum and being an FP seems to generate interest (and respect) from others.

Links

• The Faculty of Forensic and Legal Medicine - www.fflm.ac.uk

Dr Sarah Redvers is a GP and trainee forensic physician

Q&A Dr Sarah Redvers, GP and trainee forensic physician

What attracted you to the role of forensic physician?

The senior partner at our practice won the contract to provide primary care services for the local prison and, as a salaried GP at my training practice, I was up for a change of scene. I saw more pathology in one morning than in a fortnight of general practice and this inspired me to take on Custody medicine. Responsibility, independence and the legal side attract me.

What do you find most challenging about the job?

It can be a tiring environment, but balancing forensic and GP work stops burnout on both sides. I realised early on there will be disgruntled customers some days, but it can be difficult learning not to take it personally. Sometimes, working independently means feeling isolated, so I’m always mindful to get to training events and catch up with colleagues.

Has anything surprised you about the role?

Forensic medicine is an up-and-coming specialty. Already I’ve been involved in training other forensic physicians, GPs and police officers and I’ve been asked to do work for the Faculty of Forensic and Legal Medicine. It has opened doors for teaching, appraisals and research.

What do you consider the most important personal characteristic in a good forensic physician?

Unflappability. The ability to stay calm under pressure comes in particularly handy when dealing with a detainee in a cell who has taken loads of amphetamine and, equally, when standing up in court to give evidence.

What is your most memorable experience so far?

Being called out to my first ‘sudden death’. A young, alcohol-dependent woman was found at home. The house had been cordoned off so I examined the body for injuries and took in the surrounding paraphernalia. The investigating officer and I discussed possible causes for her death and it felt slightly like being in a TV drama – I was both thrilled and nervous to be the first ‘medical input’ for the case. It’s not often you consider foul play in your differential diagnoses.

Is there any advice you could give to a GP trainee considering becoming a forensic physician?

A lot of doctors worry about personal safety, but the only times I’ve felt vulnerable were doing hospital jobs. I finished my GP training five years ago and would never have envisaged doing what I do now. Don’t be afraid of dipping your toe in (one shift /session a week) and see if it’s for you.