Asthma: five myths debunked
Dr Vincent Forte explains why clinical forensic medicine is exciting, despite not being all it appears to be on TV
Dangerfield drives a classic car, accompanied by an attractive female detective heading an investigation in which he is indispensable. You can therefore understand my disappointment at being introduced to a vomiting drunk lying on the cell floor during my first call as a forensic medical examiner (FME).
The NHS does not offer medical services to detainees forensic medical examiners provide basic primary care.
Fitness to detain, interview, travel and be charged are affected by physical or mental illness and intoxication or withdrawal. Assessment is critical to the admissibility of evidence in court. Section 136 of the Mental Health Act allows the police to detain anyone acting strangely in a public place and leads to full assessment under section 12 of the act.
Examining police officers
Officers are assessed for fitness to continue duty when injured at work or allegedly the perpetrator of an offence against a detainee.
Road Traffic Act
Fitness-to-drive assessments often involve difficult drug users who've passed a breath test. Blood samples for alcohol estimation usually yield penitent, nearly sober people who'd had that critical 'one for the road'.
Meticulous history and examination skills are essential in cases of sexual and other assaults, including non-accidental injury to children.
FMEs attend hospitals to sample blood for alcohol and drugs in drivers involved in road traffic accidents, and perform intimate examinations of 'stuffers' (drug couriers using body cavities as a bag) done on clinical premises because of the risk of fatal overdose through rupture of a drug package during retrieval.
Cases of suspicious death lead to woods, beaches, locked garages and scenes of unbelievable squalor. Was the death accidental, through murder, or was it suicide? The answer is sometimes obvious, sometimes obscure. If the full paraphernalia of a scenes-of-crime investigation follows, the FME becomes redundant.
·Giving trial evidence as a professional witness, less often as an expert witness.
·Principal FME: includes recruitment, training of FMEs, clinical standards, the duty rota, and disciplinary matters.
Full GMC registration and postgraduate qualification in general practice or A&E medicine are basic. Career FMEs are expected to study for the Diploma in Medical Jurisprudence and train regularly. Association of Forensic Physicians membership is recommended. Section 12 approval is financially worthwhile as it adds £115.87 to the standard fee.
Pros and cons of the job
Earnings depend on volume of work. Rates should follow the annual guidelines of the Association of Chief Police Officers and AFP, but may be locally arranged. Annual earnings for full-timers prepared to graft can exceed six figures. Between £15,000 and £20,000 is more usual for a part-timer.
GPs working as FMEs must engage practice support it's very disruptive to daytime work without cross-cover. Family approval is a sensible idea for those not wishing to stay single.
How to find the work
Many police forces now use an agency. Others still have a traditional team of committed local GPs. Your local police headquarters can provide appropriate contact details.
FME's work is always lonely, often tiring yet never dull and curiously satisfying. And remember Dangerfield is to forensic medicine what The Practice is to primary care.
Vincent Forte is a GP