She can see up to six victims of sexual assault a day and get called to court at a moment's notice but Dr Catherine White relishes being
a forensic examiner
Forensic physician is the title given to doctors formally known as police surgeon and still sometimes called forensic medical examiner. The work is varied, with some doctors doing the full range such as custody medicine.
Increasingly there has been some specialisation, with some only doing sexual assault work and being based at a sexual assault referral centre (SARC). However, large parts of the country are not covered by Sarcs.
I have been working in this field for 11 years. I had been a GP partner for a year when there was a high-profile case in the media involving a TV personality being accused of rape.
The alleged victim had to wait several days to have an examination before a suitably qualified female doctor could be found. This struck me as very unfair to both parties. The event coincided with a recruitment drive at St Mary's in Manchester.
It looked interesting, I applied, got the job and the rest is history. Three years ago I became the clinical director, and now divide my working week between general practice and St Mary's.
Why do the work?
I love GP work but sometimes get frustrated at the rush of seeing patients in 10-minute slots and being perceived as a jack of all trades. A sexual assault examination can easily take two-and-a-half hours and one has the opportunity of becoming an expert in the field.
Forensic physicians in Manchester have a contract with the police. There is a retainer for being available and an additional payment for having obtained the Diploma in Medical Jurisprudence.
The rest of the pay is call-out fees. An average case will result in a £200 fee. On top of this there may be statements to write and a court appearance, both of which command a modest fee.
There are also huge opportunities for training and research. A lot of the work occurs out of hours and sleep deprivation can be an issue. But there is also a demand for cases to be seen during the day, particularly for child victims.
We recently did a study looking at why doctors left St Mary's and court demands topped the list. The courts are aware of this and are trying to accommodate doctors' other commitments. Over the years I have found them flexible.
I am often on standby to attend court but seldom get called. If you can live with a certain level of uncertainty, something most GPs are good at, it is not a problem.
People often comment that doing this type of work must be harrowing and stressful. I find it immensely rewarding. You are seeing people at their lowest, and they really appreciate the professional care you give them. It is an area where you feel you really can make a difference even if it is just showing them respect.
What skills are required?
GPs are ideal for this type of work. We tend to have a good knowledge of 'normal', are able to make decisions, have paediatric, gynaecological and psychiatric experience and are used to working with other professionals.
I think you have to like people and have a natural curiosity about them. We see all ages; the youngest was seven months old, the oldest 93 years. We see men and women from all walks of life. There are a fair number of vulnerable people, whether that is through mental health problems, learning difficulties or alcohol, as they are much more likely to be targeted as victims.
Their stories can be terrible but it is important to remain independent. The doctor is acting on behalf of the court, and you have to remember that you are only hearing one side of the story.
A large proportion will have no injuries, but if there are injuries these must be documented meticulously. Having good statement-writing skills will go a long way to keeping you out of the witness box. Should you be called to give evidence you need to follow the maxim 'Dress up, stand up, speak up then shut up'. Simple but effective.
As well as the forensic aspect of a case, the doctor will have to consider the therapeutic needs of the client which will vary from case to case (see table left).
At St Mary's we saw just under 1,000 cases last year. This averages at two to three cases a day and it is not uncommon to have five or six a day. Each doctor does six eight-hour shifts a month.
The on-call is done from home. We work as part of a team which includes crisis
workers who will attend the centre to support the victim and liaise with the police and doctor.
Different areas of the country will have different set-ups.
Postgraduate examinations are recommended not only for the knowledge acquired but for your credibility as a witness.
Catherine White is a part-time GP and forensic examiner at St Mary's Sexual Assault Centre,
St Mary's Hospital Manchester