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Working as a forensic medical examiner

Dr Sanjeev Gaya gives an insight into his work as a forensic medical examiner, or police surgeon as they used to be called

Dr Sanjeev Gaya gives an insight into his work as a forensic medical examiner, or police surgeon as they used to be called

Forensic medical examiners (FMEs), formerly called police surgeons, are a group of doctors working in the field of clinical forensic medicine. Most FMEs are GPs and work on a part-time basis. A significant few work as FMEs full-time.

FMEs are contracted by their local police force and in some cases by medical companies that hold a contract with a force. Service provision and requirement vary regionally and are subject to change.

In the Metropolitan Police in London, FMEs are initially contracted on a two-year probation basis, followed by a 10-year renewable contract.

The requirements are that you are registered with the GMC, are able to drive, are preferably a member of a medical defence organisation, have completed the initial training course and undertake to complete 24 hours of CME in clinical forensic medicine yearly. Initial training, usually a week long, is organised by the police force or contracting company. Costs vary, but some forces provide free training.

In the Met Police, there are 100-120 FMEs organised in regional groups. Each group, headed by a principal FME, serves designated police stations. My group serves three stations and consists of seven doctors.

We work 12-hour sessions. I do on average 14 sessions monthly, equally spread between day and night. The fees are paid on a per-item basis. First examinations at any particular station or location during the day and at night are about £50 and £75 respectively. An ensuing examination at the same station is remunerated at £33 during the day and £50 at night. Sexual offence examinations are remunerated at a higher half-hourly rate.

I see 1,600-2,000 cases yearly, working a weekly average of 48 hours. Travelling is reimbursed at 40p per mile. Statements bring in £38 each. Court attendance fee, paid by the Crown Prosecution Service, is scaled on the duration of absence from work or the cost of engaging a locum.

The newly set up Faculty of Forensic and Legal Medicine (www.fflm.ac.uk), under the umbrella of the Royal College of Physicians, is the academic body overseeing clinical forensic medicine. Its creation is particularly exciting as it is the first step towards clinical forensic medicine being recognised as a specialty in its own right.

The faculty will be setting up a membership exam in clinical forensic medicine in the near future. Until then, there are a number of postgraduate qualifications available, the diploma in medical jurisprudence (DMJ) run by the Worshipful Society of Apothecaries of London (www.apothecaries. org) being the most popular.

I took up work as an FME following a chance encounter with a trainer and immediately found the work absorbing and fulfilling. There is no such thing as a typical day as an FME, which is one of the beauties of the job.

But recently I had to do the following in the course of a day:

• I examine a detainee for fitness to be interviewed. The detainee has been arrested on suspicion of murder and suffers from depression. He is a middle-aged man accused of strangling his wife. The purpose of the assessment is to identify factors that could lead the suspect to make a false confession during interview. I have to put in place safeguards which will reduce that risk.

I prescribe an antidepressant and leave instructions for its administration. I recommend that he has, as a safeguard during an ensuing interview, an appropriate adult present – that is an independent person acting on the detainee's best interest. I recommend he be observed every 30 minutes and that objects of harm be removed from his person.

• I am then called to an address where a young woman has been found hanging and the police want advice on anything suspicious. I observe the scene and examine the body. Unopened boxes of Prozac and temazepam are on a bedside table. In the kitchen there are several empty boxes of paracetamol and a half-full bottle of gin.

A suicide note to the girl's ex-boyfriend is read out to me. Her body is on the upstairs landing. A ladder rests against the loft opening. Her body is cold and hard and hanging by an electric cord suspended from a beam in the loft. She has multiple linear scars on both forearms. I pronounce life extinct at 12.50pm and opine a suicidal death. I ask for the coroner to be contacted and then I leave.

• In the afternoon I see a drunken man who is brought to me kicking and screaming. I find his behaviour too threatening to continue the examination. I ask that he is taken back to the cell and that he is roused every 30 minutes. I ask to be recalled to see him in four hours.

• I am asked to see a detainee suspected of having assaulted his wife. He has been sprayed with CS gas and hit with a baton when he threatened arresting officers with a knife. He is remarkably calm and alleges police brutality. The CS crystals present on his clothes irritate my eyes and throat.

He claims he was repeatedly punched on the face and chest, the latter vehemently denied by the arresting officers. I examine him. He has minor signs of CS gas irritation. He has two adjacent tramline bruisings on the left arm, consistent with his account of being hit twice.

I document these injuries in my notes. I examine him from head to toe for injury because of the allegation of police brutality. I find no other injury.

• It's 5.30pm when I finally arrive at another station, having fought my way through the evening rush. A man has been arrested on suspicion of driving while impaired. He was over the prescribed alcohol limit on the intoximeter machine and the police want me to assess him for impairment under section 4 of the Road Traffic Act.

I find him to be inebriated with alcoholic liquor. He fails all impairment tests. There are no other conditions to explain his current state. I advise the sergeant that this man is not fit to drive at the present time.

• At 6pm the phone rings again. A witness liaison officer tells me I am needed at the Old Bailey the next day to give evidence.

I had examined the defendant six months previously. He was claiming self-defence to a charge of grievous bodily harm. I panic because I am on-call tomorrow. I ring several colleagues before I find cover for court.

An emerging specialty

FME work can involve unsociable hours, the risk of being assaulted, driving all day through slow-moving traffic and being subject to the vagaries of court. Some people may find the pressure of giving evidence at court in an adversarial system too much to bear.

However, I like the fact that I am self-employed, paid gross, can run a lot of expenses against tax, choose when and how long to go on holiday, am well remunerated and part of an emerging and interesting specialty.

Dr Sanjeev Gaya works as an FME in south London

Some people may find the pressure of giving evidence at court in an adversarial system too much to bear.

Dr Sanjeev Gaya

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