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Principles of Forensic Medicine


The book is written as a practical guide to the main areas of concern for a forensic physician, with a reminder of the most salient points at the end of each section or chapter.

In clinical medicine, we are always advised that the notes we take must be legible, accurate and comprehensive, in case they are required as evidence in legal proceedings at a later date. However, look at any set of patient's notes on the wards and they are complete with acronyms, abbreviations, and often illegible. The forensic clinician examines patients in police custody, and everything that s/he writes is subject to the same potential scrutiny as any other doctor, but in their case the likelihood of those notes coming before the courts is greatly increased. It is for this reason that the forensic physician receives extra training in the law relating to contemporaneity with respect to note taking, and the ability to refresh one's memory from one's notes in court at a later date.

Clinical notes in the forensic setting must address the following questions, when (the record was made) how (the record was kept) what (the record contains) where (the record was stored) The book sets out methods of answering each of these questions in a practical manner, and goes on to address issues of consent and confidentiality. The concepts of consent and confidentiality are two of the major tenets of medical ethics, and are the subject of leaflets produced by the GMC. The forensic physician is placed in a dilemma - s/he has a responsibility to the patient in the same way that any doctor has, but also a responsibility to society and the system of justice to carry out forensic examinations. The findings of these examinations may not necessarily result in an outcome that is beneficial to the patient. Dr Robinson provides us with a succinct summary of the relevant issues surrounding this dilemma, and also steers the interested reader to additional sources of information.

Most doctors will be required to give their evidence to a legal forum of some description - be it a magistrates court or coroner's court - and will be required to present their evidence in the form of a statement. The writing of statements is described in this book, and Dr Robinson gives a brief introduction to the law of evidence relating to statements and giving evidence. Having studied the law of evidence, it is clear that a text of this size can only possibly scrape the surface of the subject, but for the general reader I was impressed with the overview given. More detail on the giving of opinion evidence, and the duties of the expert witness would be beneficial, but again the aim of this text is to give a practical overview, and any criticism should be taken with that aim in mind. The chapters on Fitness to be Detained and Fitness to be Interviewed take the reader through common medical conditions encountered by the forensic physician, such as acute asthma, epilepsy and substance abuse. G

uidance from a variety of sources is drawn together to provide the Forensic Physician with a handy guide to dealing with patients in the custodial setting with these conditions. As a medical student having been in casualty clerking patients with these conditions, it strikes me that the forensic physician is placed in an extremely difficult position - not only does s/he have to diagnose these conditions, but they also have to decide whether those patients can be managed in custody, or whether they need to be transferred to hospital for more sophisticated care. The Police and Criminal Evidence Act 1984 (PACE) Codes of Practice govern how a prisoner is treated in custody, and the forensic physician must consider how these impact on the prisoner presenting with symptoms that may affect their ability to be detained or interviewed etc. In order to ensure that there is no miscarriage of justice, the physician must determine whether a patient is fit to be interviewed, or whether the symptoms complained of are likely to interfere with their ability to answer questions correctly, or whether their symptoms amount to them being under 'duress', and consequently making all their answers inadmissible in evidence at a later date.

A particularly difficult judgment call must surely be where an intoxicated individual also complains of a head injury - a common enough occurrence, but at what stage does the forensic physician decide when to transfer the patient to hospital? The remaining chapters continue in the same style, with an overview of the subject, with practical tips on what the forensic physician should cover in his/her examination routine. This slim volume was a pleasure to read. Although there were no photographs or illustrations in the core text, this did not detract in any way from the ease with which the book could be picked up and read. The author certainly succeeded in his aim to provide the reader with a practical introduction to the subject of clinical forensic medicine, and I would recommend it to any medical student interested in forensic medicine, as well as any other student of law or forensic science, as they will get an informed overview of the role of the forensic physician, which is lacking in most other forensic medicine texts.

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Tags: forensic, police, medicine, surgeon, importance