|Year : 2012 | Volume
| Issue : 4 | Page : 253-256
State medicine at cross roads
Murali M Patnaik, Vaddi Narayana Rao, Mude Jagadeesh Naik
Department of Forensic Medicine and Toxicology, MIMS Medical College, Nellimarla (VZM), Andhra Pradesh, India
|Date of Web Publication||27-Dec-2012|
Murali M Patnaik
Qr. No: E-1, MIMS, Medical College Campus, Nellimarla - 535 217
Source of Support: None, Conflict of Interest: None
In these days of rapid advancement of medical science, there is need for reforms in its teaching. The educationists in India are trying their best to do so in the rigid framework of four and half years of under graduate curriculum in the vision document 2015. Working like a censor the educationists are trying to cut short certain subjects, which are, felt can be coped up by the students themselves. Even before vision document 2015 the axe has already fallen on the departments of Anatomy, Physiology and Bio-chemistry departments. With greater emphasis on public health and some emphasis on basic and foundation courses, some further reductions have to occur in other subjects. The focus of attention now is on forensic medicine. Three issues have arisen in the vision document 2015. (1) Whether the subject of forensic medicine can be reduced to a one-year teaching program? (2) Is there a need to vertically integrate the teaching of forensic medicine in the last two semesters of under graduate teaching? (3) Should clinicians teach the subject of forensic medicine by splitting? These issues have been adequately dealt with in this article. Also, discussed is the state of affairs of the practice forensic medicine in India today for which certain remedies are suggested to lessen the inadequacies, deficiencies and the delinquencies noted in the teaching and practice of forensic medicine.
Keywords: Reforms in forensic medicine, vision document 2015, vertical integration
|How to cite this article:|
Patnaik MM, Rao VN, Naik MJ. State medicine at cross roads. J NTR Univ Health Sci 2012;1:253-6
| Introduction|| |
Forensic Medicine as we know is also called State Medicine. State medicine appears to be at cross roads at this juncture after traveling for more than 150 years in India. If, changes as envisaged in vision document 2015 are put into practice it would be difficult to fathom the results it will produce in the years to come.  We have therefore decided to put forth a forceful and thread bear perspective, from the viewpoint of a medico legist, highlighting arguments for and against the proposals contained in the vision document.
| Discussion|| |
Let us now analyze the three issues raised in the vision document; the situation would appear as under.
Vertical integration of forensic medicine
In the words of Doctor Cyril H. Wetch, M.D., J.D. past president of American academy of forensic sciences, "Forensic medicine is a complex and intellectually demanding of professional pursuits".  In essence, forensic medicine requires the application of knowledge acquired in almost all the subjects of medicine, so that the report generated on this account shall stand the scrutiny of the bar and the bench. The bulk of the content of forensic medicine consists of subjects who require knowledge in surgery, obstetrics, medicine, psychiatry, orthopedics etc. Needless to say, it would be appropriate to teach the subject of forensic medicine alongside these clinical subjects in the last three or four semesters of the undergraduate curriculum, so that the students can better comprehend the subject of forensic medicine. Indeed, it would be a revolutionary reform that is very much needed to vertically integrate the teaching of forensic medicine in the context of vision document 2015.
Restriction of teaching of forensic medicine to two semesters
As we have discussed earlier, basic and foundation courses have to be incorporated in the M.B.B.S curriculum after 2015.
If we look into the evolution of forensic medicine during the last one and a half centuries, from the days of Norman Chevers who was a Medico Legal Adviser on the military commission to the Governor General of India in 1850s to our own Jaisingh Modi (1875-1954); to the present day the actual progress of forensic medicine towards establishment of the departments in almost all the medical colleges took shape only in 1960s and the full-fledged subject of forensic medicine as taught in the days of the Jaisingh Modi remains more or less same with few recent advances like DNA finger printing being added. Although, the content has not much changed the relevance has changed very much; as the crime rate and the modus operandi of criminals has changed from simple ways to complicated ways requiring more effort to deal with, by the enforcing agencies.
Under the changed circumstances, restriction of teaching of forensic medicine to two semesters requires intense efforts with two hr for teaching theory, one hr of tutorials and two hr of practical every week; which in turn requires full-fledged teaching staff as per MCI norms. In this changed scenario we feel that if the inputs as mentioned above were in place, there would not be any problem to go ahead with a two-semester syllabus for forensic medicine.
Teaching by clinical faculty by splitting-desirable?
As the bulk of the forensic medicine consists of three topics namely mechanical injuries, sexual jurisprudence and toxicology, it appears that the clinicians (surgeons, obstetricians and physicians) can teach the subject as well. This is fundamentally a wrong notion as the scope of forensic medicine is on a different wavelength compared to the clinical subjects. The medico legist teaches the subject from the view point of a court room scene like post mortem appearances, exact size, shape and locations of injuries, artifacts, DNA finger printing, etc. Whereas the clinician looks and views the subject and the patient from treatment point of view and his mind is preoccupied at curing the patient. Further, the clinician feels perturbed and worried to know and understand the medico legal aspects and feels disinterested and shows apathy to teach forensic medicine. The clinician should be best left to deal in his own domain for optimal results. In a similar fashion, the medico legist, visualizes and teaches his subject from medical and legal aspects; should be left to deal within his own domain.
Further the requirements of the department of forensic medicine in respect of labs, museum, equipments and text books in accordance with MCI norms is best taken care of by the medico legist.
A doctor in whatsoever specialty or capacity, as a member of noble profession should always be on the right side of law so as to lead a dignified professional. For this to be attained, a professional man should have a minimum knowledge of the following acts and sections of the Indian Penal Code as mentioned below. Ignorance is no bliss in law.
- Workman's compensation act 1923
- IMC act 1933, 1956
- The drugs and cosmetics act 1940, 1945, 1950, 1954
- Pharmacy act 1948
- Geneva convention 1960
- Registration of births and deaths act 1969
- M.T.P. act 1971
- Torture, WMA Tokyo 1975
- Narcotic and psychiatric substance act 1985
- Consumer protection act 1986, 1993
- Mental health act 1987
- Human rights act 1993
- Organ transplantation act 1994
- PCPNDT act 1994
- Pollution control act 1998
- Clinical establishment act
- Sexual harassment at places of work
- Disability act
- Ethical and legal issues covering people living with HIV and AIDS (PLWA)
- IMC-professional conduct, etiquette, ethics regulation 2002
- Sec. Of IPC-299 to 377 and others
- Minimum knowledge of few sections of the CrPC, Civil code and IEA
Above acts and codes can be better introduced to the under graduate students by the teachers of forensic medicine alone. Having regard to these different angles of teaching, we are of the view that clinical faculty are not suitable to teach forensic medicine.
The unseen fourth factor (A third eye view)
We would now like to focus our attention on the all-important aspect of state medicine, the authority of which vests in the home departments of state, central and union territories governments. These are the bodies, which are supreme and enact the laws for the population at large.
Let's now analyze the evolution of state medicine in India, as part of home department.
During British rule the medico legal work including postmortem examination was conducted by the civil surgeons and asst. surgeons located at district headquarters and few important tehsil headquarters, mostly by European doctors. Those days population was less, vehicular deaths were negligible and crime rate was also less. The burden of medico-legal work was small. Today the population of India is 1200 million in contrast to 200 million (Undivided India) in the year 1901. Millions of people each year are dying due to traffic accidents. The crime rate has increased many fold; putting an enormous burden of medico legal activity on the system. At the same time a large number of doctors are now available in the nook and corner of the country. Some of these block and mandal level CHCs are sharing the burden of medico-legal work. Any proposals to shift the medico-legal examinations to the district and medical college level will be a retrograde step and may lead to serious law and order problems, as the burden of medico-legal work cannot be coped up by these secondary and tertiary institutions alone.
| Conclusion|| |
While the need for reform in medical education is acute, the outcome of reforms should be able to achieve the desired result of optimal benefit to all branches of medicine. In the rigid framework of four and half years of under graduate medical study, for the reason that medical graduates are already spending lot of time in acquiring postgraduate and super specialty qualification, in this situation the balancing act of rationalization becomes a tricky issue. It now appears the axe will fall on the forensic medicine department. In order to pre prepare for such an eventuality we have already discussed the three pertinent issues raised in mission document 2015 which we hope would definitely be taken up by the panel studying these issues, so that, after tremors are not felt in the forensic medicine fraternity. ,
In fact what is needed for forensic medicine is strengthening of teaching of the subject at the under graduate level. In view of the remarks of ministry of home affairs of govt. of India "The status of the medico legal practice throughout the country is in a deplorable condition".  This is the result of neglecting the subject of forensic medicine. Inadequacy of acumen due to inadequacy in training has resulted in erroneous conclusions, and the doctors will face awkward situations inside a courtroom. In this context of inadequacy, it is seen that the MCI has prescribed seventy hours of theoretical teaching and thirty hours of practical work for the under graduate academic curriculum which in itself a just sufficient to cover the courses of under graduates. If the subject has to be taught with some degree of emphasis, it would actually take eighty hours of theory teaching and forty hours of practical works, which includes demonstration of ten to twenty autopsies.
Universities in India have reduced the marks given to the subject to one hundred marks instead of two hundred marks categorized earlier.  In this pattern, with no markings for practical records and just ten marks for oral examinations conducted by four examiners; appears inadequate. In such a situation the students take the subject lightly. And the net result is inadequate knowledge levels and deficient service delivery, which is a reflection of the statement of the central home ministry. Therefore we suggest that the examination for the under graduate courses should be restored to two hundred marks, for strengthening teaching of forensic medicine.
Further it is sad to say that medico legal work is not assigned to private medical colleges. As a result of which private medical colleges have to depend on government hospitals of the area for this activity. Any dependence would naturally dilute the quality and quantity of the work. Therefore we are of the view that MCI should recommend to government to declare private medical colleges as medico legal centers. This is an urgent reform required to boost the teaching of forensic medicine in private medical colleges.
In addition, the infrastructure in the periphery with regard to postmortem centers should be strengthened to suit the needs of the growing population. We would like to suggest that institutions of chemical examiners should be opened up even at the regional level inside the states depending on the volume of work to cut delays and improve the efficiency. Lastly, we would like to add here that the medico legal services should be brought close to the door steps of people which is in consonance with present democratic thinking in the country and further the dead and the injured are respected in this way, not to speak of the difficulties that would be saved for the living involved in these issues.
| Acknowledgements|| |
- Chairman and Dean of MIMS; for their enthusiastic response and active support and encouragement in preparing the article.
- Sri Arun Kumar L.T of FM and T Department of MIMS Medical College for giving typed shape to the article.
| References|| |
|1.||Vision document 2015. Available from: www.mciindia.org/tools/announcement/MCI_booklet.pdf, last accessed date-june 2012. |
|2.||Wecht CH. Parikh′s textbook of Medical jurisprudence and Forensic medicine and Toxicology. 6 th ed., vol 1. New Delhi: CBS Publishers; 2002. p. 10-1. |
|3.||MCI standards for undergraduate studies. Available from: www.mciindia.org/for-colleges/Standard-for-250.pdf. [Last Accessed on Nov 2010]. |
|4.||Standing orders of civil medical department for 1895 issued by government of Madras. |
|5.||Jayapalan VK. Director KVG Medical College, foreword to the textbook of forensic medicine and toxicology by V.V. Pillay. 13 th ed. Hyderabad: Paras publishers; 2003. |
|6.||Courses of study Forensic medicine: Handbook for students published in 2009-10. 8 th ed. 2010, N.T.R. health university, Vijayawada. |