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. 2003 May 10;326(7397):1037. doi: 10.1136/bmj.326.7397.1037/a

Medical experts and the criminal courts

Meaningful audit could be difficult to attain

John A M Gall 1
PMCID: PMC1125941  PMID: 12742935

Editor—Although I agree with Milroy, I think it unfortunate that he did not extend his editorial to propose a system for the auditing and assessment of quality in medicolegal work.1 Experience shows that meaningful audit could be very difficult to attain for many reasons that include the following five.

The first is the legal system. The adversarial system is simply one of winning and not one of finding the truth. This encourages the use of “hired guns” and brings pressure on experts from both sides to provide “favourable” reports in the interests of maintaining client satisfaction and obtaining further medicolegal work.

The second is the absence of evidence based forensic medicine. Properly conducted research in the field has been comparatively limited and many of the forensic “facts” are neither supported by nor based on controlled research findings but on published personal views.

The third is personalities and titles. Personality conflicts and favouritisms can interfere in the objective assessment of performance and the establishment of a list of accredited “experts.” Titles are a problem as professorial and associate professorial appointments are not always indicators of either knowledge or competence, although are often viewed as such, particularly in the courts.

The fourth is representation. People who provide medicolegal services are associated with a wide variety of learned societies and colleges. Most do not have effective audit systems in place, and even if they did, no uniform standard exists across all fields.

The last is assessment of court performance. Court presentation is an important aspect for any medicolegal practitioner but can this be objectively and inexpensively assessed?

Audit and quality assurance programmes are certainly necessary and are long overdue but the implementation of an objective system free from bias could be very difficult. Many changes are needed including consideration of both national and international governing bodies that are inclusive of all medicolegal practitioners.

Footnotes

Competing interests: None declared.

References

BMJ. 2003 May 10;326(7397):1037.

Clinical forensic medicine needs to become part of the syllabus

Neville Davies 1

Editor—Although Milroy was discussing expert medical witnesses,1-1 he might have usefully broadened his review to include professional medical witnesses. In our increasingly violent society doctors often give factual evidence about injuries; although professional witnesses, they also give expert opinions on their causation. Miscarriages of justice may and do occur when their knowledge base is inadequate.

Criminal medicolegal problems are not restricted to forensic pathology, a recognised specialty. Clinical forensic medicine, needed to ensure competence when evaluating injuries due to criminal trauma, is not even a subspecialty. Considering the numbers of patients presenting in accident and emergency departments with such injuries, the necessity for training in this discipline is self evident. Ninety per cent of victims of domestic violence are seen in general practice, where the same caveat applies.

Although the General Medical Council pays lip service to the legal aspects of medicine, clinical forensic medicine is conspicuous by its absence in the undergraduate syllabus. Neither do the royal medical colleges show any interest in taking steps to improve medical evidence in criminal cases. The new Council for the Registration of Forensic Practitioners will work towards accreditation of forensic medical examiners for the various constabularies, but this will do nothing for most general practitioners or doctors in accident and emergency medicine who may find themselves stranded in the witness boxes of magistrate and crown courts.

For decades doctors at the criminal medicolegal interface have unsuccessfully sought sponsorship from academic bodies to build an organisation dedicated to remedying this deficiency. The legal profession should help its medical sister put her house in order and bring pressure to bear where it will help most. It would be interesting to hear Lord Justice Auld's views on this proposition.

Footnotes

Competing interests: None declared.

References

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

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