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Forensic Medicine: Are they Real Medicine?

I have written a few post before this as a series of story on doctors in Malaysia. Everyone can view the post here:

  • How to Become Doctor in Malaysia

  • Are you Still A doctor?

  • House Officer : Are they Real Doctor?

  •  Direct Selling Doctor In Malaysia

  • I have talk in details regarding a pathway for a doctor after becoming a medical officer. In my previous post, I also talk regarding Aesthetic medicine which I find it to be an unreal medicine. I still think it that way. I believe most doctor will agree on that except aesthetic doctor themselves.

    Also in my previous rant I mention about forensic medicine. I have been thinking a lot of forensic medicine. Are they real medicine because from what I know and from my experience, Forensic Medicine is very special. It's like a special branch in medicine. They does not do what other doctors do everyday. They deal with dead people....

    Forensic Medicine: A Cycle completer

    I do not need to talk about different branches of medicine, it is broad. Everyone should realised by now that medicine can be divided into a limitless speciality as long as they are new thing found, medicine can be branching as that new thing. For example, no one knows about nuclear medicine perhaps 100-200 years ago. Now, nuclear medicine in common. Molecular medicine, genetic medicine, as times goes by, many new branches of medicine will follow.

    To generalize it, I like to think medicine in this way. A real medicine is when someone find a diagnosis and treat them. Everyday, this is what doctors do. Our work and life are dedicated in finding a diagnosis and solved it. That is medicine in general. Thus, if you are thinking of making a new branch of medicine, then start doing something that follow this rules. If what you do does not relate in anything in diagnosing or treating a disease, then you are not doing real medicine.

    Nuclear medicine, molecular medicine, sport medicine, combat medicine (does this thing exist?), all deal in trying to help in any way of making a diagnosis and eventually will lead to a treatment and a better life for a patient. Medicine also need a patient to be called medicine. If you are treating a healthy person who want to be pretty or not satisfy with God's creation, then that is not considered as patient. Patient is someone who are ill. Patient does not equal to a customer. Thus, there are no such thing as patients are always right. I am being sarcastic again towards aesthetic, I am being unfair here.

    Never mind, let us look at the other branch of medicine that is quite interesting, but does not interest me, Forensic Medicine. They are those doctor who deal with dead people. I know, perhaps someone who are reading this post is a forensic pathologist, and he or she must said that Forensic does not only deal with dead people. People that are still alive also sometimes need forensic opinion, maybe. However, I am being naive here, the main core of business for Forensic is dealing with dead people. Full stop. KFC might be rich in selling other product such as that expensive carbonated drinks or cheezy wedges, or maybe the burger...but their main core business is fried chicken. So, we do not want to go in details on what a forensic pathologist do.

    Forensic medicine itself is a wide area to be covered. But if you encountered someone who said he  or she is a forensic doctor in Malaysia, 95% confident level they are Forensic Pathologist. What they do? As you know, cut that people to find the cause of death @ post mortem @ autopsy. What they do is pretty interesting and horrifying (for me). They cut dead people..really cut it. Remove the organs, cut the skull, remove the brain... If that body they cut still alive when they started, the body must be 100% dead after they finished. It look cruel, gruesome, nauseating.. I, too, also have to join their autopsy as I am taking pathology as my master study now so I know. There were nothing beautiful happen in that post mortem area.

    People must be afraid to be post mortem now. Why they? They will be dead by the time someone order a post mortem. Nothing to be afraid of. I am just joking, but seriously, a lot of people refused post mortem because of the nature of the post mortem that really..not that beautiful as I said. I am not trying to scared the public, but this is reality. Sometimes I wonder, why do you need to cut that dead body like a fish if you already know that the deceased died because of gunshot to the head. I am feeling very lucky not choosing forensic as my master study. I really do not like it.

    Unfortunately, no one can refuse post mortem. Post mortem was done not because that doctor love to cut dead people (some of them do), but it was done because of the law. Post mortem can only be done under police authorisation. We used to call it P61. It was actually a form that will be released by police (numbered P61), and given to the hospital and then the respective doctors will do their work. If the doctor themselves simply cut all dead people, they will be no different from any other character in that horror movie everyone should remember.

    So, why the law order for post mortem or autopsy. Simple, to determine the cause of death. This cause of death can be presented in the court, and if not, the cause of death is very important in world health statistic. I give an example, hundred people died in a village in 1 month. If you bury the dead, without post mortem, how will you know the causes of their sudden death in 1 month period. Are they killed? Are infectious disease cause the death? Or maybe some factory leaked a poisonous material into their water source? It's important to know, for our record, for our statistic so that later, when another village affected, we will know the causes of that happening. We have prevented a horror movie to be made based on what happen in that village... unless they were killed by some demons or something. Get back to my point, post mortem is necessary. No one can refused it no matter how hard it will be, especially if it happen to our family member.

    Enough talking about what forensic do and so on. I want to get back to my ultimate question. Is forensic a real medicine. If we come back to my simple rule of medicine, diagnose and treat, these group of people in forensic sure involved in diagnosis. No doctors can see what they can see. It was very hard for us doctor during operation even on a simple task like finding an appendix, but for forensic people, they take out the whole guts out. Then search for whatever they want. So now, forensic is doing half medicine job? Diagnosis. Do they treat the dead people. No. No medicine can cure dead people. None. So this forensic does not follow the rule of medicine (I invented). So, can we classify them with aesthetic doctor?

    No. They are real doctor, they are doing real medicine. How so? Do you think I am just being biased? I said it, medicine must diagnose and treat. So how do I get to say Forensic is real medicine.

    I've been thinking this for few weeks before I wrote this. I always think of this. Trying to find an answer on how to explain why forensic medicine is real medicine. I know they are real but I can't explain it. Until today, when I discussed with one of my colleague. I love how she solved the problem until I want to named it after her. She is taking forensic pathology as her master study and I believe she will be a forensic pathologist in few years time. I will named this after her as a credit. Her name was Dr. Nadiawati but I don't like that name (nothing personal), but we called her Nadot thus I will name this Nadot's Cycle of medicine.

    Nadot's Cycle of Medicine

    In medicine, my rules are diagnose and treat. You find any branch of medicine out there, they must be related to this two thing. This is our world, this is like a religion to us doctors. The day we stop this two thing is the day when we were out or quit of being a doctor. So, medicine does not work as a single unit but multiple cooperating unit that will eventually end up with diagnosis and treatment. We, pathologist will not be able to give diagnosis to clinician if the clinician never interviewed that patient, never examined and never knew what to diagnose. 80% of diagnosis will be made clinically, and the other 20% will be supported by pathological investigation, radiology, nuclear medicine, molecular, or whatever there are in medicine. The treatment will be given by clinician, the surgeon, or anyone who involved based on the correct diagnosis that has been made earlier. So medicine, is a group of people who try to diagnose and treat a patient.

    However, before an illness become an illness, they are a group of doctor who will be out there to stop them. No, not aesthetic doctor. I am talking about public health doctor. Those doctor in public health area will be involved in the prevention of the disease. Prevention is better than cure, so as these group of people who diagnose and treat find out that perhaps they should be one step ahead of the disease, public health branch eventually developed. Public health is very important because they are like someone who negotiate before a war happen. They are the front liner. Those who cannot be saved by them will end up in hospital for another group to handle. Public health eventually will ask for help from these hospital group of doctors. For example, they may ask a cardiologist to give a talk in the public, or consult physician in the hospital if they have doubt in preventing the disease. Pathology will help in term of their screening test. All those normal blood sample will be sent to the lab and if it is proven to be not normal, they can act as early as possible. Radiology also will help. Have you ever had a chest x-ray during medical check up. That's radiology part. In developed countries, even molecular medicine people also will help in genetic screening and so on.

    It is very dynamic and involved a lot of team work. So this public health is the first thing that will happen in the cycle of medicine. The prevention part. Once prevention has failed, here comes the doctors in hospital to come and try to diagnose what has happen. No need to talk about this, everyone know how it goes. Diagnosis, lab test, radiology, diagnosis, treatment. Everyone must have their experienced admitted to hospital or maybe their relatives. This is where you can see real medicine happen. What you did not realise is the war is also out there. These group of people in war are considered as sweeper. The one who goes out there early as a scout is those public health people.

    So after the prevention, the diagnosis and treatment, where does this cycle goes? Bingo, forensic medicine. If prevention failed, the treatment failed, there are only one place you might end up. Not hell, not heaven. Its forensic department. Here, what they do is to again find the diagnosis, the real diagnosis. Someone might died because of a motor vehicle accident. Not many realised that that person maybe die because of heart attack then causing the motor vehicle accident. Only forensic will know it. Someone might died because of assaulted by the authority, but forensic know that the person is dead because of rhabdomyolysis or fatty liver disease before he was assaulted. Did I go to far? I think I did.

    Let us go back. Once the diagnosis has been made by those forensic people, now they know that this thing can be prevented. For example, if someone died because of heart attack, but during autopsy they find out that the person might be having a myocarditis, or pulmonary infarction. Thus, this crucial information will be relay back to the clinician and clinician will be aware better in the next cases that came with the similar presentation. If you recall my story about a village where 100 people suddenly died in one month time, this is where forensic play their most important part. They will determine what causes the death, then after they found out they will relay this information to the public health / prevention group of people. If that 100 people die because of an infectious disease or contaminated water, thus the public health doctor will be aware of it and they will act accordingly to prevent another village from ending up the same way.

    Here we can see that forensic medicine is the end of the journey in the medicine and they were also a connection where the cycle will return itself back to the prevention team.

    The cycle will look like this

    Public health --> Medicine (this include clinical and non clinical doctor) --> Forensic --> Public health.

    In circle it will look like this:

    Obviously it is not as simple as this. But I think it's a good explanation to make common people understand that Forensic is involved in the real medicine. For that, I call it Nadot's Cycle of Medicine. Perhaps we can add more branch later to make this cycle more specific but as for now for explaining my point, that would be enough. So, if you are interested in Forensic, you can apply it under master in pathology. Without them, the cycle will not be completed. 

    Foe every birth in this world, there will also be death


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