- Email: [email protected]
Forensic autopsy practice in the Middle East and its comparison with the West
Accepted Manuscript Forensic autopsy practice in the Middle East and its comparison with the West M. Madadin, Assistant Professor PII:
S1752-928X(15)00166-3
DOI:
10.1016/j.jflm.2015.08.016
Reference:
YJFLM 1225
To appear in:
Journal of Forensic and Legal Medicine
Received Date: 18 June 2015 Revised Date:
6 August 2015
Accepted Date: 27 August 2015
Please cite this article as: Madadin M, Forensic autopsy practice in the Middle East and its comparison with the West, Journal of Forensic and Legal Medicine (2015), doi: 10.1016/j.jflm.2015.08.016. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Title: Forensic autopsy practice in the Middle East and its comparison with the West Type of manuscript: Correspondence (Letter to the editor) Author (with affiliation):
RI PT
M Madadin * Assistant Professor
SC
Forensic Medicine Division, Department of Pathology, College of Medicine, King Fahd Hospital of the University, University of Dammam, Dammam, Saudi Arabia (KSA) *
Corresponding author
M AN U
[email protected]
AC C
EP
TE D
No conflict of interest
ACCEPTED MANUSCRIPT
Dear Editor,
RI PT
I read with keen interest the recent article “Forensic autopsy practice in the Middle East: Comparisons with the West”.1 I would like to clarify some misunderstandings which might arise from the article, specially relative to forensic autopsy practice in Saudi Arabia.
AC C
EP
TE D
M AN U
SC
The authors mention that those who have successfully completed the 4-year postgraduate training program in forensic medicine in Saudi Arabia are not forensic pathologists.1 Certainly, in Saudi Arabia, post graduate training in forensic medicine includes both forensic pathology and clinical forensic medicine. Forensic pathology includes both gross and microscopic examination of organs and the examination of the dead body as one entity. A pathologist is not only a specialist in medicine focused on microscopic tissue examination. A specialist in medicine who spends time examining the organs grossly and the dead body as a whole is also a pathologist. Although the training in histopathology for post-graduate forensic medicine students in the aforementioned program is for a short period of 6 months, they are certainly well versed with forensic or medico-legal autopsies, this being one of the major focuses of the training program, and therefore, are as well trained in forensic pathology as specialists in many countries around the world, including European countries. Teamwork is the essence of a better outcome in any project, and therefore it is the practice in Saudi Arabia to consider the involvement of anatomic pathologists in the microscopic examination of tissue preserved at autopsy. Similar is the case with toxicological or chemical analysis of the viscera and body fluids retained at autopsy wherein this task is completed by the chemists. A physician or a surgeon in any specialty has to rely on laboratory medical personnel and so is the case with the forensic medicine specialists. Obviously no claim is made that the successful student of the aforementioned program is a histopathologist. The aforementioned program trains a student to be both a forensic pathologist and a clinical forensic medicine specialist. The authors1 go on to mention that autopsy rates are decreasing in the West, but are increasing in the Arab world. The authors cite references to support the former part of the preceding sentence. However, these references2-6 are wrongly cited as these references actually refer to a decline of clinical / hospital autopsies and not forensic / medico-legal autopsies in the West. The authors1 have incorrectly made a comparison between hospital autopsies in the West and forensic autopsies in the Arab world. The authors1 also mention that the well-established post-graduate teaching program in the Eastern Province of Saudi Arabia needs to be replicated to other provinces of Saudi
ACCEPTED MANUSCRIPT
Arabia. The authors1 have failed to recognize that the post-graduate teaching program is available in all major provinces of Saudi Arabia.7
M AN U
SC
RI PT
The authors1 suggest division of forensic pathology and clinical forensic medicine in the Arab world. In Saudi Arabia, the aforementioned postgraduate program is designed to train doctors to be a forensic medicine specialist who is competent in both forensic pathology and clinical forensic medicine. The suggestion by the authors1 does not take into account practicalities of the Arab world. The authors need to consider the legal system, regional infrastructure and manpower in relation to the practice of forensic medicine, and the objectives of working as a holistic forensic medicine specialist rather than merely as a forensic pathologist. Many countries across the globe accommodate both forensic pathology and clinical forensic medicine under the umbrella of forensic medicine. The curriculum in forensic medicine at the postgraduate level includes both the clinical and pathological aspects of forensic medicine. Nevertheless, my suggestion is that there is more to be gained by increasing the training period in histopathology from 6 months (present postgraduate curriculum in Saudi Arabia) to 18 months as is the case in Australia.8 In my view, I encourage further training in basic anatomical pathology / histopathology in aforementioned program, but not necessarily full 4 or 5 years of training in histopathology, and continuation of clinical forensic medicine alongside forensic pathology under the umbrella of forensic medicine.
AC C
References:
EP
TE D
As conclusion, I suggest more research, studies and assessment, considering all factors such as international standards, social aspects, infrastructure, jurisdiction..etc.,in order to evaluate the practice and post graduate education of forensic medicine (clinical and pathological) in Saudi Arabia then changes and update accordingly.
1. Al-Waheeb S, Al-Khandary N, Aljerian K. Forensic autopsy practice in the Middle
East: Comparisons with the West. J Forensic Leg Med 2015;32:4-9.
2. Shojania KG, Burton EC. The vanishing non-forensic autopsy. N Engl J Med 2008;358:873-5. 3. Nemetz PN, Tanglos E, Sands LP, Fisher WP, Newman WP, Burton EC. Attitudes towards the autopsy: an 8-state survey. MedGenMed 2006;21:80. 4. Davies DJ, Graves DJ, Landgren AJ, Lawrence CH, Lipsett J, MacGregor DP, et al. The decline of the hospital autopsy: a safety and quality issue for healthcare in Australia. Med J Aust 2004;180:281-5.
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
5. Petri CN. Decrease in thefrequencyof autopsies in Denmark after the introduction of a new autopsy act. Qual Assur Health Care 1993;5:315-8. 6. Wood MJ, Guha AK. Declining clinical autopsy rates versus increasing medicolegal autopsy rates in Halifax, Nova Scotia. Arch Pathol Lab Med 2001;125:924-30. 7. Forensic medicine program.SCHS website [internet]. 2015[cited 2015 June 15]. Available from:http://www.scfhs.org.sa/en/MESPS/TrainingProgs/TrainingProgsStatement/Pathol ogists/Pages/default.aspx 8. Royal College of Pathologists of Australasia website.
S1752-928X(15)00166-3
DOI:
10.1016/j.jflm.2015.08.016
Reference:
YJFLM 1225
To appear in:
Journal of Forensic and Legal Medicine
Received Date: 18 June 2015 Revised Date:
6 August 2015
Accepted Date: 27 August 2015
Please cite this article as: Madadin M, Forensic autopsy practice in the Middle East and its comparison with the West, Journal of Forensic and Legal Medicine (2015), doi: 10.1016/j.jflm.2015.08.016. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Title: Forensic autopsy practice in the Middle East and its comparison with the West Type of manuscript: Correspondence (Letter to the editor) Author (with affiliation):
RI PT
M Madadin * Assistant Professor
SC
Forensic Medicine Division, Department of Pathology, College of Medicine, King Fahd Hospital of the University, University of Dammam, Dammam, Saudi Arabia (KSA) *
Corresponding author
M AN U
[email protected]
AC C
EP
TE D
No conflict of interest
ACCEPTED MANUSCRIPT
Dear Editor,
RI PT
I read with keen interest the recent article “Forensic autopsy practice in the Middle East: Comparisons with the West”.1 I would like to clarify some misunderstandings which might arise from the article, specially relative to forensic autopsy practice in Saudi Arabia.
AC C
EP
TE D
M AN U
SC
The authors mention that those who have successfully completed the 4-year postgraduate training program in forensic medicine in Saudi Arabia are not forensic pathologists.1 Certainly, in Saudi Arabia, post graduate training in forensic medicine includes both forensic pathology and clinical forensic medicine. Forensic pathology includes both gross and microscopic examination of organs and the examination of the dead body as one entity. A pathologist is not only a specialist in medicine focused on microscopic tissue examination. A specialist in medicine who spends time examining the organs grossly and the dead body as a whole is also a pathologist. Although the training in histopathology for post-graduate forensic medicine students in the aforementioned program is for a short period of 6 months, they are certainly well versed with forensic or medico-legal autopsies, this being one of the major focuses of the training program, and therefore, are as well trained in forensic pathology as specialists in many countries around the world, including European countries. Teamwork is the essence of a better outcome in any project, and therefore it is the practice in Saudi Arabia to consider the involvement of anatomic pathologists in the microscopic examination of tissue preserved at autopsy. Similar is the case with toxicological or chemical analysis of the viscera and body fluids retained at autopsy wherein this task is completed by the chemists. A physician or a surgeon in any specialty has to rely on laboratory medical personnel and so is the case with the forensic medicine specialists. Obviously no claim is made that the successful student of the aforementioned program is a histopathologist. The aforementioned program trains a student to be both a forensic pathologist and a clinical forensic medicine specialist. The authors1 go on to mention that autopsy rates are decreasing in the West, but are increasing in the Arab world. The authors cite references to support the former part of the preceding sentence. However, these references2-6 are wrongly cited as these references actually refer to a decline of clinical / hospital autopsies and not forensic / medico-legal autopsies in the West. The authors1 have incorrectly made a comparison between hospital autopsies in the West and forensic autopsies in the Arab world. The authors1 also mention that the well-established post-graduate teaching program in the Eastern Province of Saudi Arabia needs to be replicated to other provinces of Saudi
ACCEPTED MANUSCRIPT
Arabia. The authors1 have failed to recognize that the post-graduate teaching program is available in all major provinces of Saudi Arabia.7
M AN U
SC
RI PT
The authors1 suggest division of forensic pathology and clinical forensic medicine in the Arab world. In Saudi Arabia, the aforementioned postgraduate program is designed to train doctors to be a forensic medicine specialist who is competent in both forensic pathology and clinical forensic medicine. The suggestion by the authors1 does not take into account practicalities of the Arab world. The authors need to consider the legal system, regional infrastructure and manpower in relation to the practice of forensic medicine, and the objectives of working as a holistic forensic medicine specialist rather than merely as a forensic pathologist. Many countries across the globe accommodate both forensic pathology and clinical forensic medicine under the umbrella of forensic medicine. The curriculum in forensic medicine at the postgraduate level includes both the clinical and pathological aspects of forensic medicine. Nevertheless, my suggestion is that there is more to be gained by increasing the training period in histopathology from 6 months (present postgraduate curriculum in Saudi Arabia) to 18 months as is the case in Australia.8 In my view, I encourage further training in basic anatomical pathology / histopathology in aforementioned program, but not necessarily full 4 or 5 years of training in histopathology, and continuation of clinical forensic medicine alongside forensic pathology under the umbrella of forensic medicine.
AC C
References:
EP
TE D
As conclusion, I suggest more research, studies and assessment, considering all factors such as international standards, social aspects, infrastructure, jurisdiction..etc.,in order to evaluate the practice and post graduate education of forensic medicine (clinical and pathological) in Saudi Arabia then changes and update accordingly.
1. Al-Waheeb S, Al-Khandary N, Aljerian K. Forensic autopsy practice in the Middle
East: Comparisons with the West. J Forensic Leg Med 2015;32:4-9.
2. Shojania KG, Burton EC. The vanishing non-forensic autopsy. N Engl J Med 2008;358:873-5. 3. Nemetz PN, Tanglos E, Sands LP, Fisher WP, Newman WP, Burton EC. Attitudes towards the autopsy: an 8-state survey. MedGenMed 2006;21:80. 4. Davies DJ, Graves DJ, Landgren AJ, Lawrence CH, Lipsett J, MacGregor DP, et al. The decline of the hospital autopsy: a safety and quality issue for healthcare in Australia. Med J Aust 2004;180:281-5.
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
5. Petri CN. Decrease in thefrequencyof autopsies in Denmark after the introduction of a new autopsy act. Qual Assur Health Care 1993;5:315-8. 6. Wood MJ, Guha AK. Declining clinical autopsy rates versus increasing medicolegal autopsy rates in Halifax, Nova Scotia. Arch Pathol Lab Med 2001;125:924-30. 7. Forensic medicine program.SCHS website [internet]. 2015[cited 2015 June 15]. Available from:http://www.scfhs.org.sa/en/MESPS/TrainingProgs/TrainingProgsStatement/Pathol ogists/Pages/default.aspx 8. Royal College of Pathologists of Australasia website.