David Payne asks: Should forensic medicine be female-led?

David Payne Since 2000 the Havens centres in London have helped more than 11 000 people of both sexes who have been raped or sexually assaulted. Like many sexual assault referral centres (SARCs), the Havens doesn’t employ male doctors. All of its examiners are female, so if you want a male doctor at a follow up appoinment, you can attend a fortnightly clinic in Whitechapel.

Are the NHS-run centres right not to employ male doctors? No, according to forensic physician Michael Wilks, deputy chair of the BMA’s forensic medicine committee. And he cites demographics to make his point.

The association is concerned at the low number of alleged rapes that go to court, and the reliance on good forensic evidence to secure a conviction. Convictions rose from 55% in 2006/07 to 58% in 2007/08, but they remained at the same level last year. It’s estimated that only 11% of people who have been raped tell the police about it.

Dr Wilks told BBC radio’s Woman’s Hour last week that forensic medicine has struggled to get a voice and what’s needed is well trained specialists who have been in post long enough to gain experience, to analyse injuries appropriately, to interpret wounds, know what samples to take. 

He said he’d probably regret saying so, but in in his view the current gender inbalance in forensic medicine exacerbates the problem, presumably because women take maternity leave and are more likely to work part time or take a career break after starting a family.

That, and a tendency among police forces to contract out services to private providers.

He told presenter Jenni Murray: “The fact that you’ve done so many cases that when you go to court you can be trusted as being authoritiative. We don’t have any of that now and the main reason is because police forces have been contracting services out to private providers, who are not getting to grips with the need for really good training and the second factor in that is that they are using doctors who don’t stay around long enough to get that expertise.”

The BMA agrees with the recent findings of Baroness Vivien Stern’s report into how rape complaints are handled in England and Wales. It calls for forensic services to be more NHS-led, to guarantee better governance and standards of care.

Dave Whatton, chief constable of Cheshire, told the programme that many SARCs don’t offer a “gender choice” to alleged victims. “If you’re a woman, and you’be been raped, and you’re going to go through quite an intimate examination, then there is quite rightly a request from many people to have a woman doctor doing that examination.”

But Dr Wilks is concerned that making forensic medicine a gender issue could ultimately contribute to depriving the specialty of experienced practitioners. “The Havens have made it a particular policy not to employ male doctors. I don’t agree actually. It’s not been my experience over many years of examining victims of rape, that there is such a big gender issue as is being suggested.

“I think the important thing is empathy, professionalism and dealing with a woman at an extremely vulnerable state of an investgiation and I have never actually experienced a resistance as a male doing an examination and I wonder what male victims of rape (8% of the total) feel about not having the choice of a man.

“There’s a demographic here. It’s more likely that a male doctor will be in long term employment as a forensic medical examiner and will gain that experience and I think it’s a shame that some of the Havens and the SARCs are making this a gender issue.”

The irony that it was two men having this debate in the radio studio was not lost on Ms Murray.

If I were a male rape victim, would I feel more comfortable if I were examined by a male doctor, even if the perpetrator of the alleged offence was another man? I’m not sure. Is it different for women?

The radio debate reminded of Brian McKinstry’s contribution to a 2008 BMJ head to head article. He argued that the “feminisation” of medicine will lead to disproportionate concentration in a small cluster of family friendly specities (primary care and psychiatry), and that medicine should reflect the gender balance in society.

In 2002-3, all UK medical schools had more female students than male, with the percentage of women exceeding 65% in some.

One respondant to Dr McKinstry’s call for a more balanced approach to recruitment was “Orwellian double speak for ‘don’t hire women.'”  

Another said it was time to move past talk of demographic “time bombs” and focus on developing workforce measures that look at healthcare outcomes for patients.

Wasn’t Dr Wilks saying a similar thing?

David Payne is editor, bmj.com and doc2doc.