Finding a true vocation thanks to medicolegal reporting

Becoming a medicolegal expert is both challenging and rewarding as those who weave it into their chosen profession discover.

Take Dr John Frazer, for example. He came across medicolegal work in his early days in general practice and it went on to help shape a highly successful career as a consultant general adult psychiatrist with a special interest in forensic psychiatry.

“My introduction to my career was interesting. It was 1984 and I was a GP trainee undergoing vocational training (VTS scheme). In my first psychiatric job which was part of the VTS, I was asked to prepare a medicolegal report in a gambling case of a patient I was treating in outpatients,” he recalls.

“I was aware I had a natural leaning towards forensic psychiatry and was told by the head of the VTS that my supervising consultant thought I had a talent for psychiatry. Therefore, I decided to carry on working in psychiatry as a parttime clinical assistant alongside my then career as a full time GP partner in a local practice.

“I was subsequently headhunted by one of the local forensic psychiatrists who later became my mentor. I remember him encouraging me and supervising me preparing more medicolegal reports. I have always been fascinated by people's life stories and started doing these mainly criminal reports. They were very interesting and enabled me to direct those who needed further psychiatric treatment to the relevant services.”

Eventually, the forensic psychiatry started to take time away from his day job and he had to decide whether to continue as a GP or become a full-time consultant psychiatrist.

“An advantage of medicolegal work is it's much better paid than general practice and it didn't make any sense to give up a very well-paid interesting job. I spoke to my mentor, and he said, ‘John, you are a psychiatrist, you just don't know it. You'll pass your exams first time.’ And I did.”

Dr Frazer then had an interview to join the Leeds Psychiatric training scheme.

“At the meeting, I was asked how I would cope with a loss of status? And I said, ‘well, status to me is an artificial concept because we all go to the toilet, and we all die.’ And they said, ‘when do you want to start?’ Which was wonderful.”

As Dr Frazer retrained, he continued with his medicolegal work alongside his work as a junior doctor and in 2003 was appointed as a consultant in low secure forensic psychiatry in Leeds.

“I realised that it made sense for my NHS job as a forensic psychiatrist to align with my role in providing forensic psychiatric reports to the court. This was at that time referred to as “Category 2 work”; most forensic psychiatrists then had a role in assessing offenders with possible psychiatric disorders to the criminal courts.”

Between 2003 and 2015 he continued as a full-time consultant psychiatrist with special responsibility for forensic psychiatry to the Leeds and York Partnerships NHS Foundation Trust looking after and reporting on potentially dangerous offenders. The work also included him assessing patients in conditions of low secure, medium and high security. This involved preparing reports, going to court and giving verbal evidence.

“Criminal reports are very interesting - that's the upside. The downside is that you are dealing with some potentially very disturbing situations,” he says.

Dr Frazer quickly learned how to manage hostile situations after some close calls early in his career and he managed to escape being seriously assaulted throughout his career.

“I used to have eyes in the back of my head. One of the things that you realise is, if somebody is saying something negative towards you, they're saying, ‘I might physically attack you.’ You end the interview swiftly, but kindly. And you treat everyone with great respect and listen to them. Generally speaking, you will not have a problem if you do that.

“In my opinion, the safest job (in terms of physical risks to yourself) is in forensic settings – it is far safer than general practice or general adult psychiatry which tends to be blind to physical risk to others or underestimates it. There's a lot of substance misuse in the community which is reflected in unpredictable behaviours in those suffering from alcohol and or drug misuse.

“When you are dealing with people who are dangerous to others, you have a full complement of staff. These risks are therefore much better managed in forensic psychiatry, and you feel much safer because you know that there are lots of people around. If there's any history of destabilised or violent behaviour in a community setting, the police also go in first to make sure that whatever situation is arising is under control.” 

Dr Frazer has now stopped taking new instructions although he continues to manage his existing active cases. He remains a consultant on call to the Cygnet Group of Hospitals in Bradford and is also an E-mentor for students at Leeds University

Significantly, he has worked with TLA since 2012 and is keen to highlight the benefits of the relationship.

“The team at TLA act in a very open way and there is never a conflict of interest between one side or the other. They are very honourable people to work with and I have found our relationship has been rewarding both personally and financially.”