Forensic Medicine — Forensic and Legal Medicine, NMC MBBS licence examination syllabus (Nepal Medical Council).
Most doctors meet the legal system through paperwork they completed without thinking about it.
You examine a man brought in after a fight. You treat his injuries, write a brief note, and he goes home. Eighteen months later a lawyer's letter arrives: there is a prosecution, and your notes are evidence.
You remember nothing about the evening. Everything now rests on what you wrote — how carefully you described the wounds, whether you measured them, whether you recorded what he told you, and whether you were careful to describe rather than to speculate.
This chapter is about the routine tasks that turn out later to have legal weight: the record, the injury description, the death certificate, and what happens when care is alleged to have fallen short. None of it is exotic. All of it is done badly under time pressure by doctors who never expected to be asked about it again.A clinical record serves the patient's care first. But it has a second function that only becomes visible in retrospect: it is the only durable account of what happened, and in any dispute it will be read closely by people looking for what is missing.
Two principles carry most of the weight.
Record the relevant negatives. If you considered a serious diagnosis and excluded it, write down that you looked. A note saying "no neck stiffness, no photophobia, no rash" proves you thought about meningitis. Silence proves nothing — and the working assumption in any review is that what was not recorded was not done.
Never alter a record after the event. If something needs correcting or adding, write a fresh entry, dated and timed, saying what you are adding and when. An altered note is catastrophic: it converts a defensible clinical decision into an apparent attempt to conceal, and it destroys your credibility on everything else you wrote.
This is the single most useful discipline in the chapter, and the one most often got wrong by well-meaning doctors trying to be helpful.
Write what you observed: the site (measured from a fixed anatomical landmark), size, shape, colour, the character of the edges, and the depth if it can be seen. Record it on a body diagram. Photograph it where local policy and consent allow.
Do not write conclusions about how it was caused. Phrases such as "entry wound", "defence injury", or "injuries consistent with assault" are interpretations, and they carry three problems:
The death certificate is a legal document and the source of national mortality statistics. Completing it carelessly corrupts both.
Part I records the causal sequence. Write the immediate cause on the first line, then work backwards through the chain, with the underlying cause — the condition that started the sequence — on the last line used. The underlying cause is the one counted in statistics, which is why its position matters.
So for someone who died of pneumonia after a stroke that left them bed-bound, the sequence runs from pneumonia back to the stroke, and it is the stroke that is counted.
Part II is for conditions that contributed but were not part of that chain — for example diabetes that impaired healing without being a link in the causal sequence.
Certification is for deaths from natural causes where you know the cause. Anything else is referred to the appropriate legal authority.
Refer when the death is or may be unnatural — injury, poisoning, burns, drowning, suspected suicide or homicide — and note that this applies even if the causative event was long ago. Someone who dies of complications of a fracture sustained in an assault months earlier has died an unnatural death.
Also refer deaths in custody, deaths during or shortly after a procedure, maternal deaths, deaths that are simply unexplained, and any death where you cannot state a cause.
The pressure in practice runs the other way. The family is grieving and wants to proceed with the funeral; referral means delay and possibly a post-mortem examination. It is tempting to write something plausible. Do not: certifying a guessed cause can conceal a crime, and it is a serious professional offence in most jurisdictions.The exact list of referrable deaths, the authority to notify and the procedure are set by national law. They are not reproduced here because they differ between countries and are revised — learn the rules that apply where you practise, and keep them to hand rather than trusting memory.
Requests arrive in a hurry and usually when you are busy. Three points cover most situations.
Confidentiality still applies, but is not absolute. Patient information is disclosed with consent, or where the law requires it, or where there is a sufficiently serious risk to others. A police officer asking is not by itself a legal requirement to disclose. When unsure, disclose the minimum necessary, record what you disclosed and why, and take advice.
Examination requires consent. A person brought by the police is still a patient with the right to refuse. Explain what the examination involves and what will happen to the findings — particularly that a report may go to a third party — before you begin. A person who does not understand where the information is going has not truly consented.
Preserve evidence where it is possible to do so without compromising care. Treating the patient always comes first. But where it costs nothing — retaining clothing, avoiding unnecessary washing of a wound, keeping a sample — do it, and record who took custody of anything you hand over.
Doctors worry about negligence in a vague, anxious way that is not very useful. Knowing the structure helps, because it shows where cases genuinely succeed and fail.
Four elements must all be established:
What actually reduces claims is not defensive medicine. It is good records, honest and early explanation when something goes wrong, and a genuine apology. Patients and families frequently say they went to law because nobody would tell them what happened — the complaint began as a request for an explanation and hardened when it was refused.
The professional duty of candour — being open with a patient when something has gone wrong — is covered in the ethics chapter, and it is worth noting that it aligns with self-interest rather than conflicting with it.
No statutes, section numbers, prescribed time limits or form numbers appear in this chapter, and no wound-age or post-mortem interval estimates. Legal requirements are jurisdiction-specific and revised; timing estimates from appearance are unreliable. Learn the rules that apply where you practise.
Create a free account to tick topics off, take notes as you read, watch the video lessons and get a day-by-day study plan built around your exam date.
Loading…