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We read with interest the considered views of Professor Vanezis and Dr Leadbeatter regarding the role of forensic pathologists dealing with the next of kin of those people whose deaths are subject to medicolegal investigation.1 It might be of interest to your readers to know that the issues raised by the authors have been dealt with at the department of forensic medicine, at Westmead in Sydney for the past decade.
The department offers a specialist grief counselling service, targeting the needs of families attempting to come to terms with the complications of a coronial investigation at a time of crisis and great distress. The counsellors routinely contact the next of kin in all cases, discussing with them forensic and coronial procedures and outlining the counselling service, which includes individual sessions, group debriefing, and court support. The service operates with the full support of the New South Wales State Coroner, but is funded solely by the department of forensic medicine.
Professor Vanezis and Dr Leadbeatter propose the provision of “next of kin clinics”, conducted by the pathologist, to discuss postmortem findings. Such a service is regularly provided at Westmead as part of the counselling unit's brief. Although thoroughly endorsing the authors' remarks on the need for accurate and timely information, we have found that several alterations need to be made to the model broadly outlined by the authors for the families to gain maximum benefit from the information sessions.
Ongoing contact between the family and the counsellor from the time of necropsy to the receipt of its results, to ensure that the family is confident that forensic staff will be both frank and reliable in the delivery of information and support.
A preliminary session between the family and the counsellor, to ensure that all the family's concerns are identified, thereby ensuring that the meeting with the pathologist is as comprehensive as possible.
The presence of the counsellor at the meeting as mediator and support person for the family. Such a mediation role involves ensuring that all the family's issues are adequately considered, that the tendency some pathologists have to use jargon is kept under control, and that clarification is sought where necessary.
We have found that these alterations are necessary to ensure that the emotional needs of the family and the occasionally unavoidable power imbalance between grieving relatives and a medical specialist are properly dealt with. This latter concern can most clearly be seen in the reluctance of non-medically trained relatives to seek clarification and to admit to doubts and concerns while speaking with a representative of “the system”, however well intentioned.
We have been pleased with the success of the service over many years, and self reported feedback from clients suggests both a sense of confidence in the forensic system and in coronial findings as a result. We are delighted that our colleagues in the Northern Hemisphere are finally becoming aware of the value of such a system.
The authors reply
Drs Drayton et al are to be congratulated on setting up what appears to be a splendid service for relatives, and we note with interest their comments, particularly on how we could modify our work practice in the UK.
We have always been conscious of the fact that when running such clinics we have had to tread very carefully, bearing in mind the sensitivities of relatives, as well as our medicolegal obligations to the investigating authorities. The system we have adopted is designed to provide information to the next of kin regarding the necropsy performed on their loved one, and to answer any concerns they might have regarding our findings. It is not designed to be a specialist grief counselling service. We have intentionally not attempted to take this approach because as pathologists we are not grief counsellors. Nevertheless, it would be extremely useful for all doctors to have some formal training in dealing with the bereaved. As you can appreciate, we have given some thought to the structure we have adopted, and what our role would be in such clinics in relation to our own situation in the west of Scotland, and obviously we would like to see the service that we provide extended to other areas in the UK. As we have stated in our paper, the service we offer at the present time, albeit limited when compared with the one offered in Australia, is nevertheless very welcome and we believe of some benefit to the next of kin.