Summer 2017 by Galenicals

THE BLACK BAG

BRISTOL MEDICAL SCHOOL Summer Term Ed., 2017 1

Editors-in-Chief: V. K. MANDAGERE & M. Y. QUINN Sponsorship Director: P. MODI Contributions: TEAM MB21, O. COLLERTON, B. GOMPELS, J. KONDRATOWICZ, C. PROSSER, Dr. T. THOMPSON, A. YONGA. @BlackBagBristol The Black Bag theblack_bag The Black Bag has been the medical school magazine since 1937. Published thrice every year, we are the voice of both students and alumni. Initially designed by the Faculty of Medicine as a scholastic publication, the Black Bag was taken over by students in the 1970s and replaced with a slightly less-polished perspective on the raucous life of medical students. Today, our articles range from the informative to the satirical, providing a platform for both thought-provoking discussion and comical musings. We look to reflect on the wide variety of Galenicals sub-societies (sports, music, drama) as well as to evaluate (and lampoon) the current state of the Bristol Medical School and the world of medicine. The Black Bag are always looking for contributors. If you are interested in writing for us, please email: blackbag@galenicals.org.uk

THE BLACK BAG EDITORIAL Countdown to MB21

4-5 7-9

Satire: Tequila Sunrise MEDIC TRIBES: The Rugby Club

10-12 13

Politics & Commentary:

Parking spaces and Biscuits Immigration and the NHS in Brexit Britain The Deprivation of Deprivation

15-18 19-21 23-27

Reviews:  Pre-Clinical Revue

28-33

EDITOR’S AFTERWORD

EDITORIAL So, another year of MB ChB under your belt, and only an inconceivable number of years to go. Cue the ‘I’m now officially X fifths of a doctor!’ Facebook statuses that nobody gives a fifth of a shit about (apart from maybe your mum). The results have been delivered, you’ve climbed into the dusty graveyard that is the ‘my grades’ section of blackboard, and you’ve spent several minutes nervously trying to work out what all these random numbers actually mean. Raw, scaled, mean, mode: you’re not sure whether you’ve passed your exams or accidentally been sent a mashup of a GCSE maths textbook and a vegan restaurant menu. With our shiny new freshers ready to start in September, the faculty are sharpening their tools and preparing to experiment on their guinea pigs with the new MB21 curriculum. While you’re trekking up St Michael’s every morning, rucksack bursting at the seams with yellow booklets full of slide printouts for 17 different units, the new first years will be causing havoc in the BRI, cracking open a cold syringe with the boys as fully trained healthcare assistants. Don’t be bitter though, your 170 hours of lectures on crop-t protein were much more useful than practical clinical skills anyway. Shedding some light on the mystery surrounding MB21, Dr. Eugene Lloyd has kindly written an article for this edition of THE BLACK BAG that outlines the new curriculum and the reasons for

the change. If being stuck in the prehistoric MB16 leaves a sour taste in your mouth, just remember that our souls have been sold in return for a Microsoft hub which, naturally, you will use once and never see again. Rumour has it that our treasured hub has been claimed by the anatomy demos, who use it to regularly partake in the world’s largest-screen Netflix and chill. With the general election looming, allow us to wet your democratic whistle with our two political offerings from the wonderful Joanna and Caitlin. With Joanna picketing on the merits of a simple biscuit, and Caitlin setting out the key issues surrounding this election, we hope you find these articles strong and stable informative and enjoyable. If your Papez is still short-circuited from exams and you need a more light-hearted read, look no further than Ashley’s review of the tour de force that was PCR 2017. A triumph from start to finish, STAN OF THE DEAD raised a significant amount of money for charity, and gave Dr. Sarah Allsop a long overdue roasting, a win-win for everyone (including several faculty members trying to hide their grins). While you’re enjoying a cider in the sun during this glorious globalwarming ‘summer’(bound to last 6 days, tops), spare a thought for our contributor Owen, who shares his adventures in tee-totalism. Brace yourself for vomit containing whole chicken nuggets, and metaphorical wheelchairs as Owen’s antics wouldn’t be out of place in an episode of The Inbetweeners. If boredom (or inspiration) strikes over these long summer months, be sure to send us all your ideas for articles, stories or poems to The Black Bag. Our next publication will be the long awaited 80th anniversary, so get writing for the chance to contribute to a piece of Bristol Medical School history and be sure to enter our competition in partnership with the Arts in Medicine Society. Yours, The Editors.

Countdown to MB21 In September 2017 a new, enthusiastic cohort of medical students will be welcomed into our medical school. They will be the pioneers of the MB21 curriculum. We know that Bristol Medical School produces excellent graduates and last year the Chair of the General Medical Council asked us, “If your current (MB16) curriculum is so good, why do you need the MB21 curriculum?” The answer lies in the way that the MB16 curriculum is structured i.e. into a series of units in order to meet the historical requirements of the University. Each of these units can demonstrate educational excellence but there is a lack of integration between the units which has sometimes lead to unnecessary repetition and a heavy burden of summative (must pass) assessment. MB21 has been developed based upon the latest evidence from the medical education literature and in collaboration with students, patients and members of the public. Your student society Galenicals has been a very active voice in this curriculum review. Many of you have been consulted about the changes and some of you have taken part in pilot activities. Where possible, learning opportunities that are being developed for MB21 will be rolled out to benefit MB16 students such as the GP assistantship in year 5 as part of PPP and inter-professional learning events with pharmacy and nursing students. We’ve purchased cutting-edge Microsoft Hubs that will help ensure that the core curriculum will be delivered at all our sites (see how many familiar faces you can spot at https://youtu.be/ V3HhovP1zLw). MCBoM, HBoM and Systems of the Body 1 will not exist in MB21 and there is no “preclinical” and “clinical” divide. It’s all Medicine right from day one! Each year of the course is a unit that will build

sequentially upon the previous year with helical themes recurring throughout. Year 1 MB21 students will start with the “Foundations of Medicine” that will help them to make the transition to learning in the University environment. They will also be trained in basic life support and first aid, complete six shifts as healthcare assistants and learn about clinical reasoning (the core business of being a doctor) and communication skills through effective consulting learning opportunities. The focus of year 1 is upon health and well-being from a biomedical, population and social perspective using a blended approach of Case Based Learning (CBL), practicals and some lectures with the emphasis being upon the application of knowledge to clinical practise as opposed to rote-learning. Another radical change is the introduction of the concept of progress testing. This tried-and-tested methodology was developed in medical schools in the Netherlands over twenty years ago and is gaining popularity across European and UK medical schools. It involves all students on the MB21 curriculum sitting an equivalent assessment covering the entire medical curriculum several times per year. The first time that they sit it will be in September of year 1 (when there is no pass mark, it simply provides a baseline measurement), when they sit it towards the end of year 4 of MB21 it will form part of “finals”. The advantage of this approach is that it allows a mechanism for proving detailed feedback to every student on their personal results in questions from different disciplines to identify areas of strengths and areas for improvements. As students move through the years the sequential progress tests produce something akin to a growth chart. All students that are found to be “failing to thrive” will be provided with extra academic and pastoral support. This approach will help us to ensure that students of Bristol Medical School are given excellent preparation for the General Medical Council’s National Licensing Assessment (NLA) that will be introduced in the 2021/2022 academic year, long after you will have graduated! It also 8

represents a change in philosophy such that it is not the role of the curriculum to prepare the MB21 student for the [progress] test but rather for the test to ensure that the MB21 is achieving the required learning outcomes. As always weâ&#x20AC;&#x2122;ll be relying upon you, as senior medical students, to help us welcome our new entrants in September in order to make them feel welcomed, valued and supported. Remember that the first few months can be exciting and terrifying at the same time. You may not be undertaking the same curriculum but, like many generations before you, you will all go on to be proud MB ChB graduates of the Bristol Medical School.

Dr. E. LLOYD, Prof. J. HENDERSON, Ms. S. ELLIOTT Bristol Medical School, Faculty of Health Sciences TEAM MB21

Tequila Sunrise Confessions of an unwillingly sober student

It was a plain sunny day and the perfect sort for bad news. As days went, it was a conciliatory pat on the head, a “there-there” as I sat in the surgery facing the nurse. “Probably best that you listen to the signals your body is sending you.”, she said. I thought I had. It had been pretty emphatically telling me to see a doctor. My nonchalance was undercut somewhat by the shrillness with which I confirmed my diagnosis, and the panicked look in her eyes told me I was a bit more distressed than was really necessary. For context, over the Christmas break and after a particularly colourful night out, I had thrown up two whole chicken nuggets. My friend said it was like a magic trick, which did leave me wondering what his birthday parties were like as a child. I was inclined to agree with him though, as I don’t really recall eating them. It got worse from there and now to here; tramping out of the Student Health Service and down St. Michael’s Hill, mocked by a golden tequila sun and a sky like a thousand flattened Forster’s cans. No more alcohol. There’s more to life than booze, but that sort of dull pragmatism takes a back seat when you’re sat on King Street contemplating how fast you could run with seven different people’s

pints clasped firmly in hand. For now, I endured the strains of fourteen copies of the same hairy bloke playing some acoustic variation of “Smells Like Teen Spirit” each, of course, in his own key. The pub culture is one that’s died off a little for students nowadays. At least in the more youthful years where it hasn’t so much died off as been dredged from the river Avon with a handful of gaudy club flyers stuffed in its mouth. You still can’t deny the romance of a pub on a summer’s afternoon however, when even the smell of stale beer and other crusted liquids makes you pine for a cold pint that you aren’t totally convinced you ever really enjoyed in the first place. It’s ingrained in us that booze equals fun. Maybe even booze2 if you’re feeling adventurous and/or keen to impress your teammates with a display of willingness in a perfectly innocent and by no means homo-erotically enthused initiation ritual. And no, that’s not bigoted because one of my best friends is a rugby player. As you may have guessed by now I am actually quite bitter about the whole thing, while equally being disappointed in myself for it. How much can I blame the university culture before I accept that alcohol was less of a social crutch for me, and more of a social wheelchair with an accompanying 45 degree incline? Quite a lot as it happens, but at least sobriety has given me some interesting drunk gazing opportunities. For instance, I had never been to a club sober before, and while watching a bunch of sweaty people writhing together in a darkened room was always more my flatmate’s thing, there were some fun moments. Horror of horrors, I even danced a little bit. When I was approached by a 11

girl I’d never met before saying, “Oh my god Michael, are you ok?”, I was so grateful for the sentiment that I didn’t even mind that the name was wrong. I assured her I was fine and just sober, to which she responded, “But your face is totally... you look like a different person!” At this point she paused and her eyes bulged slightly, I think as her train of thought finally caught up and then ran her over. Then she left without another word, but I’m at least accustomed to that. As I floundered, a man slumped on the bar caught my eye. Not for his novelty giant sunglasses (alright perhaps at first for that) but for the slightly queasy smile playing across his jaeger marked lips. The same smile that flashed nicotine stained teeth at me as I left and the same weary smile that greeted me when I got in and happened to glance in the bathroom mirror. We all have our poisons in one vein or another that for some brief period help us to stay grounded, or above it all, or makes it seem as though beneath it all is not so bad. Perhaps alcohol wasn’t the crutch that I thought it was, but there will always be something. You just have to recognise that something for what it is and apparently I compulsively self-narrate. I’ve never been one for life lessons, but if Whole Person Care has taught me anything, and by God it had better have, it’s that exercise, yoga and mindfulness are the only acceptable crutches one can have on this miserable death orb of a planet. So you’d better pick one. 1st

O. COLLERTON Year, M.B. , Ch. B.

MEDIC TRIBES: The Rugby Club Set the scene. Exams are all over, the summer stretches out in front of you and the dark red walls of Lounge surround you. You take a quick glance at your watch. It’s only 11:30pm. Hips Don’t Lie has been already been played three times. You’re wondering whether Shakira herself could shake her hips any more.

Rare photo of the UBHRFC Captain (1995, colourised)

A pungent mixture of korma and vomit wafts towards you. Just when you thought the night couldn’t possibly get any worse, a gaggle of shirt wearing, tie-clad males drift down the stairs and head straight to the bar. They wreak havoc as they go. The alpha male, notably hairier than the rest of the pack, leads from the front-, bearing a striking resemblance to the sensory homunculus you can vaguely recall from your preclinical days.

A crate of VKs appear from nowhere, and the pandemonium continues as they are systematically deleted within 4 seconds. As a green faced fresher runs to the toilet- the pack moves on to the second crate. Those who fall behind are left behind. Looking around what was a fairly empty dance floor is now filled with testosterone. Two larger specimens whose only allergy is salad, appear to be scrummaging rhythmically to Africa by Toto. The two elders of the club, who are only standing thanks to the wall holding them up, discuss how Warren Gatland had a distinctive lack of Welsh players within his Lion’s Test squad. An hour later, the bottle of echo falls that seemed so appealing at the time is taking its toll. The chino brigade are starting to drop like flies. Slowly but surely, the dance floor starts to clear and the sofas fill, piled high with bodies of men with faces only a mother could love. Behind all the bravado and layers of appalling chat- you suddenly notice that at least in this state they’re totally harmless. A TRUE CYNIC

The Black Bag needs an ILLUSTRATOR! Contact us at blackbag@galenicals.org.uk if interested

MAGAZINE

Parking spaces and Biscuits: Incentivising new doctors to stay within the NHS The growing realisation that doctors are leaving the NHS to seek greener pastures is a disquieting one. Increasing numbers of junior doctors do not intend to enter specialist training in the NHS after completion of the FY2 year (dropping to only 50.4%), with 12.7% going abroad and 13.1% taking a break from medicine. So why is the prospect of working in the NHS for the next 40-odd years so unappealing? Why is it that fresh-faced doctors, having barely begun what has traditionally been seen as an exciting career, feel the need to take a break before they have even started. The problem does not only apply to juniors, but also extends to those with more experience under their belts. Consultants are also upping sticks. Many are choosing to retire early, with a spate of hospitals being hit by a wave of disillusion. The Alexandra Hospital, Redditch saw five A&E consultants jump ship together in 2015, citing ‘intolerable stress on staff’ as a key reason. Much of this is due to a shortage of workers to cope with an increasing workload due to an ageing population. Worryingly, looking abroad to plug the gap doesn’t look like a promising move, as more are leaving the UK than arriving. Twenty per cent of doctors employed by the NHS are nonBritish but on the background of Brexit, many are choosing to get out before it gets ugly. It goes without saying that in an already overstretched workforce, their departure will leave a gaping hole. According to another BMA report last June, ‘only one in five doctors are satisfied with their current careers’. Medicine no longer looks quite as appealing as it once did for the brightest students. This year admission rates were down approximately 15% compared to 2014. Admission rates currently mirror demand, with the assumption that most medical students will 15

serve the NHS on qualification, ensuring that graduates are guaranteed a job, and the estimated £200,000 needed to train each student is a sound investment. But once the amount of people staying becomes less certain, this economic balance becomes more difficult to maintain. Let too many people onto medical courses and you run the risk of leaving graduates without jobs, recruit too few and you are severely understaffed; and this doesn’t take into account the amount of time it takes to replace consultants. The way forward is not deterrence. The Health Secretary suggested fining those who do not stay working within the NHS for at least four years. This poses a frightening attack on the freedom of future medical students. If anything, this is more likely to dissuade people from entering the profession. Not only would this reduce morale further, but it avoids tackling the underlying reasons for this wave of NHS dropouts.

“Junior doctors are treated like factory workers, not highly trained professionals.” - Professor Jane Dacre, President of R.C.P. Doctors ought to feel valued and be motivated and supported. Obviously it will be difficult to rectify the fact that the NHS is in severe deficit but all hope might not be lost. There are some areas that can be easily targeted for immediate improvement. For a start, most of the dissolution seems to stem not from squabbles over pay (as Mr Hunt would seem to imply), but from a general dissatisfaction with working environment, in the broadest sense. Unsafe working hours with little recognition is a sore and dangerous point. But this is not new, before the 1993 European Working Time directive junior doctors would regularly work up to and above 100 hours a week. But long 16

hours seem more painful this time, because the medical profession appears to be going backwards. It has been widely suggested that this is part of a government agenda designed to undermine the status of the medical profession who are seen as a troublesome bunch. During her recent lecture at Bristol University, Dame Carol Black (former government advisor on work and health) emphasised that morale and job satisfaction are often most improved by manageable (and less expensive!) environmental changes, which managers often overlook. Medicine is a great privilege but also an emotionally and physically draining job, and without small, but significant perks to keep up camaraderie and offer retreat when the going gets tough, doctors can feel they are being worked into the ground. Many consultants hark back to the days when tight-knit firms supported each other; these have since been replaced due to the introduction of shift work. It is a view shared by many doctors, including Will Marsh, that a decline of respect for doctors leaves an environment in which ‘there is no sense that this is a workplace to value, or one that you feel valued within.’ Gone are the days of subsidised lunches in the hospital canteen, and numbers of doctor’s ‘messes’ or common rooms is slowly dwindling around the country. According to the BMJ, the new contract means ‘there is no longer a statutory requirement in the UK for FY1s to be resident, which in turn means that hospital accommodation no longer needs to be provided without charge,’ meaning that doctors scheduled for overnight

shifts have no choice but to fork out to have a bed (no small sum for a junior doctor on a £26,000 salary fresh out of university). Or take for example difficult parking situations where medics are no longer guaranteed a spot, but actually have to PAY to go to work in the morning, and often park in an inferior place. These things, though little, add to a feeling of being repeatedly slapped in the face and many doctors have had enough. On the bright side, these are examples of the kind of things that can be relatively easily changed. In this writer’s opinion the way forward is not to ‘stuff doctor’s mouths with gold’ as when the NHS was born, or use a stick with which to beat those who seek a better working life, but rather to incentivise; and that might just start with parking spaces and biscuits. J. KONDRATOWICZ 3rd year M.B., Ch. B.

Immigration and the NHS in Brexit Britain Last year’s referendum was arguably won on two major issues. Immigration was often framed in the context of our underfunded and struggling health service, as exemplified by Nigel Farage’s controversial comments on immigrant exploitation of the NHS for antiretroviral HIV drugs in the run up to the 2015 general election. Therefore, a year later it came as no surprise to see the NHS being used as a vehicle to win support for the Leave campaign; quite literally, how could we ever forget the big red Brexit bus? National pride for the NHS was capitalised on by the infamously unfounded claim that £350 million extra could be pumped into the NHS if the UK left the European Union, and that reduced immigration would ease the burden on an overstretched health service. And with a general election coming up on the 8th of June, immigration and the NHS continue to be hot topics. Whilst Theresa May’s Conservatives are set on promoting a “strong and stable” government for the upcoming Brexit negotiations, Corbyn’s Labour party are campaigning primarily on the issue of our ailing NHS. One year on, uncertainty still predominates and it is difficult to anticipate exactly how leaving the EU and changes to immigration policy will impact our NHS.

Key Facts:

2015 resulted in:

57,000 EU nationals work in the NHS

19% cut in nursing training

10,000 of those are doctors

1% pay cap

Academics have highlighted that the UK is one of the countries most heavily reliant on immigration to staff its healthcare system. Considering the figures above , recruitment from the EU has been a crucial buffer, plugging potential nursing gaps in the NHS. But whatâ&#x20AC;&#x2122;s the incentive to work in todayâ&#x20AC;&#x2122;s NHS, where the workload continues to escalate, there is a widely criticised 1% below inflation pay, and staff shortages commonplace. For instance, since 2010 the number of nurses has risen by only 9%, whilst the number of hospital admissions and procedures have increased at four times that rate. Following the abolition of NHS bursaries for nursing training and the resultant accruement of tens of thousands of pounds of student debt, numbers of applications for nursing in the UK has plummeted. If nursing in the NHS continues to become a less appealing profession for British citizens, the value and necessity of recruiting staff from overseas will continue to grow. However, it seems that the recruitment of nurses from EU countries is already haemorrhaging. In the month following the referendum 1304 nurses from other EU nations came to work in the NHS, yet by December 2016 this number had plunged to only 96. Companies that recruit healthcare workers from EU countries are expressing concern that people are being put off working in the NHS by the uncertainty surrounding the looming Brexit. More worryingly, the Liberal Democrats have analysed 136 NHS trusts and seen that since 2014 and 2016, the number of nurses leaving our healthcare system has increased by 68%. Not only are we deterring valuable healthcare staff from joining the NHS, but we are repelling them. The European Commission has made it clear going into discussions that the rights of EU nationals are

paramount, whilst Theresa May has not guaranteed to uphold the right to remain and work for those already here, prompting criticism that she is using people as bargaining chips. Further considerations include the ease of facilitating collaborative research projects into new treatments and health technologies without free movement of people, and what the UKâ&#x20AC;&#x2122;s new role will be in EUwide public health work on major diseases such as cancer or communicable diseases. The consensus of the scientific community is that that the scope and quality of UK research will be at risk after leaving the EU, not only through changes to immigration and legislation, but by reduced, and unfairly redistributed, governmental funding. Additionally, although we currently have the Great Repeal Bill that mimics all current EU legislation, the government will be at liberty to alter the environmental and social laws which have previously acted as a societal safety net. This could potentially have significant implications on public health. Whichever way you went last June, these issues are critical if we strive to work in a sustainable NHS. Article 50 has been triggered; Brexit is happening. As future healthcare professionals, we have a responsibility to improve the healthcare system for the good of ourselves if not for society as a whole. We must all make sure our views and concerns are heard by those who have an obligation to represent us. C. PROSSER 2nd year M.B., Ch. B.

THE BLACK BAG

and ARTS IN MEDICINE SOCIETY

presents

“80TH ANNIVERSARY COMPETITION” Would YOU like to design the front cover of THE BLACK BAG? In Autumn 2017, The Black Bag will release its 80th anniversary issue, and we want someone in the medical school to create a cover that reflects the history of Bristol Medical School and the magazine.

Email your design to blackbag@galenicals.org.uk by 15th October

The deprivation of deprivation Why language matters in talking about communities. In the eyes of God all people are equal but in the eyes of society some are definitely more equal than others. I speak with a little authority. If you’ve ever driven on the flyer-over towards the Avonmeads cinema and retail complex (the wistfully named, “St Philips Causeway”), you may have noticed a clutch of tower blocks to the left. This is Barton Hill where I work as a GP. Barton Hill has (or had) the distinction of being the 17th poorest electoral ward in the United Kingdom - a distinction that has served the area rather well. In the noughties it was in receipt of £50million of European funding which paid for, amongst other things, the Wellspring Healthy Living Centre (where we work complete with art room, therapies suite, training kitchen, dentist, crèche and pharmacy). The area still has above the national average rate of unemployment, teenage pregnancy and people addicted to narcotics. Crime rates are

twice those of Cotham (but a third those of Easton). The majority of the residents live in tower blocks. As a result it would be considered an area of high social deprivation. Social deprivation lacks a unitary definition – it synthesises measures of health, (un)employment, housing, crime, educational attainment and, of course, income. Such measures highlight inequalities and, as in the case of Barton Hill, can bring muchneeded infrastructural investment. What really ticks me off however is the actual word deprivation. I believe the use of this word is in itself a form of deprivation and should be discouraged if not banned altogether. I do not believe it is right for educated middle class people (such as doctors, politicians and epidemiologists) to use an essentially negative term to describe communities. Here for instance are synonyms for deprivation listed in a common thesaurus: poverty, impoverishment, penury, privation, hardship, destitution, need, neediness, want, distress, financial distress, indigence, pauperdom, beggary, ruin. Not very nice associations I think you’ll agree. Too close too in my book to the word “depravation”, meaning “corrupt and morally debased”. The problem sits with the mother verb “to deprive”. Deprivation requires both a subject, the person or persons doing the depriving, and an object, the victims of the piece. I strongly believe that it is a social good to try and tackle health inequalities. For instance life expectancy in Avonmouth is nine years less than it is in Clifton (according to the Bristol CCG website). But when discussing health inequalities with

social scientists I can’t help picking up the vibe that somebody (probably me) should be feeling guilty about the current predicament. Guilt can be a good thing, our moral compass tapping us on the shoulder, though I’m not sure that it’s the best prompt for social change. I am sure that is not a good plan to use language that encourages people into a victim or entitlement culture. The word deprivation implies that one group of people is being deprived of its basic human needs - decent housing, freedom from the fear of crime, a living wage - by another group of people. The temptation then is for the deprived community to feel hard done by, downtrodden, and victimised by the rich. Epidemiology has found some truth in Julian Tudor-Hart’s famous Inverse Care Law (Lancet 1971) - which states that NHS care is delivered in inverse proportion to actual need. However it seems to me at Wellspring that a huge amount of resources are directed at this community (excellent GPs for instance). At the Wellspring Healthy Living Centre, here in Barton Hill, we use an “assets based” model which focuses more on empowerment (acknowledging and building on present resources) than deprivation (focusing on what is lacking). Because there is no doubt that this community, despite its troubles, has many wonderful assets. One of the defences of the term “deprivation” is that it is not applied to individuals but rather to communities, and so shouldn’t upset anyone. But I thought I’d asked some of my patients if they felt they were living in deprivation. I’ll have to be honest and say that the great majority had no idea what I was talking about. But if people did understand I’m not sure that they’d be altogether happy. It feels to me like a term that casts a really negative shadow over the place where people live and work. It

also gives those of us who live in richer neighbourhoods a sense of superiority or at least of relief that we don’t have to suffer these deprivations. It is calling people something not of their choosing – rather like how people living with cerebral palsy were burdened (until quite recently) with the pejorative term “spastic”. I’d like to question whether the commonly used indices of deprivation are capturing everything of value. Barton Hill is exceptional in having a huge migrant community. 80% of the kids at Barton Hill primary school are from BME backgrounds. Yes these families are typically quite low income, and there are definitely cultural fault lines running through the community. But these groups have qualities you might struggle to find in Clifton – I think for instance of the strong family units of the Somali community. It’s very unusual for a Somali elder to be in a nursing home. Almost invariably old people are cared for by the wider family in the home. True this tends puts a disproportionate burden on female carers, but overall I find it inspiring. Also, if like me, you think that it would be quite a good idea to cut our carbon emissions then so-called deprived communities, like Barton Hill, are ahead of the game. They live in the inner city, close to their jobs, to which they walk or use public transport. So in summary, this article argues that the term deprivation is itself a social harm. It’s a label that is used to describe communities in a way that is stereotyping, derogatory, involuntary and disrespectful of the diversity and many assets that such communities exhibit. Those who use the term do so in a well-meaning way. The term is a useful catchall for very real social ills and inequalities. It can be used to attract funding to such neighbourhoods. But I would love to see some new language brought into the mix. If we need to doom and gloom how about “hard pressed” or “socially challenged”? Straying into something more radical, how about “emerging” communities? Every day in clinic I meet patients who probably fit the stereotypical definition. I’m thinking of one lass who conquered her heroin addiction to become a hardened alcoholic. Her two children are in the (formal)

care of their grandmother, she hasnâ&#x20AC;&#x2122;t worked in her adult life and attends (or fails to attend) multiple hospital outpatient clinics. However the majority of my patients do not fit the stereotype at all. So letâ&#x20AC;&#x2122;s wake up and start referring to these communities with the sort of language they really deserve. End deprivation now!

Dr. T. THOMPSON Reader in Healthcare Education Head of Teaching for Primary Care Bristol Medical School

The Pre-Clinical Revue: STAN OF THE DEAD This year’s PCR began as all shows really should: a tale of epidemiology. Overall, the puns were never-ending and nothing was off limits. I’m sure the lecturers felt a bit of the sting that came with being so accurately portrayed (my opinion: please don’t get me in trouble). The true digs, however, were at the expense of the students. They got to do what the rest of us wish we could do on a daily basis: savagely slate our friends for their dumb choices under the umbrella of “it's just a play”. It gives us all a great idea about how to approach our friends in future. That's the sign of a good comedy: makes you laugh and makes you think. Disclaimer #1: no friendships were ruined in the making of this production. Some MVPs Mind-blowing acting, palpable on-stage chemistry and non-stop comedy: this play was truly fun to watch. Some beautiful performance included that of Harold Bright as Dr. David Morgan so fluently, so heartbreakingly that when he loses his best friend at the beginning of the play, you feel for him. Abbie Festa managed to encapsulate all there is to Dr. Sarah Allsop with one gesture, one look. It was more than just the delivery of her lines, she was transformed from body language to facial expressions.

Everyone loves a good bromance. The Mos or â&#x20AC;&#x2DC;Mo squaredâ&#x20AC;&#x2122; were tremendous, funny throughout. The comedic timing and line delivery from Rayyan Ahmed and Gihan Jirasinghe were golden moments and their presence on stage was eternally welcome. Now the final MVP went above and beyond, took his character to new soaring, hilarious, highpitched heights. This was Jake McDonald as Dr. Jan Frayne. At the end of the day a mid-riff bearing top and a wig can only take you so far, and Jake brought so much more to this role. His acting was phenomenal, everything from the fake lecture scene, the rhythm of her speech, the interaction with the other actors was unbelievably portrayed. He played her so effortlessly you almost forget about the actor underneath. The costumes also deserve some special recognition because they couldn't have been more accurate; I couldn't help but notice that the Trevor on stage and the one sitting right in front of me in the audience were wearing the same shirt. Now that, is true method that even Jared Leto would applaud.

La La Laughter Music lifts a show. From the Mo squared duet to seriously killer – pun intended – high notes, the jokes were really enhanced to a new level. The lyrics on the screens made it feel like the greatest karaoke session. The truth is, I think Stormzy would be proud. I’m probably not alone in asking for the play’s soundtrack because it put La La Land to shame. I spoke to the demos who had nothing but great things to say. Mike felt that they got the demos ‘down to a tee’ and Lucy was ‘really impressed with how it was written’ and that it was ‘ACTUALLY a funny joke.’ But I think Stuart perfectly encapsulated how all felt at the show: “I’m having the best time, it’s really funny, really really funny. The best night of my life.” High praise, if ever I heard some. Disclaimer #2: all these words are really from the demos and Stuart may or may not have been drunk when interviewed. Trevor Thompson, though, was a bit upset because he felt that the portrayal of Joe was not exactly fair, “I think you’re being a little bit nice

to Joe, he’s not really as organised as he seems.” This fact the most definitely broke the hearts of Joe fans everywhere. All jokes aside, this play was awesome. The writing was superb, the acting was flawless and the props, costumes, tech and lights were all the cherry on top of a wonderfully served sundae. I couldn’t have been prouder of my classmates for the work they had managed to achieve and for such a great cause. Disclaimer #3: this cringey stuff I was totally forced to write. To top the evening off, before the play I got to interview the people behind it all Ashley Yonga (AY): What inspired the plot for the play? Rob (R): Laziness (they laugh) James (J): We spit-balled lots of ideas and obviously usually you do it around like something we tried to throw a few ideas out there, we had some shocking names AY: Like what? J: Inoculated Bastards -R: We’ve kind of purged all memories of the bad stuff J: We’ve really cut that out R: Well we hope so (they laugh again – loads of laughing) AY: Well you’ll see in the revue won’t you? J: We actually really wanted to do a zombierelated one, and we both 31

like Shaun of the Dead R: We’re massive nerds J: I would say I’m Simon Pegg, you’re probably Nick Frost R: I would say very much J: And Toby’s Edgar Wright … that’s a thumbs up from Toby. Let it be shown on the record (I keep my promises) AY: I already asked what the most ridiculous idea was and you said you didn’t remember? R: It would have come from me won’t it? J: At one point, Rob wanted to do Avatar, it was kind of ridiculous, R: If you blue up, you can’t go wrong J: We decided no to do Avatar, far too long in makeup and the staging would have been shocking AY: Budgets! What would your three-word slogan for a billboard or bus be? R: Dynamic J: Wonderfully dynamic adequacy AY: Beautiful! (I really do see a Daredevil type PR in their future) R: I would say also throw in there – J: Funny! R: Yeah! We’ll see how it goes (true writing chemistry -- they finish each other’s sentences) AY: If you could take on of the

lecturers with you on a deserted island who would you take and why? R: Wait to an island, who would we take? AY: Yeah R: Are there two islands? I don’t think we’d take each other … after this (Maybe the disclaimer about no friendships being ruined was premature) J: The person that I wanna chill out with the most is probably Paul Martin. He’s not even in the play, per se he gets a shoutout but he’s seems like just a sound guy. I heard Prof. Cahill got wankered at the Med Ball so he could be a great laugh with a deserted island and a bottle of Rum. (We get interrupted … again … by Jake McDonald) R: Wouldn’t want Jake on the island, interrupting our interviews! (I’m sure this was a joke but that drama queen side was showing) AY (to Rob): Who would you take and why? R: As much as I love Trevor and my character, I don’t feel like he’d add a lot – I mean he might do! – but I don’t think. David Morgan because I think he’d get stuff done, I just wouldn’t. Cast members… I don’t know tough one. I feel like Jake, whilst he interrupts interviews for a living he’s very very talented in a number of things. I’d take him, good guy. AY: Who would you not take and why? Both of them: Each other (finishing each other’s sentences again…) Don’t worry gents, your play was plenty funny and you raised £1250! So what if you can’t take each other on a deserted island… A.YONGA 2nd year, M. B., Ch. B.

EDITORS’ AFTERWORD Thank you for reading THE BLACK BAG. It took us blood, sweat and tears, so even if you didn’t enjoy it, keep it to yourself. Medical Students were once described by Charles Dickens as “a parcel of lazy, idle fellars, that are always smoking and drinking and lounging…”. We hope this issue has you fully convinced that he was right. If we haven’t just put you off, why not send us an article? We want the whole of the Bristol Medical School community writing for us- students, staff and alumni! All ideas are welcome. Email us at blackbag@galenicals.org.uk The Autumn Term Edition of the next academic year is a particularly special one for THE BLACK BAG: the 80th Anniversary. We are teaming up with the Arts In Medicine Society to hold a competition to see Who can best design the 80th Anniversary front cover? Keep up to date with both Facebook and Twitter pages for more details! — YEAR REPS: Year 1: N. REES Year 2: J. HUTCHINGS Year 3: C. ALBRINES PROOFREADERS: M. E. C. McGLADDERY, C. TANG, R. NASSERI

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