April 2014 by The Medical Student

theMEDICALSTUDENT

April 2014

The voice of London's Medical Students/www.themedicalstudent.co.uk

FGM

Being prepared as doctors > page 8

A face to the name

Who was James Paget? >> page 22

The Academic Programme Up your street? >> page 10

Sport

JPR cup, varsity & more > page 24

Department of Health extend tuition fee arrangement for another year Chris Smith The Department of Health has agreed to extend current tuition fee arrangements to cover 2015/2016 entry. This deal included maintenance loans and grants, securing access to medicine for an additional year. These arrangements have been extended from 2011 (when tuition fees rose to £9,000) and while the extension is welcomed, long term planning is desperately needed to ensure that medicine remains accessible to all students, not just wealthy ones. The BMA medical student committee is specifically pushing for greater support of graduates, who are more dependent on financial support. The push for support from the BMA could not come at a better time. The NuS Pound in Your Pockets’ survey found that only six out of ten NHS-funded students were in receipt of a student loan. This resulted in medical students being more likely to turn to their parent university or family and friends for financial support. NuS subsequently found that more than two thirds of students were worried about debt. kate McFarlane, Student Finance and Bursary Manager at QMuL, says the worst is yet to come, predicting that “students on the £9k fees” will struggle to support themselves “when they are mid-way through their course”. The interim agreement, extended to 2015/2016, will allow undergraduates in England to continue to access a tuition fee loan for the full cost of years 1-4, with the NHS Bursary covering the fifth year. Graduates starting on graduate entry programmes will continue to self-fund £3,465 in year

1 with a Student Finance England loan covering the remainder £5,535. The NHS Bursary will cover the first £3,465 of year 2-4 tuition fees, with a Student Finance England loan for the remainder. Graduates will continue to remain ineligible for any tuition fee loans until year 5 when they can access the NHS Bursary. Arrangements for 2016/2017 have not yet been confirmed and in light of the recent news that the new £9,000 tuition fees are not profitable for the government, the Department of Health may review this interim policy. In the letter announcing the extended arrangements to the BMA, DH workforce strategy director said “All parties would like to be in a position to implement a solution for the 2016/17 intake but feasibility is dependent on decisions taken on the spending priorities in the next parliament.”

Over 200 final year medical students without a Foundation School job krishna Dayalji The uk Foundation Programme Office (ukFPO) announced earlier this month that 7, 114 applicants had successfully been allocated to a foundation school, with 82% of applicants being allocated to one of their top two foundation school choices – a 4% increase from last year. As anticipated already by foundation schools and applicants alike, there were more applicants than vacancies for the fourth consecutive year. Yet, 97% of applicants have been allocated to a foundation school, to all of whom TMS would like to congratulate.

However, a further 235 applicants have been placed on the reserve list pending allocation over the next few months – almost 1% less than last year. Whether these applicants are allocated a foundation school will be dependent on other students failing final exams or withdrawing from the application process. Professor Derek Gallen, National Director of the ukFPO said he was delighted that we are in a better position than last year with fewer students on the reserve list. Yet, he added: ‘We acknowledge that there is still work to do over the coming months to support those on

the reserve list and ensure they are allocated as soon as possible. ‘The ukFPO and the foundation schools are working hard to make this process go smoothly. As in previous years, we will continue to improve the application process in response to feedback from students and other stakeholders.’ The BMA Medical Students Committee (BMA MSC) co-chair, Andrew Wilson, added: ‘These students face an uncertain future on the reserve list, not knowing where their first jobs as doctors will be during a period of increased pressure with final exams. ‘This is the fourth year of over-

subscription to the foundation programme and we hope the government commits once more to providing additional jobs for this year’s applicants on the reserve list.’ The ukFPO said applicants on the reserve list would be well supported by their medical schools, and kept informed about when the reserve list allocations will take place. An Oversubscription Guide for Applicants created by the ukFPO has also been made available to download from their website (http://www.foundationprogramme.nhs.uk/pages/home/ keydocs).

theMEDICALSTUDENT / April 2014

News Editor: Chris Smith and Krishna Dayalji news@themedicalstudent.co.uk

[Editor's Letter]

fter spending a good hour checking my emails, catching up with the news and checking Facebook I censure myself for my procrastination, angrily close my browser and get a book out. After a strong five minute stint at attempting 500 SBAs for Medical Students, my eyes begin to glaze over and I daydream out of my window and wonder, in my own existential way, what I will end up doing in my career as a doctor. I was rather hoping that my first clinical year would awaken within me an unerring passion for cardiology, or neurology or perhaps nephrology and I would be able to sit down happily and say “Now this is what I want to spend my life doing.” As I reach the end of this year, there has been no such revelation.

[Editorial Team] Editor-in-Chief/Peter Woodward-Court News Editors/Chris Smith & Krishna Dayalji Features Editor/James Wong Comment Editor/Robert Cleaver Culture Editor/John Park Doctor's Mess Editor/Zara Zeb Education Editor/Sarah Freeston Sports Editor/Mitul Patel Images Editor/Upi Sandhu Treasurer/Jen Mae Low Illustrator/ Dominik Chapman (p14)

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This, on occasion, can lead to some anxiety. Seemingly everywhere around me I find colleagues who have found their calling and are already proficient researchers in their chosen topic; they are attending conferences with their posters and writing up projects for the much sought after PubMed ID. When I hear about such occurances, that most unpleasant sensation of being behind everyone else begins to ferment deep within me and I feel I am missing the boat to the career I want, whatever that may end up being. It is all too easy to be tempted to follow someone else’s vision of success. For some reason cardiologists are seen as ‘winners’ and we look askance at GPs. Excited whispers circulate when there’s

[NEWS] a talk being done by a famous neurologist, and there is disinterest when a psychologist speaks. If you haven’t done lab work you’re not ‘competitive’ and don’t even think of applying to London if you’ve done a non-science BSc. Hearing these unfounded rumours, we dedicate a lot of our time to things that, when we take a step back, we do not really enjoy but are doing to simply jump through yet another hoop. “It gets good once you start working” the rumours reply. How much of this groundwork do we have to do befre we get the the promised ‘good stuff’? How much of life must pass us by before we reach the lofty height of consultancy, only to realise that we are now in the middle age and haven’t enjoyed the ride to the top?

Sometimes, paradoxically, it is hard to think clearly about our own vision of what we want out of our lives without being pressured by society’s view of what it means to be a success. We would do well to make sure we are not standing idly by pipetting T-cells in our most auspicious years when we would rather take a step back and sign up for something where we do not count the hours down until we are free to leave. With my final moralistic letter written, my I extend my warm thanks to all of you who have been avid readers of TMS this academic year. I have enjoyed editing the paper immensely, and I hope you will enjoy the new edition, with a new editor, come the new academic year in September.

GMC: Reports on medical schools should be more accessible Chris Smith News Editor Reports from the General Medical Council (GMC) on the quality of medical schools and their training should be made available to medical students, doctors and patients, says an internal report by the GMC. The report reviews its arrangements for quality assuring medical education and training during 2012/2013. Following the merger with the Postgraduate Medical Education and Training Board in 2010, the GMC took responsibility for reviewing medical education and training at undergraduate and postgraduate levels.

Recommendation 15 of 21 concluded that the GMC’s reports ““should give greater attention to the transparency and accessibility of information for patients and the public, students and trainees.” The report draws parallels to Ofsted reports and the mechanisms used to provided parents an informed decision when selecting schools. Yet, it is quick to add that the reports are “lengthy, detailed, technical reports aimed at those responsible for commissioning, managing and delivering training.” They are currently inaccessible to the average medical student and it is unbeknown how to overcome that hurdle.

Although, do medical students really care about quality assurance of medical education? The GMC are happy to admit that they make an “assumption that patients and the public have no interest” in these reports. Regardless, the GMC must retain public trust by regulating itself in a “transparent and accessible” manner. In a post-Mid Staff era, calls for transparency and accessibility are welcomed. Jean-Pierre van Besouw, president of the Royal College of Anaesthetists and the academy’s education lead, commends the report: “this is a timely review that will ensure greater transparency and better quality assurance in postgraduate medical education.”

[NEWS]

theMEDICALSTUDENT / April 2014

News Editor: Chris Smith news@themedicalstudent.co.uk

RuMS President Swathi Rajagopal We’re fast approaching the end of another brilliant term at RuMS and as ever, there are many achievements to be celebrated and many events to look forward to. Our RuMS hockey teams deserve a huge well done for their performance in the London varsity series. Both close games, the boys drew 2-2 but unfortunately lost in penalties and the girls showed GkT what RuMS are made of with a victory! A big thank you to everyone who came along to support them. Lumsden cup saw RuMSBC outperforming the rest on the netball courts, raising a lot of money for a brilliant charity ‘kEEN’. The infamous sports ball is fast approaching on 26th April and is all set to be a great night, with extra entertainment and even more clubs involved this year. Congratulations to all the players receiving colours and awards! If you still haven’t got your ticket buy them now at http://uclu. org/whats-on/sport/rums-sports-ball before prices go up. Our MDs are participating in the annual uH revue on 4th April at SGuL, aiming to prove that we are not only the best, but also the most hilarious students in London. Come along and show your support – tickets are only £5 and available via uCLu. Lastly, graduation ball tickets for 2014 will be on sale very shortly. The event is to be held at the beautiful Tower of London with a three course meal, entertainment and open bar all night – you definitely don’t want to miss out.

Medgroup Chairs Dheeraj Khiatani & Mark Gregory Our words this month come to you live from April Fools day. We’ve enjoyed reading Alex Salmond’s plans for Scotland’s cars to drive on the right, and news of fracking in Buckingham Palace...unfortunately it’s become apparent that news of ICSM winning the Rugby uH cup last month was no joke! The Mary’s boys were in fact convincing winners on the night, beating Barts and the London 28-6 in an impressive display of rugby, in front of a large crowd. The final, now in its 139th year (minus pauses for World Wars) was a great exhibition of medical school sport at it’s best and a timely reminder that our medical school sports teams are worth fighting for, despite the unhelpful interventions of our friends over at BuCS. Away from the sports fields, March has seen the election of next years Student Council’s at the majority of our five medical schools. Many congratulations to all those who have won a position, however small or illustrious. Our time at medical school would be highly tedious and significantly worse without the hard work of so many you put in to events, societies, sports teams and welfare. As for us, as we both approach our mid forties, it’s probably about time we left you to the student life and sought gainful employment within the worlds 3rd largest employer...maybe in a couple of months!

ICSM President Steve Tran Welcome all! Congratulations to Imperial Medicals Rugby Football Club (@IMRFC) for annihilating Bart’s RFC 30-6, which means they secure their 51st united Hospitals Cup win. This makes IMRFC the most successful club in the history of the uH Cup, the oldest rugby cup competition in the world dating back to 1875 (1). This win came a week after our annual Varsity against IC, where the first XV reclaimed the J.P.R. Williams trophy. Other than pummelling Bart’s, our women’s team have also been very successful. In addition to winning their Varsity, our Netball 1s are being promoted to Division 1 of the BuCS championship and our Rowing Women’s Senior 1st VIII beat all other united Hospital crews at the Women’s Head of the River Race. Finally, March was the month of our BIG Election. ICSM students voted in their numbers to secure the School of Medicine as the TOP department with the most number of voters throughout the university. Congratulations to our newly elected Officers and I wish them all the best when they all start their roles at the end of this academic year. For those with time off, enjoy the break! Otherwise have a lovely Easter.

SGuL President Mohammed Amer From a visit from Princess Anne to open our international centre to our a series of themed weeks,March has been a busy month for George’s! We enjoyed our RAG fortnight, including Man-o-man and woman-o-woman which spotlight our manliest and wo-manliest freshers, and finishing with the traditional race around the pubs of Wimbledon! Next came Heritage week, where we got the word out about the Heritage of George’s and why we’re proud to be George’s (Cor-Blimey!). Last week was Ethics week, where we had a series of stands around campus getting people to think about their impact on the environment. Once again we have dived into show season, with a fantastic and hilarious Tooting show modelled on a fairytale theme, followed by the George’s Musical ‘a Tale of Two Cities’ which was both brilliant and emotional! Our final show is the inter-university Music and Dance Show known as Face off! Last year we won the double and this year we are back again to claim our title. We finish the Term with our free end of term disco to see our freshers off into Easter!

theMEDICALSTUDENT / April 2014

News Editors: Chris Smith and Krishna Dayaji news@themedicalstudent.co.uk

[NEWS]

Budget accounts for London’s Second Air Ambulance Krishna Dayalji News Editior Wednesday 19th March 2014 saw Chancellor George Osborne don the infamous Red Box outside 11 Downing Street as he mentally prepared himself to outline his fifth Budget as Chancellor. In the hype and debates surrounding the annual event, you may have missed a rather interesting allocation of monies. Yes, you heard it here, Mr. Osborne has promised £1million to pay for the capital’s second air ambulance! The London Air Ambulance (LAA), run by the Royal London Hospital, currently has one helicopter based in Whitechapel to respond to serious trauma incidents such as some road collisions. However, it is believed that this extra sum will cover the cost of running a second aircraft and extended flying hours for one year. Whilst sharing this news to the House of Commons in his hour-long address, the Chancellor added that air ambulanc-

es would no longer have to pay VAT on fuel; a change that will pay for three missions to reach critically injured patients, says LAA. Chief executive Graham Hodgkin said: “This is fantas-

tic news for the people of London as it is thanks to their support we are able to celebrate this milestone in the charity’s development. “£1million will give us the opportunity to acquire a sec-

Community placements compulsory for foundation doctors Chris Smith News Editior Foundation doctors will have to undertake a community placement, following the recent publication of a Health Education England (HEE) report to broaden the Foundation Programme. A community placement is defined as general practice, psychiatry, community paediatrics, palliative care, public health or any other organised community placement. Community placements will be introduced from August 2015 and compulsory in all Foundation Schools from August 2017. They would last four to six months, with the aim to ensure that all foundation doctors meet the ambitions of the Foundation Programme curriculum. The placements are likely to be carried out during the second year of foundation training. The report said that F2 doctors were “more suited” to working in the community because they did not

require the same level of supervision as F1s. Alternatively, the integrated placements would take place outside the hospital setting and would focus on integrated care models. For example, foundation doctors on an integrated placement could be placed in a community emergency multidisciplinary unit or a medical unit day assessment service, HEE said. While the recommendations are ultimately to improve the skills of foundation doctors, all key medical organisations are aware of the impending shortfall of GPs. There may be a secondary benefit of exposing all foundation doctors to General Practise, in the hopes that more take up the specialty. The report is highly supportive of close, quality supervision especially as a F1. It suggests that F1 placements should be “in settings where there is a critical

mass of healthcare professionals who can provide immediate support and direct supervision”. All foundation doctors should also receive an academic tutor to support them for the whole of F1, F2 or both years. Redistribution of foundation posts is also a recommendation. HEE proposes that specialities traditionally filled by foundation doctors could be reorganised to be replaced by other professionals such as physician associates, staff grade doctors, and nurse practitioners. Chris Walsh, director of education and quality at HEE, says “Implementing the recommendations in this report will be challenging; however, we’ve worked closely with our local education and training boards, royal colleges, trusts, and partners to deliver these recommendations. We all agree that education and training must keep pace with changes in health and social care provision.”

ond helicopter to give London 100 per cent air cover during summer daylight hours and maintenance periods. “In practical terms, we estimate we’ll now be able to reach a further 400 patients each year

by helicopter.” However, LAA is a charity relying heavily on donations, and so running and maintaining an additional helicopter for more than a year may be troublesome. Graham Hodgkin added that efforts to raise extra money will need to be stepped up such that enough funds remain available for the vital service to survive. It has been estimated that £6million a year will be needed to keep the helicopter trauma service running in the capital. Elated with the news, The Mayor of London Boris Johnson tweeted: “Delighted @LDNairamb & their brilliant team to get govt funding towards a second emergency helicopter in the skies above London #lifesaver”. Whether you believe that this was a wise allocation of money or not, TMS would love to hear your views on the topic, and hopefully we can publish them in next month’s paper (anonymised for those who wish so!).

Write for Us! The Medical Student is always looking for keen writers to get involved with the paper. If you have an idea for an article, big or small, don’t hesitate to contact us: editor@themedicalstudent.co.uk

theMEDICALSTUDENT / April 2014

News Editors: Chris Smith and Krishna Dayalji news@themedicalstudent.co.uk

[NEWS]

BMA responds to Shape Research In Brief of Training Review BARTS AND THE LONDON, SCHOOL OF MEDICINE AND DENTISTRY

Krishna Dayalji News Editor Doctors at the recent British Medical Association (BMA) annual consultants conference have unanimously voted against the medical training overhaul suggested by the independent Shape of Training Review, arguing that major changes implemented by the report will be ‘dangerous for patients’. The independent Shape of Training review, led by Nottingham university vice-chancellor David Greenaway, is considering the future of uk postgraduate medical education and training. Published in October 2013, the review describes the need to change uk medical education and training such that doctors are trained to the highest standard complementary to society’s changing needs in healthcare. The report recognised that with the fast changing needs of patients in the uk, there is a greater need for doctors who are capable of providing general care in broad specialities across a range of different settings. Whilst the BMA recognises the need to regularly review the way in which doctors are trained and supports the review’s suggestion that a more broad-based training scheme is needed, the association has very recently raised concerns surrounding some of the fundamental changes the Shape of Training Review suggests. Of particular concern is: 1. Changing of the formal training structure, and 2. Moving the point of General Medical Council (GMC) registration to the end of medical school. The Shape of Training Review suggests that the current Certificate of Completion of Training (CCT) should be replaced with a Certificate of Speciality Training (CST), and doctors could work towards ‘credentials’ – specialty competences currently gained as part of the CCT, which would be available according to local population needs. The review argues that this can be achieved through the development of a broad based training scheme delivered over shorter 4-6 year programmes. However, the key problem

Queen Mary’s Women’s Health Research unit launches East London International Women’s Health (ELLY) appeal. Barts Health NHS Trust are collaborating with clinicians, researchers and volunteers to tackle the global problem where one woman dies every minute from a pregnancy related complication somewhere in the world. By building a network of sustainable partnerships which support and educate women locally and globally, ELLY aims to tackle this problem. ELLY has three main areas of focus: Training and development; Research i.e. reducing the risk of pre-eclampsia through diet; Global Projects i.e. obstetric haemorrhage course in South-east Asia. that the BMA highlights is the fact that the report does not provide an explanation as to how training in all its depth and breadth could be enhanced by shortening or changing certification standards, and at the same time, be expanded to include more generalist training. As such, consultants have warned that doctors of the future will be less well-trained than today’s consultants. And so, the association worries the changes could lead to the creation of a sub-consultant grade by moving highly specialised skills outside the scope of postgraduate medical training. The BMA adds: ‘Instead of training doctors to [certificate of specialty training] level, we believe that patient care in the NHS should be led by highly trained and highly skilled consultants who have obtained a CCT.’ The review has also suggested moving forward the point of GMC registration to the end of medical school, placing the duty on medical schools to demonstrate that graduates are ‘capable of working safely in a clinical role’. Currently, medical students only receive provisional GMC registration on graduation and need to complete their F1 (foundation doctor 1) year successfully in order to qualify fully. It is argued that this particular change will help address the issues surrounding foundation programme oversubscription and the current unsatisfactory governance arrangement or the F1 year. Health Education England (HEE), also recommend this option. However, the BMA has provided a two-point counter argument.

Firstly, the BMA argue that under the current conditions, it would be very difficult to add further F1 clinical training in to an already comprehensive undergraduate curriculum, and so it is ‘not convinced’ that this solution will produce ‘fit-to-practice’ doctors. Consultants maintained that changing the point of registration would make it harder to identify those who were clinically incompetent and would allow uncontrolled prescribing rights before new doctors had demonstrated clinical competence in a controlled environment. And secondly, the association has also highlighted broader workforce implications that this change will have. It would open the oversubscribed foundation programme to more competition from European Economic Area (EEA)-trained doctors, thereby leaving those uk trained doctors who are unable to secure a place in the Foundation Programme to compete on a global medical market. The BMA has further highlighted that in reality, “many will struggle to find employment abroad – many will not have the language skills to compete in the Eu market, and many others will struggle to get visas to work in Anglophone countries outside the Eu.” Staggeringly, each of these doctors lost to the uk workforce will represent a loss of the £269,000 invested in their education. It seems that ‘uncertainty’ is the buzzword used to describe all discussions surrounding medical training at the moment, and a clear realistic assessment of the career that awaits medical trainees is a long way away.

ST GEORGE’S, uNIVERSITY OF LONDON Hospital patients with learning disabilities face longer waits and mismanaged treatment due to a failure to understand them by nursing staff, says a report by senior nursing staff. Dr Irene Tuffrey-Wijne, senior research fellow in nursing at St George’s, university of London and kingston university, said: “People with learning disabilities are largely invisible within the hospitals, which meant that their additional needs are not recognised or understood by staff. The study found basic care like nutrition was being ignored and clinical investigations delayed.

kINGS COLLEGE LONDON High-frequency breathing support for premature babies could lead to better lung function in later life. A new study led by researchers at king’s College London has found that premature babies supported immediately after birth by high-frequency oscillation - a type of breathing support - had better lung function as adolescents than those who received conventional ventilation. The children ventilated with the high frequency method also showed higher academic achievement in three of eight school subjects.

IMPERIAL COLLEGE LONDON In a study funded by Cancer Research uk, scientists at Imperial College London have shown that the non-invasive scan can detect dormant cancer cells in mice. Cancer cells can go dormant, stop growing and begin to store energy. using positron emission tomography (PET) scans, researchers could identify dormant cancer cells with high energy stores. This could warn doctors and patients of a potential relapse.

uNIVERSITY COLLEGE LONDON A high dose of simvastatin, a cholesterol lowering drug, significantly reduces brain shrinkage in people with multiple sclerosis (MS), found researchers from uCL, with colleagues from Imperial College London, the London School of Hygiene and Tropical Medicine, and Brighton and Sussex Medical School. Researchers carried out a phase II study to see the effect of high dosage on brain atrophy in MS. The

[NEWS]

theMEDICALSTUDENT/April2014

News Editors: Chris Smith and Krishna Dayaji news@themedicalstudent.co.uk

Imperial achieves highest number of students onto Academic Foundation Programme James moore & philippa Shallard Guest Writers

Forty-two Imperial students will enter the Academic Foundation Programme (AFP) for 2014/15, the highest number of students from any uk Medical School. The AFP offers the brightest and most academically able newly qualified doctors an opportunity to develop research, teaching, and leadership skills alongside clinical training in their first two years after graduating. Of the 42 students, 22 will be staying in London, six will go to Oxford, one to Cambridge, four to the West Midlands and the others dispersed over the country. Six gained a surgical academic place, six in GP, two in Medical Education, and the rest in different aspects of medicine. AFP trainees usually undertake a four month research placement in their second year, and many are successful in presenting at conferences and getting published. Several doctors who complete the Aca-

demic Foundation Programme go onto secure Academic Clinical Fellowships and follow the academic pathway. . Miss Philippa Shallard, Foundation School and undergraduate Services Manager in the Faculty of Medicine said: “At Imperial, we have always encouraged our medical students to apply for the AFP. A key uSP of Imperial and its students is their academic ability and we believe that the AFP offers an unparalleled opportunity to develop academic skills that would facilitate easier entry into the Integrated Academic Training Pathway.” Application to the AFP is very competitive and applicants are interviewed if shortlisted (unlike applicants to the standard Foundation Programme.) Imperial has taken the view that if a student is keen on an academic path then they need to start thinking early during their medical school career about how to be in a position to provide evidence of their experience in, and commitment to, research, leadership and/or medical education by the time they are applying in their final year.

“Achieving the highest number of students for any medical school in the UK is another outstanding success for the Imperial College medical programme. It is a testament to the exceptional work of our staff and students” Dr Liz Lightsone, Reader in Renal Medicine and Academic Director, NW Thames Foundation School

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theMEDICALSTUDENT/April 2014

Features Editor: James Wong features@themedicalstudent.co.uk

[FEATURES]

Time to talk about FGM Jassimran Bansal Guest Writer

As a medical student, there are no excuses for not knowing about female genital mutilation (FGM). Leyla Hussein’s Channel 4 documentary ‘The Cruel Cut’ brought the issue to our MPs and to our TV screens at the end of last year. The Guardian, alongside 17 year old Fahma Mohamed and Change. org, launched the ‘End FGM’ campaign earlier this year, resulting in almost 250,000 signatures on an e-petition to the government. Almost daily, articles are published in newspapers across the uk warning of the dangers of FGM and encouraging campaigns against it. Despite this media frenzy, many medical students still do not know what FGM is, how to recognise it, and why it is so harmful. Most importantly, many health professionals do not know that they can do something about it.

What is FGM? FGM, also known as female geni- Bristol Safeguarding Children Board. (2011). Factsheet for Professionals - Female Genital Mutilation tal cutting or female circumcision, is defined by the World Health (WHO, uNICEF, uNFPA, 1997). the devastating consequences of birth. Organisation as ‘all procedures There are four types of FGM: Al- this cultural ritual. Women who The WHO estimate that more involving partial or total removal though the term ‘circumcision’ is suffer Type III FGM are often left than 125 million girls worldwide of the external female genitalia or often used when talking about with one tiny hole through which are currently living with FGM. other injury to the female genital FGM, the use of the words ‘cut- they are expected to urinate, men- The practice occurs most comorgans for non-medical reasons’ ting’ and ‘mutilation’ better reflect struate, have intercourse and give monly in parts of Africa and the Middle East, where it is socially and culturally acceptable among tYpeS oF Who ClASSiFiCAtion certain communities. However, it FGm also occurs in the uk and British girls are frequently taken abroad during the school holidays to unPartial or total removal of the clitoris and/or the prepuce dergo FGM. FGM occurs at sometime between birth and the age of TYPE I (clitoridectomy) 15, and is arranged or carried out by a girl’s family. It is an extremely Partial or total removal of the clitoris and the labia minora, with or traumatic experience, often taking place in the home, without anaesTYPE II without excision of the labia majora (excision) thesia, by a medically untrained person. Non-sterile tools such as knives, razor blades, scissors and Narrowing of the vaginal orifice with creation of a covering seal by even sharpened rocks or pieces of TYPE III cutting and appositioning the labia minora and/or the labia majora, glass can be used, predisposing the girls to a high risk of infection. with or without excision of the clitoris (infibulation) But why does this shocking practice take place? Although religion is believed by many to be All other harmful procedures to the female genitalia for non-medi- the main reason, there are actuTYPE IV cal purposes, for example: pricking, piercing, incising, scraping and ally no religious scriptures that promote or condone FGM. FGM cauterization has become a cultural tradition in some communities, where girls

who do not undergo it are seen as impure and unclean. There is pressure to follow in the footsteps of grandmothers, mothers, sisters and friends to be socially accepted within a community. Moreover FGM can be seen as necessary for girls to undergo to be eligible for marriage and/or to be able have children. Many believe that FGM will reduce a woman’s libido and prevent her from having extramarital relations. It is important to understand that many girls themselves want to be cut; they see it as a rite of passage and do not find it morally reprehensible. FGM is illegal in the uk. The prohibition of female circumcision act 1985 states that it is an offence to practice or to aid, abet, counsel or procure someone else to practice FGM. The Female Genital Mutilation Act 2003 stipulated that the penalty for committing this offence would be up to 14 years in prison, except when the cutting takes place during labour to facilitate birth. However, in nearly 30 years, there have been no succesful prosecutions for committing FGM in the uk. Possible reasons for this include the fact that the FGM Act requires a girl to testify against her parents, unlike cases involving child abuse. But is FGM not a form of child abuse? France has no specific FGM laws and has prosecuted over 100 people for FGM in the last 30 years under child abuse laws. Political correctness has also been blamed for a lack of prosecutions in the uk. Leyla Hussein argues, ‘It is definitely racist not to engage with FGM’, and suggests that people are afraid to tackle the issue for fear of attacking another culture’s traditions.

How does FGM present to doctors? As future doctors we must be able not only to visually recognise FGM but to understand the problems that women might suffer from as a consequence of FGM. FGM may be more commonly seen by obstetricians/gynaecologists, but sufferers may present with symptoms anywhere from general

[FEATURES]

theMEDICALSTUDENT/April 2014

Features Editor: James Wong features@themedicalstudent.co.uk

practice to urology or even A&E. Clinical complications of FGM are numerous, and can be split into acute and chronic features. At the time of cutting the risks are severe: haemorrhage, infection and death. Chronic features post-FGM such as problems urinating, recurrent infections and problems with intercourse might be less severe, but strongly affect quality of life. Furthermore, FGM has a huge psychological impact on women. Survivors may present with depression, anxiety or post-traumatic stress disorder as a result of being put through a painful ordeal by close family members. We must be aware of FGM so that we can be prepared to deal with its physical and emotional complications.

What can we do about it? You may be thinking that as a Acute complications • • • • • •

death severe pain infection septicaemia haemorrhage urinary retention

medical student, there is not much that you personally can do about FGM. This is not the case! There are several important things we can all do to help stop FGM.

Record FGM cases

Do your bit to ensure that the presence of FGM is documented in the notes to prevent shocked reactions by future colleagues and to allow them to consider the complications of their patient having FGM.

Identify high-risk individuals

Girls born to mothers with FGM or girls with sisters/mothers who have had FGM may be at high risk of FGM themselves. Report your concerns to a senior member of staff.

Chronic complications

Report FGM cases

When you come across FGM in a patient, let your medical colleagues know (if they don’t already), and ask them if the situation needs to be escalated.

Educate yourself & others about FGM

• • • • • • • • • • • • • •

Apareunia (inability to perform intercourse) Dyspareunia (pain on intercourse) Sexual dysfunction/anorgasmia Chronic pain Dysmenorrhoea Urinary obstruction Recurrent urinary tract/pelvic infections Dermoid cysts Difficulty conceiving Increased risk of childbirth complications Vaginal lacerations during intercourse Difficulty passing urine and faeces Need for later surgery in childbirth psychological distress

Don’t be afraid to talk about FGM to your colleagues and to your patients!

Sign the petition

Hilary Burrage is petitioning Home Secretary Teresa May to ‘Enforce the UK law which forbids FGM.

Do your bit to stop FGM today! http://www.change.org/en-GB/petitions/uk-government-enforcethe-uk-law-which-forbids-fgm-female-genital-so-called-cutting

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[FEATURES] /10

theMEDICALSTUDENT/April 2014

Features Editor: James Wong features@themedicalstudent.co.uk

Election Fever Narmadha Kali Vanan Features Subeditor The election fever has been sweeping across all the London medical schools, as can be seen from the banners of smiling candidates and manifestos stuck around campus. This issue, we decided to interview the newly-elected presidents of the medical student unions of Barts, Imperial and UCL about themselves, their vision and their campaign. Here goes!

Sam Rowles BLSA President 2014/15

Tell us about yourself. My name is Sam and I’m a 4th year medical student at Barts and The London. I have massively enjoyed my 4 years at BLSMD so far, in a large part because of the Students’ Union and everything that it provides on top of just a degree. The clubs, societies, events and overall community are what shape your time at university and I believe my experiences so far gives me the rounded view I believe a future president requires. During my time at BLSMD so far I have competed for 6 sports teams, attended countless societyorganised lectures, sat on 3 committees and taken part in RAG, Music and Drama events. I believe I have seen both good and bad sides of BLSA so far, and have the experience now to contribute my views. Outside of university life, hailing from Weymouth, Dorset; I am

naturally quite into my sailing. I have competed at the sport to a relatively high level, winning a number of competitions over the years and competing for Team GB at both European and World championship events.

How did you feel when you first found out that you had won your union’s presidential election? The moment that 4pm passed, I felt somewhat of a wave of relief wash over me. I was content in the knowledge that I had done all I could, and the results were now in the hands of the gods. I told myself from this point onwards I would be relaxed and calm, there was no need to get nervous and nothing could be changed now. As if that would last! By the time it came to 8pm, and the results were starting to be announced, I had still amazingly managed to maintain this zen-like calm but, as soon as it came to the sabbatical officers announcements, I was instantly reduced to a quivering wreck. I begrudgingly traipsed over to the stage as Sarah called out the names of everyone running for the positions and stood there, shaking like a leaf, knowing that in a few minutes it would all be over, one way or the over. The announcement came, and at first I was just shocked. In disbelief. I couldn’t believe what I had just heard. It took a long time for that surreal feeling to wear off, in fact I still wonder whether it all must has been one big mistake, but that is now being replaced by a peculiar mixture of dread and excitement. I know the year ahead is going to be incredibly difficult and a steep learning curve, but I can’t wait to experience it.

What do you think went well in the last year for BLSA? It has been a fantastic year so far, with accolades on the sports field, with a number of teams going undefeated for the entire season

and the rugby club through to the UH final once again, vying for an unprecedented third consecutive victory. The Societies haven’t been lagging behind either, with our Medsin branch hosting the Medsin Global Health conference, and the QMBL Neuroscience Society improving on last year’s Neuroscience Symposium with an even bigger and better event this year. There have been a host of other changes on the academic side too, with the Dentists preparing to move into their brand new Dental school, more biomedical students moving down to the Whitechapel campus under the Life Sciences project and all intercalated degree offerings being upgraded from BSc’s to MSci’s. All in all it has been a terrific year again for BLSA, and I’m excited for whatever the next year will hold.

What do you aim to improve during your tenure as the president of BLSA? My dream would be for every single student to feel engaged in their students’ union. I realise that it is a near impossible task to achieve, especially in just one year, but I hope that through a multitude of small changes we can improve on the current situation. It’s the little things like welcome packs for all students before they arrive, personal welcomes and shout-outs to all new students, a relevant updated website and a central events calendar that can all add up to a more engaging atmosphere that people will want to be a part of.

If you could do one thing differently during your campaign, what would it be? Life doesn’t stop because you are campaigning for a position. I spent the two weeks dashing between my own lectures and shoutouts, slavishly trying to catch up on any work I had missed with a looming exam the following Friday. Having not run for a position before, the whole campaign was a little bit of a baptism by fire. That

said, between my flies bursting open midway through my first shout-out, chasing anonymous online bloggers for corrections and speaking at the ever-daunting hustings, I had a hell of a two weeks and wouldn’t change any of it. That said, I’m sure I would be more critical if the result had fallen the other way!

exciting. I also received the least amount of RONs (Re-Open Nomination) for a candidate running for President unopposed, so it is nice to know that an overwhelming majority of students believe I will do a decent job.

What do you think went well in the last year for ICSM? I would have to say the iPads that the faculty gave to all 5th and 6th years. It has been so useful to read up on Pediatrics whilst bored on the tub. The rugby club also won the JPR Williams Cup against Imperial College. This definitely brought back a huge amount of pride for ICSM, from students all the way up to key members in the Faculty.

Hassanzadeh-Baboli ICSMSU President 2014/15

Tell us about yourself. My name is Dariush and I am from west London. I am currently a 5th year at ICSM, having started as an undergraduate in 2009. I have held various positions of responsibility over the years, but the most relevant to this role was the Clubs & Societies officer of ICSMSU in 2013. Whilst holding this position, I dealt with various issues including the whole BUCS merger situation, successfully fighting for an increase in grant money and acquiring free kit for all our sports clubs. In 2012, I was also the Producer for the Light Opera Society and am currently Treasurer for the rugby club.

How did you feel when you first found out that you had won your union’s presidential election? I was very happy, but as I was unopposed it was not a surprise. I did run for the same position last year but unfortunately did not get elected, so to get it this time is

What do you aim to improve during your tenure as the president of ICSMSU? A key issue that has been brought up multiple times is the idea that many students do not feel that the SU represents them properly, or that the SU dissapears after Freshers’ Fortnight. My aim is to change this problem. The problem is students may not know who to contact when something is bothering them. Regardless of the issues, whether it is academic, to do with a sport or a welfare query, students will have opportunities to raise their concerns throughout the whole year. I will also make sure that the SU has a strong presence within ICSM, especially for the younger years.

If you could do one thing differently during your campaign, what would it be? I think I produced a decent campaign, especially considering I was unopposed. I made a slick website and gave out promotional ‘VoteDariush’ pens. My plan was to give a few ‘shout-outs’ in lectures, however I was unavailable during working hours as I has to attend hospital placements.

[FEATURES] /11

theMEDICALSTUDENT/April 2014

Features Editor: James Wong features@themedicalstudent.co.uk

What do you aim to improve during your tenure as the president of RUMS? I would be 100% satisfied by this time next year, when my successor is elected, if no doubt is left in anyone’s mind in RUMS and the medical school that RUMS has the interests of medical students at the

Layth Hanbali RUMS President 2014/15

heart of its functioning, and that it is effective in campaigning and delivering on those views and interests. If people go back to seeing RUMS as a representative organisation, I would consider my tenure as mission accomplished. I would also love to increase the number of people running for positions, as well as the number of people

working on sub-committees and leading campaigns within RUMS.

If you could do one thing differently during your campaign, what would it be? I would have loved to engage more

Providing all the tools you need Every step of the way

Tell us about yourself. My name is Layth Hanbali. I grew up in Palestine till I was 12, and have been in England for about 10 years. My involvement at UCL has included: Year 1 - Media and Communications Officer - Friends of Palestine Society; Year 2 - President - Friends of Palestine Society; Year 3 - UCL Union Chair, and UCL BMA delegate; Year 4 - RUMS Vice-President for Welfare, President - UCL Medsin, and UCL BMA delegate. It is probably obvious that I have special interests in politics, global health and student welfare, which are all linked really.

How did you feel when you first found out that you had won your union’s presidential election? Thankfully winning the RUMS President position was not much of a shock as I was uncontested, but it was also a relief to know that I can start preparing for the ideas that had been brewing in my head for several weeks prior to the announcement of results.

What do you think went well in the last year for RUMS? I’m very pleased that, over the last year, we have started to bring back the role of RUMS as the main representative body of medical students at UCL. I think that slipped off as a priority over the last few years, but taking student feedback seriously, keeping close contact with members of RUMS, and campaigning on issues that are relevant to all students have contributed to people taking RUMS seriously again.

with people, particularly younger years, with what they see as their priorities and what they want to see RUMS doing for them, but the time constraints with that medical degree we’re all doing got in the way. It is never too late though and it is definitely something that I and the rest of the RUMS execs can do throughout our term in office.

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[FEATURES] /12

theMEDICALSTUDENT/April 2014

Features Editor: James Wong features@themedicalstudent.co.uk

A Modest Man James Wong Features Editor The registrar’s face was taking on a testy look. So enduring was the silence our furtive glances had developed a nystagmic quality. “Galactosaemia!” came her peremptory reply. Right on queue the disjointed chorus of ahs and head nods did little to hide our mental whiteboard of differentials being wiped clean. At the time conjugated bilirubinaemia in children only meant one thing: biliary atresia. A fair assumption; we were sitting in one of three specialist centres in the country equipped to treat these patients. Ironically the condition has become the unwieldy yardstick I now measure the incidence of paediatric disease. Biliary atresia is the most common surgical cause of neonatal jaundice with a reported incidence of 1 in 14-16ooo live births in the West. It is described as a progressive inflammatory obliteration of the extrahapatic bile duct. And Dr Charles West, the founder of Great Ormond Street Hospital, offers an eloquent description of the presenting triad of prolonged jaundice, pale acholic stools and dark yellow urine: “Case 18...It was born at full term, though small, apparently healthy. At 3 days however, it began to get yellow and at the end of 3 weeks was very yellow. Her motions at no time after the second day appeared natural on examination, but were white, like cream, and her urine was very high coloured.” 1855 was the year of Dr West’s hospital note. An almost universally fatal diagnosis and it would remain so for the next 100 years. The time’s primordial classification of biliary atresia afforded children with the ‘noncorrectable’ type, a complete absence of patent extrahepatic bile duct, an unfortunate label; they were beyond saving. Having discovered the extent of disease at laparatomy, the surgeons would normally close the wound. The venerable Harvardian surgeon, Robert E. Gross saved an enigmatic observation: “In most instances death followed a downhill course…” K-A-S-A-I read the ward’s board. It was scrawled under half the children’s names. I dismissed it as just another devilishly hard

acronym to forget. The thought of an eponymous procedure had escaped me and in biliary atresia circles, it’s the name everyone should know: Dr Morio Kasai. Originating from Aomori prefecture, Honshu, Japan, Dr Kasai graduated from the National Tohoku University School of Medicine in 1947. His ascension was rapid, having joined the 2nd department of Surgery as a general surgeon, he would assume the role of Assistant Professor in 1953. The department, under the tenure of Professor Shigetsugu Katsura, shared a healthy interest in research. 1955 was the landmark year. Katsura and Kasai operated on their first case: a 72 day old infant. Due to bleeding at the incised porta hepatis, Katsura is said to have ‘placed’ the duodenum over the site in order to staunch the flow. She made a spectacular postoperative recovery, the jaundice had faded and there was bile pig-

ment in her stool. During the second case, Katsura elected to join the unopened duodenum to the porta hepatis. Sadly the patient’s jaundice did not recover, but the post-mortem conducted by Kasai confirmed the development of a spontaneous internal biliary fistula connecting the internal hepatic ducts to the duodenum. Histological inspection of removed extrahepatic duct showed the existence of microscopic biliary channels, hundreds of microns in diameter. Kasai made a pivotal assertion: the transection of the fibrous cord of the obliterated duct must contain these channels before anastomosis with the jejunal limb Roux-en-Y loop. This would ensure communication between the porta hepatis and the intrahepatic biliary system. The operation, entitled hepatic portoenterostomy, was first performed as a planned procedure for the third case at Tohoku. Bile flow was restored and Kasai published the details of the new technique in

the Japanese journal Shujutsu in 1959. However, news of this development did not dawn on the West until 1968 in the Journal of Pediatric Surgery. The success of the operation and its refined iterations were eventually recognized and adopted in the 1970s. The operation was and is not without its dangers. Cholangitis, portal hypertension, malnutrition and hepatopulmonary syndrome are the cardinal complications. While diagnosing and operating early (<8 weeks) are essential to the outcome, antibiotic prophylaxis and nutritional support are invaluable prognostic factors. Post operatively, the early clearance of jaundice (within 3 months) and absence of liver cirrhosis on biopsy, are promising signs. At UK centres the survival after a successful procedure is 80%. The concurrent development of liver transplantation boosts this percentage to 90%. Among children, biliary atresia is the commonest

indication for transplantation; by five years post-Kasai, 45% will have undergone the procedure. On the 6th December 2008, Dr Kasai passed away. He was 86 years old and had been battling the complications of a stroke he suffered in 1999. His contemporaries and disciples paint a humble and colourful character. A keen skier and mountaineer, Dr Kasai lead the Tohoku University mountain-climbing team to the top of the Nyainquntanglha Mountains, the highest peaks of the Tibetan highlands. It was the first successful expedition of its kind in the world. He carried through this pioneering spirit into his professional life. Paediatric surgery was not a recognized specialty in Japan. By founding and chairing multiple associations including the Japanese Society of Pediatric Surgeons, Dr Kasai gave his specialty and biliary atresia, the attention it deserved. Despite numerous accolades of international acclaim for his contributions to pediatric surgery, Dr Kasai insisted his department refer to his operation as the hepatic portoenterostomy; the rest of the world paid its originator the respect of calling it the ‘Kasia’. Upon completion of their training, he would give each of his surgeons a hand-written form of the word ‘Soshin’ [simple mind], as he believed a modest surgeon was a good one. At 5 foot 2, Kasai cut a more diminutive figure one might expect for an Emeritus Professor and Hospital Director of a university hospital. During the course of his lifetime he had developed the procedure and lived to see its fruition. The Kasia remains the gold standard treatment for biliary atresia; it has been the shinning light for what Willis J. Potts called the darkest chapter in pediatric surgery. Among his peers It earned Dr Kasai an affectionate but apt name, the small giant. References 1. Miyano T. Morio Kasai, MD, 1922–2008. Pediatr Surg Int. 2009;25(4):307–308. doi:10.1007/s00383-009-2338-6. 2. Garcia A V, Cowles RA, Kato T, Hardy MA. Morio Kasai: a remarkable impact beyond the Kasai procedure. J Pediatr Surg. 2012;47(5):1023–1027. 3. Mowat AP. Biliary atresia into the 21st century: A historical perspective. Hepatology. 1996;23(6):1693–1695.

The Medical Student is always looking for keen writers to get involved with the paper, if you have an idea for an

[COMMENT] /13 Loneliness is both the cause and effect of our social media addiction theMEDICALSTUDENT / April 2014

Comment Editor: Rob Cleaver comment@themedicalstudent.co.uk

Rob Cleaver Comment Editor In a modern society such as our own we are often caught bemoaning a lack of human intimacy, a distance between us and the world. We blame external factors of course, no human readily accepts blame, whilst we nuzzle lovingly with our electronic devices - refreshing, refreshing, refreshing. Modern life dictates increasingly so that we are further geographically from people too, relationships and friendships are easily maintainable across continents and vast oceans because contact is far easier - we type a message, we send it, we don’t lick a stamp and we receive one back. Sometimes we mistake these emojis for meaningful interactions.

[Relationships and friendships are easily maintainable across continents and vast oceans. Sometimes we mistake these emojis for meaningful interactions] The University of Chicago recently published research declaring that, amongst the over 50s, if you self-identified as lonely you were 14% more likely to die young than if you did not, only 5% less than the effects of poverty on longevity. Research published in The Journal of Psychology also demonstrated that more than half of Britons over 65 experienced at least some loneliness and a quarter felt that they were persistently lonely. Loneliness has been linked to higher rates of heart attack, stroke and depression - we don’t just desire human contact, we need it. Although not true loneliness, a complete lack of human interaction on a day-to-day basis, I would tentatively extrapolate

to a younger cohort that loneliness breeds just as lavishly. Yes, as we live longer we are increasingly likely to do it alone but if you look at the generations that come after they too have an issue with loneliness. Modern life is very saturated, our livelihoods and work habits are becoming prolonged and so is our daily use of the internet and social media as we interact virtually with friends in lieu of ever seeing them face to face. There’s very little space left to fit in a human relationship or two. It is increasingly easy to become lost in the sea of seven million people but convince yourself that you’re doing fine with a self-medicating text. It is this progression of human interaction that makes the recent movie Her, Spike Jonze’s story of a man who falls in love with an operating system, a tale not that far detached from the world in which we live. We are replacing the physical with the virtual - supermarkets, recreation, friendships - and so it would come as no great surprise if a story similar to Theodore Twombly’s were to make the tricky transition from fiction to fact by the year 2025.

[Rates of living alone show no signs of plateauing, increasing in altitude past 20%, 25%, 30%] The way that society is currently arranged, its see-saw tipped markedly towards success at work, means that young people today feel far more isolated than their parents did at this age and the same for those who took part in the study. Rates of living alone show no signs of plateauing, increasing in altitude past 20%, 25%, 30%. If the story goes that you lose friends along the way as you get older then what happens when you don’t really have any left to lose? Last week I was alone

all day, both of my housemates were out until the early hours, and the only person I spoke to was a barista in a coffee shop on a walk I took to waste away the hours. By the evening I felt isolated, I craved some form of interaction as if it were a drug, as if it were the only thing that could keep me alive. If I sent you a message on social media that evening then I did it because I am addicted to you. It started me thinking that perhaps social media, for all of its positive effects, has an effect on loneliness that wears off over time. Are we able to rightly spin the term ‘follow’ from that of intrigue to a dark shadow loitering in an alleyway waiting for the victim to wander into their grasp? Has social media become a way of reinforcing that human feeling of overinflated importance of self as a mechanism for staving off isolation in a virtual-leaning world? We are intrigued by personalities because we are intrigued by our fellow humans, so the pictures painted by scrolling down timelines easily become a surrogate to interact with. However, I was brought to the attention of a tweet that shone a light on the fact that even the internet fails sometimes to give you what you want. The tweet was from an acquaintance that I’ve met only once that effectively asked the world (his one hundred or so followers on Twitter) what they thought of him. This was a product of loneliness; I often feel ignored, it could say, so acknowledge me and tell me that I am alive, please. Nobody replied.

that is not something new but that it wears off in its application in loneliness is a relatively new concept, especially as solitude becomes an increasingly prevalent part of life. If loneliness does have such a profound effect on our health then we may have to brace ourselves for increasing rates of loneliness related depression as our generation gets older and less able to make new friends through new environments and situations. Depression however is probably no harder to treat than loneliness. It is very easy to tell someone to go out and make friends, get in touch with old ones, see family members more often. It’s far more complicated than that in the vast grey area that is real life. Loneliness and depression are so able to exacerbate the other that it is often almost im-

possible to go out and interact with someone you’ve never met before and, even when we do manage it, we are far more likely to consider it an actual friendship once we’ve found their relevant handles on the internet.

[Are we able to rightly spin the term ‘follow’ from that of intrigue to a dark shadow loitering in an alleyway?] The internet can do all manner of things, often it is a creative and positive enterprise but this still is unable to stave off those long fingers of loneliness, caught in the doorway trying to get in. It is something we’re always trying to run away from, often distracting ourselves from its pursuit, urging and willing our loneliness to unfollow us and stop favouriting those tweets that are so clearly cries for a friend.

[It would come as no great surprise if Theodore Twombly’s story were to make the tricky tansition from fiction to fact] So the internet is a drug,

How reliant are you on social media? Do you think that the internet is a positive influence? Let us know via comment.medicalstudent@gmail.com

[EDUCATION] /14 Essentials of Kumar and Clarke’s Clinical Medicine: 5th Edition

theMEDICALSTUDENT / April 2014

Education Editor: Sarah Freeston education@themedicalstudent.co.uk

Rob Cleaver Comment Editor There is an image of the medical student balancing an endless pile of patient notes, scrawled lists conceived in stolen moments on the ward and somehow carrying all 1,285 pages of Kumar and Clark at the same time. Unlike the Higgs Boson, this is an impossible and unachievable vision. However the Essentials version, almost 400 pages lighter and far smaller, is a manageable task and an asset to any undergraduate. The reviews boast of it being perfect for finals revision and the perfect bed partner the night before a new rotation. Bold claims no doubt and though I can’t yet comment on the former, for the latter I am inclined to agree. This really is a more easily followable and pleasantly diluted form of parent tome.

It offers more science than its sibling Medical Management and Therapeutics which is useful for understanding what you’re seeing on the ward in contrast to putting a name to what you are seeing. Of course it does this too, but that little bit extra information, the ‘whys’ and the ‘hows’ no doubt allow you to shine brightly for your consultant when asked a potentially difficult question. Like all of the books in the series, this one is also ordered by system with chapters on each and an additional new chapter in this edition on malignant disease. Why this wasn’t included in previous editions I am at a loss but thankfully it is now included. My only complaint being that the chapter entitled Special Senses doesn’t explain or elucidate anything upon the topic of superpower inducing spider encounters! The dictionary of terms towards

the rear of the book will no doubt prove to be very useful when a definition escapes you and there is a compulsion to remember it and tie it down once and for all. Of course there are drawbacks, it is still somewhat weighty and rather larger than the snug, pocketsized cheese and onion and in that sense belongs on your desk at home rather than in your pocket on the wards. Still, it proves to be less ornamental than the full-fat edition that takes up residence on a shelf somewhere, as an advertisement of your profession, and never leaves that place again. Whether there really is a middle ground between bookshelf and ward for this book to occupy is mostly dependent upon the user. I very much doubt that a finals student would use this book instead of the full text as a reference tool. Finally, it is, much like the Oxford alternative,

still a solid slab of text, something Medical Management and Therapeutics manages to avoid but subsequently loses out on detail. It seems that in the case of medical textbooks you have to choose between ease of use and breadth of knowledge. This textbook is a useful condensing of Clinical Medicine but as a result of its nature doesn’t add any new material that a comparable edition of its parent would supply. Its content therefore is of highhttp://www.speedwellsoftware.com/ quality and high interest but the need for a smaller version remains moot in my mind. If I were to take to the ward with a Kumar & Clark title it would be with Medical Management and Therapeutics rather than this title, but it still has merits if only, as previous reviewers have suggested, to be read the night before a new attachment in front of the TV in order to paper over and fill in the cracks in our knowledge.

[EDUCATION] /15 A GP education: from matchboxes to methadone

theMEDICALSTUDENT / April 2014

Education Editor: Sarah Freeston education@themedicalstudent.co.uk

Sarah Freeston Education Editor Saturday 8th March saw the InspireMEdicine conference at UCL. Run by Medical Society, this was a chance to reignite our passion for medicine when dreary lectures and looming exam stress have taken their toll and we’ve forgotten why this all seemed like such a good idea. Although I could write pages and pages on the day itself, I want to focus on what I learnt about being a GP. The opening keynote was delivered by the biggest and most enviable power couple I have ever had the pleasure to meet (after, of course, Beyonce and JayZ): Professor Sir Simon Wessely, a psychiatrist, and Dr Clare Gerada (aka Russell Brand’s bbf). Their competitive spirit was hilarious to watch and I can only imagine how their over-dinner conversations pan out! Clare is a former Chair of the Council of the Royal College of General Practitioners and has been awarded an MBE for her services to medicine and substance misuse (i.e., pretty badass). Her bit of advice that stuck with me most was this: don’t head out trying to change the world – you won’t. You need to make a difference on a patientby-patient basis. As soon as you

can’t treat or manage a patient in the way that you consider to be in their best interests – that’s when you fight – and that’s ultimately how you’ll make a difference – from the bottom up. The first workshop of the morning was run by two GPs and focussed on life in general practice. Entitled sex, drugs and sausage rolls, two stories really stuck out for me. The first centred around a lady who came in because of a longer than normal menstrual bleed – she was concerned about cancer. She had never had a smear test, being a victim of female genital mutilation and feeling extremely selfconscious of her body to the point of not wanting to be touched by

anyone. Her GP painstakingly built her confidence over a series of appointments and finally carried out the test – much to the joy of both patient and doctor! This is certainly a scenario in which the ten minute appointment target needs to be more of a guideline than a rule. A less culturally aware GP could have said ‘come on, hop on the couch, let’s get this done’ without fully exploring the patient’s background, insecurities and fears (and would no doubt have had a much less successful outcome). This story also highlights the emotional involvement people share with their GP; that level of trust would be such an honour and privilege. I can only hope

to negotiate such complex situations in such a patient-centred way myself in the future. The second story was set in a very disadvantaged area of Edinburgh, in one of the estates hidden away from tourists and residents alike behind castle hill. A significant proportion of this GP’s patients were on methadone. My eyes were truly opened to what it would be like managing the health of people living in an area where even common antibiotics had a street value! Patients picked up their methadone prescriptions every week but only had to be observed taking their 60ml/day doses for a 2-week period every year. If this wasn’t disconcerting enough, this 2-week period could be taken any time during a designated 2 months, which the patient could decide. Some patients would wean themselves down to about 20ml/day and sell the rest to boost their income. Which is fine until they need to be watched taking 60ml. By choosing the last 2 weeks in the 2 month slot, there was time to gradually increase their dose again up to 60ml/day, thereby losing a month or so of income but not subjecting their bodies to a potentially lethal dose. The GP expressed intense frustration at some of her patients –their unwillingness to accept help or decrease their dose and those who would shout and argue for more methadone when they knew this was out of the GP’s hands. But then she heard about ‘soggies.’ By cutting up a

cardboard matchbox and putting each side on the inside of your cheeks when taking methadone, they soak up some of the liquid. These could then be sold for people to chew on. This was the point at which it really hit home that no one would choose to be in this situation – they see no way out. Managing these patients would be unimaginably tricky – especially after growing up in a completely different environment. This methadone story reminded me of Clare Gerada’s heated interview with Russell Brand who is a firm believer in abstinence-based therapy for substance misuse. ‘Rearranging the furniture on the Titanic’ was how Russell Brand described taking methadone – he argues it’s just switching from one drug to another with no benefit to the user who will likely be taking other drugs on top as the underlying issues haven’t been resolved. However, Clare believes that this opiate substitution is essential as it gives people time to nurse the underlying wounds and get their lives on track – like putting plaster on a broken leg to protect it while it heals. If nothing else, this session demonstrated that the negative stereotype of general practice being ‘the easy way out’ is unfair and unfounded and also that it’s an art form closely entwined with psychiatry and one that I want to experience more of. The conference did the trick – I’m inspired.

[CULTURE] /16

theMEDICALSTUDENT / April 2014

Culture Editor: John Park/culture.medicalstudent@gmail.com

Television shows to John park Culture Editor Game of Thrones Season 4 hBo Recovered from the bloody aftermath of the infamous Red Wedding? No? Me neither, but ready or not, fantasy epic Game of Thrones will be invading our screens in April in what looks to be a gloriously entertaining fourth season. Words can’t describe the monumental achievement of the show that keeps pushing the boundaries and raising the bar in terms of their complex storytelling and skillful juggling of the numerous characters most of whom somehow all stick to our mind thanks to the ensemble cast’s terrific acting as well as what the writers manage every episode. So where were we in the longrunning battle in Westeros for the control of the Iron Throne? First we have the Lannisters, all of them such quality characters, whether it be the spoiled child king Joffrey (Jack Gleeson) we all love to hate, and his surrounding family members, his scheming but loving mother Cersei (Lena Headey), her twin brother Jaime (Nikolaj Coster-Waldau) who has recently come home, their brainy hilarious dwarf brother Tyrion (Peter Dinklage), and their charisma-oozing father Tywin (Charles Dance). There’s the Tyrell family, most notably Margery (Natalie Dormer), who is about to wed king Joffrey, and her grandmother, the outstandingly entertaining Olenna Tyrell (Diana Rigg) whose priceless scenes are always an episode high-point. And what of Stannis Baratheon (Stephen Dillane), the self-proclaimed rightful heir to

the Iron Throne? After his humiliating defeat in season 2, he has sort of gotten back on his feet, and under the influence of creepy, freaky Priestess Melisandre (Carice van Houten - excellent), he heads north with his army to prepare for war. What’s happening up north? Brace yourselves, because zombies i.e. White Walkers are coming, as well as the Wildlings. Jon Snow (kit Harrington) tried to play double-agent and infiltrate the Wildling group, although he managed to fall for Ygritte (Rose Leslie), a doomed relationship that had an acrimonious breakup to say the least. Are the remaining Stark family members up to anything interesting? Of course they are. Sansa (Sophie Turner) is still stuck in king’s Landing, trapped in a loveless marriage, and Arya (Maisie Williams - you deserve an Emmy for your work here) is travelling somewhere mysterious in the hopes of exacting vengeance on those who caused so much bloodshed and pain to her family. From what the trailers show, Arya starts to become a sword-wielding badass, some-

thing we’ve all been waiting for since season 1. It’s not entirely clear just what’s happening to Bran (Isaac Hempstead-Wright) and his rather helpful supernatural powers, but given how many fascinating character developments there have been so far, you can be sure that George R. R. Martin, the original author of the novels, will not let a single character go to waste. Theon Greyjoy (Alfie Allen) is in a bit of a pickle, having spent the whole of past season tied up and tortured by a mad man, although his feisty sister Yara Greyjoy (Gemma Whelan) is determined to rescue him, opening up even more room for action. Last but certainly not least, there is Daenerys Targaryen (Emmy-nominated Emilia Clarke), who has been freeing slaves, conquering cities, nurturing her dragons, and forever expanding her massive army across the Narrow Sea, plotting her comeback to seize the Iron Throne. Her dragons are growing and displaying immense powers (yaaaay) therefore chaos must also ensue with beasts that cannot be tamed.

The cast list doesn’t end there - not even close. We get some newcomers, most notably in the form of Oberyn Martell (Pedro Pascal) otherwise known as the Red Viper, who shows up with a score to settle with the Lannisters. It appears the Lannisters are not the only ones who pay their debts. “There is only one hell...the one we live in now” - a quote heard in the trailers perfectly sums up what Game of Thrones is all about. It’s about immense suffering, conniving acts of treachery, bloody warfare, complex characters trying to outsmart one another: which is what makes this show endlessly interesting and gripping. The more the writers pile on, the more addictive everything becomes. One-hour episodes feel far too short and having to wait even one week for the release of the subsequent episode is one that is most challenging. If you have managed to stay away from this show, you owe it to yourself to at least check it out. There is honestly no show on television quite like Game of Thrones.

Veep Season 3 hBo When season 2 ended, VicePresident Selina Meyer (Emmy and SAG awards-winning Julia Louis-Dreyfus - priceless) bravely decided to run for Presidency. Of all the ill-advised decisions she has made in the two seasons of HBO’s excellent political satire comedy, this has got to be the worst one by a long shot. Her staggeringly incompetent team will be trying their best to come up with some kind of a coherent strategy to keep her in the race. Her office? Made up of Amy (Anna Chlumsky), a slightly neurotic perfectionist Chief of Staff putting Veep’s interests first, Dan (Reid Scott), an ambitious political ladder climber who would gladly stab anyone in the back for his career’s advancement, Mike (Matt Walsh), Selina’s Director of Communications who causes more problems than he fixes, Gary (Tony Hale), the Vice-President’s slightly dim but 110% loyal personal assistant, and Sue (Sufe Bradshaw), Selina’s dry-humoured secretary. Also present but not welcomed by the office is Jonah (Timothy Simons) who works as a White House liaison, always delivering bad news with his smug face. Selina often struggles to exert her authority in the Washington political scene, and watching her caught up in the most embarrassing moments has been the main highlight of the show. The Presidential race will no doubt bring about unforgettable moments of screw-ups and embarrassing mistakes.

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theMEDICALSTUDENT / April 2014

Culture Editor: John Park/culture.medicalstudent@gmail.com

o watch this month Devious Maids Season 2 Lifetime The five Latina maids who caused quite a ratings storm in their debut year are coming back for a sophomore season. Flora’s murder was solved, and the women were seen to be the best of friends after Marisol’s (Ana Ortiz) son was cleared of any wrongdoing; this was until the jealous actress boss Peri Westmore (Mariana Klaveno)

had Rosie (Dania Ramirez) arrested for illegally bringing her son over from Mexico. That’s not the only cliffhanger we need to worry about though: Valentina (Edy Ganem)) went off to Africa with her boyfriend Remi (Drew Van Acker) after her mother Zoila (Judy Reyes) tried to interfere, Carmen (Roselyn Sanchez) got a marriage proposal from a closeted Latin singer promising a lucrative record

deal. Much like creator Marc Cherry’s previuos hit serise Desperate Housewives, a new season brings with it a whole new set of mysteries for these lovely maids to solve. At the heart of season 2’s storyline Nicholas Deering (Mark Deklin), a handsome charming man whose wife died under strange circumstances, his employee Opal (Joanna P. Adler), a secretive, conniv-

ing woman, and Ethan (Colin Woodell), Opal’s badboy son. Of course, the irreplaceable Powells will be back (the hysterical combo of Rebecca Wisocky and Tom Irwin) who have a dirty secret to be tucked away given how season 1’s finale played out. All in all, it’s lining up to be another highly amusing, mindboggling season full of shocks, suprises and reveals.

Orphan Black Season 2 BBC America Tatiana Maslany, arguably the hardest-working actress on television at the moment, is back as a collection of clones who were manufactured for reasons that have not yet been revealed. The more they find out, the more questions that need to be answered. This genetic manipulation does not seem to have been an accident by any means, and the people responsible are trying to hide away and tie up all the loose ends, which means danger for the clones.

What was without doubt the most intelligent, exciting new shows of last year, has so much potential. Each clone, played to perfection by Maslany, has a dense, rich story of her own to tell, and as they start to intertwine, the character arcs become more complicated than ever, but carefully controlled so they don’t spiral out into preposterous territory. Only a handful of clones have been introduced in season 1 (who knows how many more there are out there?), as well as equally important supporting

characters. Hats off to Felix (Jordan Gavaris) and Paul (Dylan Bruce) for providing such firm support for our heroines. And Siobhan Sadler (Maria Doyle Kennedy), a character yet to be cracked, who is the foster mother of Sarah (one of the clones) and Felix: just what are you hiding? We can’t wait to find out. Several new recurring characters will be making their appearances in the new season: Michelle Forbes (24, True Blood, The Killing), Peter Outerbridge (Nikita) and Michiel Huisman (Treme, Nashville) have been

booked, and so has Patrick J. Adams of the Suits fame, rounding off an impressive ensemble cast who will be complicating matters even more. Which is great news - because the twistier and bendier the show gets, the better. More people need to watch this show, as ratings are everything when it comes to continuing to tell stories on tv, especially those that do not come cheap thanks to tough shooting schedules and intricate technical aspects that need to be just right. Here’s hoping season 2 gets bigger numbers.

Nurse Jackie Season 6 Showtime Jackie Peyton (Edie Falco), a talented ER nurse and mother has been through a lot of tough incidents. As many as the types of prescription pills she’s been popping over the years. The most recent season saw her finally clean up her act and remain sober, but this dark comedy’s finale ended on a slightly foreboding note, one of Jackie celebrating a year of sobriety with a pill. Has she fallen off her wagon? Or will she be strong enough to resist the constant temptation? Falco is tremendous in the leading role; always so strong and impenetrably controlled and mannered in the professional work place, although what goes on behind closed doors, away from her colleagues and friends is an entirely different story, a different side Falco brings out so well. She is the main reason why the show has been a success for so many years. That she is also surrounded by excellent supporting players is a bonus. The eccentric but lovable nurse Zoey Barkow (Emmy-winner Merritt Wever) is responsible for generating the most laughs, closely followed by hospital administrator Gloria Akalitus (under-awarded Anna Deavere Smith), and the endearingly sweet Dr Cooper (Peter Facinelli). Sadly Eve Best as snooty English Dr Eleanor O’Hara will not be joining the season but surely the show has enough to stand on to carry forward with a highly amusing and often touching dark comedy about what life can be like as an addict.

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Culture Editor: John Park/culture.medicalstudent@gmail.com

‘A boy’s best friend is his mother’ Bates Motel Season 2

‘I will follow him, follow him wherever he may go,’ The Following Season 2 Claire Matthews (Natalie Zea) died (HURRAH), but then so did Debra Parker (Annie Parisse) (BOO) as The Following wrapped up its mixed bag of season 1 last year. The story of how the charismatic and brilliant English-professor-turnedserial-killer Joe Carroll (James Purefoy) gathered up a group of equally psychopathic, bloodthirsty murderers and formed a cult started off strong, but quickly turned into a frustrating affair thanks to the utter incompetence of the FBI’s task force assigned to tracking them down. The renewed season 2 faces similar problems. The good guys dance around the issue of whether Joe Carroll is alive or not. To the audience, it’s painfully obvious that he clearly is, otherwise there would be no second season, although it takes everyone shockingly long to figure it out. Ryan Hardy (Kevin Bacon), a broken man after the death of Joe’s ex-wife-turnedRyan’s-lover Claire Matthews, is on an unstoppable path of vengeance, having left the Bureau, but spear-heading his own investigation to put an end to his nemesis who loves to taunt him. Joe, on the other hand, has been in hiding for a year in an Arkansas trailer park, thanks to a kind prostitute (Carrie Preston) who gives him shelter and deludes herself into thinking that she can fix his evil, violent ways. Doesn’t take long for Car-

roll to fall back into his old life however, as there are plenty of admirers who want to regroup and spring into action. One of Joe’s most loyal followers Emma (Valorie Curry), is back, and we also get some new faces who are bound to stir up a lot of trouble. Most disturbing are the twin killers Luke and Mark (both played by Sam Underwood), whose sadistic looks are bound to give you chills, Gisele (Camille De Pazzis) works closely with the twins, and we are also introduced to Mandy (Tiffany Boone), a seemingly shy and obedient newcomer who shows promise in what you need to be a part of Joe’s cult. Add to the mix Lily Gray (Connie Nielson), a duplicitous, manipulative woman who befriends then ultimately betrays anyone as she sees fit. So when it comes to the antagonists, the second season is well set up. But as was the case for the first season, the problems we encounter are with the good guys. It’s fine to face difficulties along the way; of course, no cop-chase can/should be solved too easily and there is that understandable need to stretch out this cat-and-mouse game for the season’s 13-episode run, but when the law enforcement cannot get anything right, it not only slows the plot down, but also piles on the amount of frustration that goes into watching one careless screw-up after another as the good guys keep making the same mistakes over and over. It’s the females who are given the worst characterisations. Out

of nowhere we get Ryan Hardy’s niece popping up to help, Max Hardy (Jessica Stroup), a New York City Police Department cop, who rather disappointingly can barely hold her own in a fight. Agent Gina Martinez (Valerie Cruz), head of the investigation on Carroll, looks and sounds important, but in fact isn’t. The show is still carrying on with its portrayal of gore, one of its defining features, and it’s interesting to see Agent Mike Weston (Shawn Ashmore) get in touch with his darker Jack Bauer side when out in the field. Is he starting to lose it? Can Ryan Hardy keep his team under control? Who knows. Mike seems to have the hots for Max too. Wonder how that will go down with Hardy. Already renewed for a third season, it would be interesting to see just where everyone can end up by the time season 2 wraps up. There is a new cult forming here, but can they really introduce one nuttier psychosexual cult after another per season? The show is losing momentum, and there are no more chilling surprises that are in store. We are more than halfway into the season now, and so far nothing has been truly eye-catchingly spectacular. Season 1 found its best moments when lead actors Bacon and Purefoy were in the same room engaging in psychological warfare. So far the two haven’t crossed paths once. Time to bring that back.

So last season we figured out that Norman Bates (Freddie Highmore) gets into these trancelike states in which he kills people without knowing. He killed his abusive father that way, and we suspect the death of Miss Watson (Keegan Connor Tracy) had something to do with Norman too. Season 2 opens with a phone call received by Norma (Emmy and Critics’ Choice Television Award-nominated Vera Farmiga), Norman’s mother, informing her of Miss Watson’s murder. We then get a time jump of four months; the Bates Motel has finally opened and is a great success although it’s facing financial business disaster with a new bypass road being built in that will severely affect incoming traffic. Norman is still practising his taxidermy skills in the basement, much to Norma’s dissatisfaction, and Norman’s halfbrother Dylan (Max Thieriot) is in the weed-growing business, one that proves to be a deadlier affair than anticipated. Norman’s obsession with Miss Watson’s passing, his incessant need to visit her grave even

months after, has Norma worried, and Sheriff Romero (Nestor Carbonell) inquisitive. Trying to bring back a sense of “normal” into their lives isn’t easy, although Norma does her utmost best to keep it together. What works so well in Bates Motel is the chemistry between the mother and son. Farmiga is excellent as the unstable but loving mother who on occasion clashes with her children (both Norman and Dylan have the tendency to not listen to their mother) and loses it. it’s in these moments of vulnerability Farmiga really shines, and the way she keeps up appearances despite the impossible events in her life. Highmore is just as good on the receiving end of his mother’s over-bearing, suffocating love. He is a young man of many issues; not remembering what exactly happened on the night of Miss Watson’s murder is one thing, he is holding on to her necklace serving as some sort of a reminder of the teacher who encouraged and supported him. As if he didn’t have enough going on in his life, there is also that unresolved love triangle subplot. Emma (Olivia Cooke), who works at the motel, likes Norman and always has, although

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Culture Editor: John Park/culture.medicalstudent@gmail.com

he only has eyes for Bradley (Nicola Peltz), a deeply troubled girl who has family secrets. While there was noticeable friction between Norman and Dylan in the first season, the two have patched things up for good now (aww) and just as events are finally about to calm down in the domestic lives of the Bates family, enters Caleb (Kenny Johnson), Norma’s brother and the boys’ uncle. And we’ve heard from Norma in the first series that Caleb is not someone you should associate yourself with, given the questionable things he has done in his life. Why is he searching for Norma? Has Norma been telling the truth all this time about her brother? Will Norman have to enter another one of his floating, semi-conscious states to protect his mother? Outside the Bates home, there is a drug war coming, given how their community of White Pine Bay, Oregon (fictional) makes their financial living. Important individuals end up dead, there are misunderstandings, false accusations, ones that will no doubt lead to further bloodshed and endless violence. There is very hardly a sunny moment - Bates Motel is a great big user of pathetic fallacy - it’s always raining, gloomy, and the Bates residence looks like a haunted mansion; and this contemporary prequel to 1960’s Psycho has found its footing.

‘To catch a serial killer, you must think like one’ Hannibal Season 2 The opening sequence of Hannibal’s second season is like no other. Dr Lecter (Mads Mikkelsen), always the accomplished chef, is working away in the kitchen, only to be interrupted by the appearance of Agent Jack Crawford (Laurence Fishburne) who looks as though he’s finally solved the mystery. Crawford is here to arrest Lecter, but he won’t go down without a fight. And so what ensues is a brutal fist-fight that sees the use of all sorts of cooking equipment for a fight to the death. The end result we are not shown, but it demonstrates that Hannibal is back, and it means business. Turn the clock back to twelve weeks earlier; Will Graham (Hugh Dancy) is locked up in an insane asylum awaiting trial for gruesome murders he did not commit, Dr Lecter on the other hand, is free to do as he pleases despite Will’s strong suspicion towards him, Crawford is having a crisis of conscience, as he feels responsible for Will Graham’s mental unravelling, psychiatrist Alana Bloom (Carolien Dhavernas) is doing her best to provide some sort of defence for her friend Will who is facing the

federal death penalty, should he be found guilty. It would appear there is another serial killer in town (not Lecter), and despite his trio team of forensic experts (Hettienne Park, Scott Thompson, Aaron Abrams) Crawford is without Will’s expertise, therefore enlisting the help of the brilliant mind of Dr Lecter who uses this opportunity to feed his hunger (literally), and Hannibal certainly has a way of turning slick, almost inspirational cooking sequences into highly disturbing, repulsive work of art as Dr Lecter smoothly prepares his daily meal, always with classical

music in the background. As usual, Dancy and Mikkelsen are both on top quality form, as the two brilliant minds try to outsmart each other. Dancy is very quietly intense in his portrayal and the way he brings about his pain and torment even in silence is a real testament to the excellent work he is doing on the show. Mikkelsen too, is incredible, always so poised and calm, turning every situation to his own advantage, which is a part of what makes him such an intriguing villain. There are still secrets surrounding his past that we aren’t too clear on. It relates to his relationship with his own

psychiatrist, Dr Du Maurier (the excellent Gillian Anderson who needs a bigger role), who is terrified of what Dr Lecter is capable of, and believes Will Graham’s story, although she does the wise thing of running away. That we know it’s Dr Lecter committing these violent (as graphic as primetime network shows can get) killings is of little consequence to the enjoyment of the show. How he dodges suspicion, hides in plain sight is oddly fascinating, and the inevitable climax will definitely be one to look forward to.

[CULTURE] /20 The Examined Life - Stephen Grosz theMEDICALSTUDENT / April 2014

Culture Editor: John Park/culture.medicalstudent@gmail.com

Zara Zeb Doctors’ Mess Editor

Stephen Grosz, a practising psychoanalyst, has gathered a collection of snapshots of the patients he’s treated over the years (with consent). As a patient I wouldn’t like to be anonymised or put into a book. In fact I don’t even want to be a case study being used to teach other medical students or students training to be therapists. But I’m glad these patients did consent, because we catch a glimpse of life on the couch. What struck me was how “normal” the everyday patients were, with “normal” everyday problems they wanted to discuss. On completing the book I wanted to share these stories with all my friends who refuse to talk to their GP or university counsellor because “they don’t have anything wrong with them”. Well I have nothing wrong with me and being analysed has improved my quality of life. This review will be a combination of personal experience and the actual book itself, because the book was real life. It wasn’t some piece of fiction; and it wasn’t a piece of nonfiction dressed up as a novel. It was what it says it is: the experience of a psychoanalyst in the field for 25 years. I use the word psychoanalyst and therapist interchangeably. I have no idea if there is a difference, but if there is, please do email me to explain it to me. I use it interchangeably because I think of my therapist as a therapist, not by his official title. It shows that even though I’m exposed to the world of therapy, it’s still as confusing to me as it is to someone who has no idea what these titles mean. By the time I put this book down I realised that I too am normal like other patients. Most importantly, I had an insight into what my therapist is thinking, how he’s making his connections, and what I’m actually supposed to do in my sessions. I as a patient just want to talk and reflect with someone who has the knowledge and expertise to guide me. With his guidance, I have accessed unconscious feelings and thinking patterns and have started to challenge them, just like Grosz does with his

patients. But it is hard work – Grosz gives a taste of the weeks and months dealing with individual patients who are frustrated at nothing changing; he talks of missed appointments; and of guessing at what is really going on in the patient’s head when they share selectively. He then makes the point that the world expects you to have a feeling, to deal with it, and move on: such as grief over a passing loved one. But there are no five stages of grief. The death of someone will hurt less with time, but there will be moments when the grief is as sharp as it’s ever been. Emotions don’t go away because you feel them. They go away because you acknowledge them; you give them time, and you move on. When they return, you

repeat the process. Maybe you haven’t experienced grief at the death of a loved one, but maybe you have felt upset about a certain area of your life that you got over but then it came back and then it went away again and then it came back. Sometimes life, feelings, and thoughts can all be repetitive, and it’s the therapists job to point out to you what you’re doing. By the end, I realised I was broken. Even though people have everyday problems they seek help for, only a small number seek help. Others just get on with it. Being broken implies I need fixing. Some of the patients Grosz saw, he saw every day for years. I certainly don’t see my therapist every day and our time will come to an end: what if I’m

not better by then? Then I realised I will never be better. The therapist will help me until our time comes to an end, and then I’ll go it alone, using what I’ve learnt in therapy to help me. But what if… You see where this is going. I discussed all of this with my own therapist, and I felt like a cheat trying to analyse myself when it’s my therapist’s job. It’s like trying to diagnose your own symptoms or a friend’s symptoms before you’ve even started clinics. Grosz’s patients lie down on a couch which I find weird as I’ve only ever sat in a really comfy chair, and I couldn’t help making other comparisons sucking me deeper into the story. Grosz has a way of relating the stories of his patients to you as the read-

er: even if you’re not the autistic child, I bet you’ve felt so angry you too have wanted to destroy something. Even if you’re not the mother missing her child, I bet you too have felt a loss. Even if you’re not the elderly gentleman who’s starting to explore his sexuality but wants to keep his wife, you too have wanted two different worlds. Explaining what little jargon he uses, Grosz manages to share the story from both the patient’s perspective and the therapist’s perspective. He even opens himself up for analysis and admits his own faults: there was an attractive female who he re-directed to someone else for treatment because his attraction would have hindered their work. In psychoanalysis, the patient-therapist relationship is so important as the therapist’s own feelings to something the patient has said or done can help explain what happens when the patient feels or thinks a certain way. Therapy takes time to have an effect, but what an honour it must be to have access to someone else’s unspoken thoughts and feelings. Therapists can’t read minds, and they have to always be aware of their own feelings and staying removed from the patient, but it’s a skill to make links and help a patient navigate through life. The patient may not be showing you a reality others agree with, but it’s their reality, and the therapist is there to treat their mind. From experience, this book is a great reflection of the work that goes on in those 50-minute sessions. I would recommend it to all medical students to help them learn empathy towards a life you’ll never hear about in 10-minute consultations, and to appreciate what another profession does. This book will make you think. It will make you reflect. It will make you analyse. Remember that therapists have had years of experience; you have only read a book. Talking to someone about whatever is in your head is an amazing opportunity, so please don’t be one of those people who thinks your story isn’t good enough, sad enough or bad enough to be heard. My story certainly wasn’t, but feeling low (even sometimes) for any reason (even if none at all) is worth talking about.

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Culture Editor: John Park/culture.medicalstudent@gmail.com

Tame tale of a Divergent John park Culture Editor It takes a while to get settled into author Veronica Roth’s new vision of futuristic Chicago. After “The War”, our planet has been left in ruins and those who have managed to scrape and salvage together whatever was left of America’s Windy City have, to be honest, done quite an awful job. Building a society of five different “Factions” with ridiculous names based on words people never use, everyone needs to decide to be one part of Erudite (the smart ones), Abnegation (the selfless ones), Amity (the peaceful ones), Candor (the honest ones), or Dauntless (the brave ones). Once the choice is made when you’re 16, there is absolutely no going back. The “Factionless”, those who didn’t fit in to any of the five groups, are tossed aside into the slums. There is a smart, disturbing element of truth in what this system reflects about modern society, seen even in schools, of how “fitting in” is the new obsession and how there is much conforming to do in order not to get picked on. But for Beatrice (Shailene Woodley), things are a little different. At her initial “testing” stage, one that determines which faction each individual would most likely fit into (and therefore one you’re strongly encouraged to choose), her test results are inconclusive. She

possesses three qualities: Abnegatio, Erudite and Dauntless. She is therefore a Divergent. Tori (Maggie Q) insists that Beatrice keeps this a secret, as the higher-up powers don’t look kindly on anyone who is multi-talented. At her choosing ceremony which involves young teenagers cutting themselves and spilling blood into each faction’s bowl, she goes for Dauntless, one that she’s always had ambitions and curiosity for. Dauntless is no easy place to be at: the training is intense, rules are cut-throat, and if you’re not good enough, you’re immediately kicked out to be a part of the Factionless. But for Tris (Beatrice’s new Dauntless name), it all becomes bearable thanks to the handsome, hunky trainer Four (Theo James) who immediately takes an interest. They flirt whilst training, go on strolls

when everyone is presumably busy training, and the ultimate climax comes when she asks to see his tattoos, which of course involves him taking off his shirt quite willingly. Only for her to stroke them very suggestively, yes, “stroke”. Hey, if you’ve got it, flaunt it, and this is exactly what Four does. Jeanine Matthews (kate Winslet), serving as the film’s main antagonist, is hunting down Divergents, who are a threat to the genius system she thinks works perfectly. For someone from Erudite, which is supposed to harbour the smartest people, who supposedly know everything there is to know about everything, her villainess strategy sucks. Her logic is so deeply flawed, and to think, all humans can be squeezed into five incredibly limited Factions, is laughable. Winslet plays her

role with a great level of sincerity, as she should, with her impeccable American accent, but when someone who is supposed to possess one of the highest levels of IQ in fact turns out to be so dumb, it is difficult to take someone like that seriously. The film has a lot of explaining to do, for the benefit of those who aren’t familiar with the books (yes, this is a young adult novel trilogy, I’ve done well to not bring up The Hunger Games yet), and you get the feeling the not-yet developed supporting characters, starting with Tori, Caleb (Ansel Elgort), Beatrice’s brother, Christina (Zoe kravitz), a girl Beatrice befriends during their Dauntless training, Eric (Jai Courtney), one of the fierce, nononsense leaders of Dauntless, Max (Mekhi Phifer), another Dauntless leader, and Peter (Miles Teller), one of Tris’ main

competitors, have a lot more to say and do than in the first installment. The first entry of the franchise serves to set the scene, one that will hopefully lead to sequels of further exploration, depending on how the film manages to do financially. As a standalone film it works too, to a certain extent. There are several decent action scenes, and where it intends, it also manages to pack quite an emotional punch. This mostly stems from the fact that Tris is torn away from her family originating from Abnegation, as she chooses to follow her heart to Dauntless. Her mother Natalie (Ashley Judd) and father Andrew (Tony Goldwyn) have small roles, but crucial ones. Woodley and James are wellsuited for their roles. Certainly in the looks department the casting directors have done a better job here than in other teen angst dramas. Woodley looks sweet and naive, gradually going through the changes to truly grasp her inner strength and intelligence, facing her fear, shaping up nicely to become a future leader no doubt. James has a little less to do; he is very good at looking serious. His skills will be put to the test in the future when he gets to interact with his father character with whom he shares a complicated relationship. Divergent is a worthy start to a promising franchise - let’s hope the sequels keep coming.

The Doctors’ Mess

Don’t Put Me in a Box Recently I came across a 2013 article published by the New Statesman entitled “Not every mentally ill person is a poster child for mental illness” where the author made a very good point: “If mental illness does not make you feel frightened, uncomfortable, bored or embarrassed, perhaps this isn’t because you’re a wonderfully open-minded, laid-back person. Perhaps it’s because you’re not close enough to mental illnesses, or only engage with sickness eloquently expressed on blogs or on Twitter. Perhaps it doesn’t seem ugly or challenging because your engagement is selective. Mental illness hurts, the way all illness hurts.” She adds that fighting stigma by showing how “normal” mental health patients look may not be challenging stereotypes but might only be laying the boundaries of what we are willing to tolerate. In the sense that as long as someone

with depression is living in the community, volunteering, doing part time work, studying, and generally living a “normal” life, we are ok to accept them. But as soon as you introduce the depressed patient who has stopped washing, stopped cleaning, stopped eating, you’d run a mile. And that scared me. What if through all my articles and conversations where I’ve said “Yes I have depression BuT I’m still superwoman because I do this and this and this” has made others think that having depression isn’t a serious illness that genuinely stops some people having a “normal” life? And then I thought, so what? Challenging people’s perceptions of my illness allows me to define who I am. Other depressed people may look at me and not be able to identify with me, but diseases put people in boxes, and I don’t want to be in a box.

Depression hurts and challenging it all the time is exhausting, and some days it overwhelms me, but I’m fighting to have the life I want in spite of my disease. Once upon a time I was fighting to be seen as an equal, as competent, as someone with more than just a massive label. I’d always go that extra mile to have a shining CV to prove that even with my illness that makes me want to hibernate, I am able to function. Then I realised the only one labelling me, is me. Even my psychiatrist and psychotherapist don’t talk about my depression – in fact I’m the only one who uses the D-word in my sessions. The author has a point, talking about mental health and seeing patients as normal people isn’t truly reflective of the severe cases of illnesses related to mental health, but talking to a Londoner on the tube isn’t truly reflective of every Londoner. I’d rather peo-

History Corner - Sir James Paget

Comics

Sir James Paget (1814-1899) has a birthday three days after mine, 11 January. Originally destined for the navy, at the age of sixteen he changed career paths and became the apprentice of a GP for four and a half years. In 1834, he became a student at St Bartholomew’s Hospital, where medical students were left to their own devices. Soon after joining he discovered the pathogen for trichinosis, a parasitic disease caused by a minute roundworm which infests the muscles of the human body. Qualifying in 1836 with the Royal College of Surgeons, he spent the next fifteen years writing for

medical journals, cataloguing the hospital museum, demonstrating morbid anatomy, lecturing, managing finances of the school and enrolling students. Paget certainly managed to do more in fifteen years, and if around today probably do far less with forty-eight hour working weeks. In 1847 he was finally appointed an assistant surgeon and became a professor at the Royal College of Surgeons, holding his professorship for six years, eventually becoming a Fellow of the College. By 1851 he was known as a great physiologist and pathologist. In 1858 he became the surgeon extraordinary to Queen Victoria. Al-

though achieving such success, he had kept himself poor for fourteen years in order to pay his father’s debts. He went on to have many more titles and accomplishments, giving lectures and publishing works, in the remainder of his very embellished career. In physiology, Paget had mastered the relevant literature in English, French, German, Dutch and Italian, and had used the microscope to be at the breaking edge of research of his time. In pathology his work was even more important where he made the subject dependent on the microscope. He also had the larg-

ple said they had a diagnosis but referred to themselves with whatever adjectives they like, even if it is “normal”, because I think people should be able to define themselves. Challenging stigma isn’t about showing the world that people with labels are competent, everyday people, but about saying, “yes I may have symptoms that you don’t have, but I also have interests you don’t have” and defining yourself how you want to be defined. I never thought my depression would get better, and now I’m learning to manage it and have the life I want in spite of it. I may have recurring symptoms for the rest of my life, but that’s ok because I’m not embarrassed to seek help, and I sure won’t let it dictate my life. I can say all of this on a good day, but on a bad day, it hurts. I’ll read this on a bad day and be thinking I’m talking out of my anus. You can’t

choose when to be ok, you can’t choose to change your symptoms, and you can’t choose to not have a diagnosis. And I acknowledge that. Everyone has their own challenges and their own approach, and mine is saying on a good day, “I choose to be ok” and on a bad day saying, “I choose to fight you”. To all those silently suffering with your own problems, you don’t need a label or a diagnosis or me talking out of my anus about how you can fight it. Only you can seek help and talking to the right people helps. Talking therapies has improved the quality of my life since I started treatment. Your biggest battles aren’t those around you keeping you down. It’s you. Define yourself. It’s blooming hard, but so rewarding.

est surgical practise in London with 17 hour days. He discovered Paget’s disease of the bones (osteitis deformans) and had two other diseases named after him: Paget’s disease of the nipple and extramammary Paget’s disease. Paget’s disease of the bone is a localised disease caused by the excessive breakdown and formation of bone, followed by disorganised bone remodelling. The affected bone weakens, resulting in pain, deformities, fractures, and arthritis of the joints close to the affected bone. There’s still no cure for the disease, but bisphosphonate and calcitonin medications are typically used to manage the disease.

All of this, as well as having a family, before dying at the age of 85. I wonder what part of his life most brought him happiness.

The

article

quoted

can

found

at:

http://

www.newstatesman.com/lifestyle/2013/10/ not-every-mentally-ill-person-poster-child-mental-illness

theMEDICALSTUDENT /April 2014

Doctors’ Mess Editor: Zara Zeb/ mess.medicalstudent@gmail.com

Prize Crossword

Diagnostic Corner

Types of Chest Injuries

1. What part of the ear funnels sound? a. Outer ear b. Pinna c. Helix d. External auditory canal 2. Where does the external auditory canal end? a. Tympanic membrane b. Middle ear c. Cochlea d. Semi-circular canals 3. Swimmer’s ear infects which part of the ear? a. Middle ear b. Ear drum c. Outer ear d. Cochlea 4. Which of the following is NOT a common symptom of Meniere’s disease? a. Vertigo b. Tinnitus c. Poor balance d. Hearing loss 5. True or False: a ruptured ear drum can heal within a few weeks. a. True b. False

ACROSS 1 Caused by penetrating injury (7, 5, 5)

6. True or False: Acoustic neuroman is a cancerous tumour. 7 Bleeding from intercostal arteries into lungs (11)

a. True b. False

3 Beck’s triad of symptoms (7, 9) 7. How can benign paroxysmal positional vertigo (BPPV) be treated? 4 Bony spicule penetrates lung causing air to be sucked into pleural cavity on inspiration, prevents air returning to bronchii on expiration (7, 12) 5 Whole sternum loosened by fractured ribs, with paradoxical inspiration and expiration chest movements (5, 5)

DOWN 2 Severe crushing chest injury causing extensive bruising and petechial haemorrhaging over head, neck, and trunk (9,8)

6 Can be caused by rib fracture tearing subcutaneous tissues into which air enters. Crepitation-like feeling on examination (8,9)

a. the Epley maneouvre b. Invasive ear surgery c. Non-invasive ear surgery d. There is none. e. Medication: non-steroidal anti-inflammatory drugs. 8. Retinoblastoma affects which part of the body? a. Brain b. Nose c. Ear d. Eyes 9. How many extraocular muscles are there?

ONLY ONE MORE FANTASTIC PRIZE TO BE WON! For your chance to win a copy of the Clinical Skills Explained (currently costing over £28 from Amazon) provided by Scion Publishing Ltd, simply send a photo of your completed crossword to: doctorsmess@themedicalstudent.co.uk

April... It’s the Study Season Make my inbox popular when you feel the need to procrastrinate. Drop me a hello, ask me questions, or send your contributions to doctorsmess@ themedicalstudent.co.uk.

a. 5 b. 6 c. 7 d. 8 10. Which of the following muscles is NOT innvervated by the oculomotor nerve? a. Superior rectus b. Inferior rectus c. Medial rectus d. Lateral rectus 11. Which of these muscles retracts and elevates the eyelid? a. Levator palpebrae superioris b. Inferior oblique c. Superior oblique d. Superior rectus Answers: 1b. 2a. 3c. 4c. 5a. 6b. 7a. 8d. 9b. 10d. 11a.

Congratulations to Paul Morillon from the University College of London for winning our Prize Crossword: Causes of Anaemia in our March issue!

theMEDICALSTUDENT / April 2014

[SPORT] /24

Sports Editor: Mitul Patel

VARSITY

Imperial

-Ethos Sports CentreVarsity 2014 got underway as Imperial drew first blood in a competition that they have not lost for years, as the Men’s Basketball tossed up ten days prior to Varsity Day at Ethos and the Medicals were overpowered 62-36. The first fixture on Varsity day itself, 12th March, saw the Netball 5s get proceedings underway, and as was the case last year, ICSM defeated IC. ICSM 4s dominated their match, leading 18-5 at half time and winning 39-14; spurred on by their injured captain, Dina Saleh, who easily turned centre passes and more than doubled ICs goals tally. The 3s followed, but the prospect of a whitewash again evaded the Medicals as they closely lost 35-31. The Polytechnics levelled the Netball two games a piece as the 2s game finished 42-25 in their favour, thanks to some favourable umpiring, and a physical game plan on court. The decider between the 1s started well for IC as the atmosphere in Ethos grew tense. However, ICSMs players remained calm and high pressure by Lindsay Hennah and Tally Shively in defence resulted in multiple turnovers. ICSM’s centre court players worked the ball up easily to Sophie Ellis and Frances Dixon who were prolific as the medics ground out a 42-33 win to end their season strongly having recently secured a long awaited league promotion.

ICSM Ladies Hockey 1s, now known as IC 1s (Medics) in action (left), whilst ICSMRFC 3rd XV contest the line out en-route to a 44-0 victory (right) ICSM wing Sammy Gottardi scored their third try after a turnover from Lizzie Robson and good work from Katherine Fok & Wakana Teranaka. ICs Alice Liberman scored in the corner after IC had reacted well to a loose ball from the Medic’s line out, and the game closed with one further score apiece; ICSM prevailing 26-10. The Men’s Rugby 2s & 3s fixtures kicked off simultaneously with differing fortunes for each. ICSM 2s took the early lead after Dan Campioni Norman gave a quick ball to Tom Howe at number 8, who accelerated towards the try line. However, the IC forwards drove over several tries in response to make the half time score favour the Polytechnics. The second half saw IC add to their lead before Tamos Martin scored a second try in vain for the Medicals, after good work from Ollie Wroe-Wright and the excellent Jamie Close. The match finished 29-10 to IC.

ICSM Rugby 3s were looking to win their first varsity fixture in 3 years on the back of an undefeated season. It was one way traffic as the 3s penned IC back into their half with some strong carries from forwards and backs alike. Laurence Pallant selflessly handed the ball to Joe Simmonds for the first try, with further scores coming fromJames Turner, who scored two fine solo efforts, centre Shaan Rashid, and Henry Clancy. The full time scoreline of 44-0 was hardly flattering as the 3s fine season continued. The most eagerly-anticipated Varsity in the Lacrosse Club’s history was a closely fought affair. The Medicals took a 7-5 lead into the last quarter. However, IC fought back, with their larger squad allowing rotation and fresh legs at the death. The match finished 9-8 to IC . Across the road, it was a less joyous day for ICSM Football who sadly failed to register a

goal against their well driven oppononents. ICSMFC 4s had the odds stacked against them, their counterparts being four divisions above them. ICSM decided to ‘park the minibus’ and made for a frustrating afternoon for the polytechnics. The game could really have been a win for the medicals, after the referee failed to spot a handball that would have otherwise left ICSM with a oneon-one, after a previous penalty shout was also turned down. IC 3s recorded a comfortable 2-0 win before the 2s kicked off and ICSM were hit with a string of injuries in the first 25 minutes which caused them to lose their shape. IC 2s gained control by scoring two goals in quick succession before the interval, and ended the tie after the ball fortunately dropped in the box giving their striker an open shot at goal in the second half. Things went from bad to worse as ICSMFC 2s progressed to

-HarlingtonThe Medicals went into the Womens’ Rugby 7s fixture with a point to prove having lost last year to IC for the first time in recent memory. ICSM drew first blood when Katherine Fok ran in under the posts and Charlie Stephens scored their second. ICSM were ahead 14-0 at the interval.

ICSM Netball Club pose after their Varsity victory (left, courtesy of Elizabeth Nally) whilst ICSM fall short in the Men’s Hockey 1st XI shoot out (right)

miss a late penalty, and the 1s were also the wrong side of a 2-0 result. The Women’s Hockey 2s match was close from the start with the score 1-0 to IC at the end of the first half. IC scored a fortunate second to pull further away, as the medicals were left to rue missed chances. In the same division for the first time in their history, the Women’s Hockey 1s game had added spice after the news on the night before Varsity that the medicals side would become “IC 1s (medics)”, having overtaken their rivals in the BUCS standings Not long after play began in the Womens Hockey 1s game, a flick was awarded to IC, but their centre midfield was no match for goalie Jessica Mistry. IC scored a beautiful goal into the top corner against the run of play to take a 1-0 lead at half time. The next half saw a drop in performance from both sides, and some sloppy marking lead to a scrappy second goal from the Polytechnics. Similarly, The Men’s Hockey 3s went into their Varsity fixture knowing that they would usurp Imperial to become the IC 5s. The first goal came from a good breakaway by IC, leading to a scrappy post finish. However the medics responded with one of the season’s finest goals - a top of the D reverse stick from Anesh Patel which left everyone in stunned disbelief. The end to end hockey continued in the second half and IC scored the winner as another break saw their striker drive the ball into the ground and take a lucky deflection off the keepers shin guard to just clip into the top of the net. After ‘GineSoc Gate’, the misogynist Imperial 2s team were all banned from playing this year’s varsity. This unfortunately led to a mismatch of ICSM 2s playing IC 4s. Despite a comfortable win of 6-1 by the medicals, there was very little decent hockey played. The final match of the day

[SPORT] /25

theMEDICALSTUDENT / April 2014

Sports Editor: Mitul Patel

2014 ICSMRFC 1st XV celebrate winning the JPR Williams Cup (photo courtesy of Sport Imperial) at Harlington [cont’n next page] was a high intensity affair between the 1s and the Medicals took the lead through Alan Kockerling, who drilled home from the top of the D. Josh Orpen Palmer kept the Medicals in front with an inspired goal line clearance and Simon Federer produced save after save as IC ramped up the pressure in the second half. However College pulled a goal back after a well worked short corner routine and from there neither side could take the match in normal time. Having taken the match on penalties the previous year, the Medicals were confident of repeating the feat but some impeccable shots from College combined with two misses from the Medicals meant the bragging rights went to the Polytechnics.

-The StoopThe highlight of the Imperial Varsity sees the Rugby 1s face off for the JPR Williams Cup. IC opened the scoring from a dubious penalty and it proved to be the only time they would lead in a one sided affair. ICSM responded well, particularly dominant in the scrum and they capitalised as scrum half Andrew Barrie powered over from a successful set piece, converted by Jonathan Super. After a penalty a piece, exWasps & England International Tom Rees touched down for

the Medicals’ second try, also converted. The half closed 20-6 after another late IC penalty. IC responded in the second half with one of their few successful lineouts; the maul collapsing at first attempt but trundling over on the second for a try that they could not convert. The Medicals dispelled any chance of a comeback as man of the match Oliver Clough touched down before veteran Chidi Nzekwue scored a fourth. It was a brilliant performance by the Medicals who, in truth, were deprived of a more reflective scoreline by an apparent willingness of the referee to award IC penalties. ICSM dominated the set piece, were fluent in possession and spent much of the game in ICs half. Varsity may have once again been won by IC, but the ICSM crowd enjoyed the final minutes as the 1s bought the JPR home, having been in the clutches of the Polytechnics for the past two years.

Merger Cup

Results

ICSM 7-12 IC

Netball 1s Netball 2s Netball 3s Netball 4s Netball 5s The Merger cup has been played ever since 1995 with the medics & dentists of Barts facing off against Queen Mary’s (QM). Wins are worth 2 points, and a further point awarded for a draw. QM, with their superior numbers were early favourites and holders, having only lost two of the titles since its inception. The first events of the 2014 edition saw the Regatta take place on 9th March between the boat clubs, with two victories for the more experienced and capable oarsmen of Barts in both the men’s and women’s division. The Indoor cricket followed on 10th March, and gave Barts 2 more points as they batted first to post 78 runs. QM replied strongly but could only manage 76 runs in the allotted overs in a nail biting finish where Barts held their nerve. The Watersports on the 13th March put Barts further in control, with points gained from both the swimming and waterpolo events. Whilst the Swimming was somewhat closer at 1.5-1 to the Medics, the waterpolo ended with an embarrassing 16-4 thrashing of QM as Barts went into Merger Cup day on Saturday 15th with a big lead already built. Queen Marys began the comeback trail in the men’s basketball at Qmotion sports hall, but had only one point to show from the morning’s hockey fixtures at Redbridge. The Barts Women’s 1st XI cantered to a 4-0 win and the men played out a 0-0 draw. The remainder of the points

would be played out at Chislehurst, where the women’s rugby added another 2 points to a growing Barts tally with the first victory. It was four points a piece in the netball, as QM 4s beat Barts 4s before a nailbiting finish in the Netball 3s game. Barts 3s had been 9-5 down at the end of the first quarter and withheld a QM comeback to finish 22-21 to the medics. The Barts Netball 2s also won but it was a disappointing finish for the 1s who lost despite a valiant comeback in the second half. Midway through the afternoon it was becoming apparent that QM would need to go more or less undefeated if they were to have any chance of holding on to the cup. Although the points were shared in the squash, Barts’ win became mathematically impossible for QM to close after the Rugby 1s and 2s completed a double over their non medical counterparts. The 1s had been fired up for this game having lost their unbeaten run the week before, and veterans Jeff Hopkinson, Dan Kearns & Mike Shaw gave the crowd what they were looking for as Barts warmed up for the UH final against rivals ICSM. With the result settled, the evening concluded with the remaining football fixtures. As was the case at Imperial, the larger pool of players at QM proved to be the difference once again, where Barts 1s earnt their only point with a hard fought 2-2 draw. QM 3s and 4s despatched their counterparts 1-0 and 8-0 respectively. The Merger cup came into Barts’ hands for only the third time as the Medicals won 29-24. We at themedicalstudent would like to congratulate everyone that took part and look forward to working with more of you as you aim to defend the title next year! Barts Netball 3s show off their lucky pants after winning a nailbiting game 22-21 (Photo Courtesy of BLSA Twitter)

W 42-33 L 25-42 L 31-35 W 39-14 W 28-20

Football 1s Football 2s Football 3s Football 4s

L 0-2 L 0-3 L 0-2 D 0-0

Rugby 1s W 37-11 Rugby 2s L 10-29 Rugby 3s W 44-0 Womens Rugby W 26-10 Hockey M1 D 1-1* Hockey M2 W 6-1 Hockey M3 L 1-2 Hockey W1 L 0-2 Hockey W2 L 0-2 *IC won on penalties Basketball M1 L 36-62 Lacrosse L7-8 Tennis L 4-8

BL 29-24 QM Netball 1s L (undisc.) Netball 2s W (undisc.) Netball 3s W 22-21 Netball 4s L (undisc.) Football 1s D 2-2 Football 3s L 0-1 Football 4s L 0-8 Rugby 1s W (undisc.) Rugby 2s W (undisc.) Hockey M1 D 0-0 Hockey W1 W 4-0 Boat M1 W Boat W1 W Basketball M1 L (undisc.) Indoor Cricket W 78-76 Swimming W 1.5-1 Waterpolo W 16-4

Contributors

Imperial: G. Azzopardi, J. Mae-Low, E. Williamson, K. Fok, W. Teranaka, T. Howe, G. Hill, T. Emms, A. Rossiter, M. Reissis, N. Sanchez-Thompson, C. Read, D. Tarr, P. Davis, E. Norman, J. Cooper Merger: BLSA & QMUL Twitter

[SPORT] /26

theMEDICALSTUDENT / April 2014 Sports Editor: Mitul Patel

UCL win Expanded London Varsity Mitul Patel Sports Editor Contributions from Sachin Sharma, Ben Meredeen & Jack Johnstone (KCL) The London Varsity series began in 2004 as a meet up between UCL and KCL Rugby 1st teams. UCL have since dominated the fixture, winning all but two matches against their London rivals. 2014 saw the universities extend the Varsity match up to include seven different sports; competing between 7th and 14th March, including the first ever inter-UH Varsity between the GKT and RUMS hockey first teams. GKT hockey’s men started well and controlled the game for the first twenty minutes. Theo Muth put GKT 1-0 up when he reacted first to a saved shot and smartly put the ball in. GKTs second came after Alex Wells brilliantly put in a reverse stick hit taken first time, which kissed the inside of the post on its way into the goal. RUMS responded well and were awarded a penalty flick that was brilliantly saved by a diving stick from Dan Curley. The game opened up in midfield and it developed into an end to end tie. RUMS managed to nick a goal just before half time after some swift attacking plays to leave the fixture finely poised at half time. The second half started at a lighting pace. The fitness of the RUMS team began to show as they applied sustained pressure for the majority of the second half. The RUMS breakthrough

came after a short corner. A flick smartly saved by Curley fell loose into the D and was quickly put away by a RUMS stick, which levelled proceedings with ten minutes to go. After 70 minutes there was nothing to separate the two sides so it would have to be decided by penalty flicks. Alec Dawson put the first away to the top left and Curley saved RUMS first effort to give GKT the upper hand. GKT claimed the victory after Muth put away the last, and GKTs 7th. 2-2 on the night; 7-6 after the shootout. In the women’s matchup RUMS scored a last minute winner in a match that failed to live upto expectations. After a dull first half, both teams had efforts saved on the line in the second. It evolved into a flowing game as both teams strived for the winner, which ultimately came from RUMS in the 78th minute when a penalty corner ended with a goal in the bottom corner. Recently, themedicalstudent covered the King of the Ring exhibition event hosted by KCL Muay Thai Society, and they came out on top again in the London Varsity Series. The first fight on 9th Marchwas between Philip Mosquera and Basil Ng. Mosquera was cool in his defence, and clinical in attack to take the first fight

KCL 5 - 8 UCL GKT Hockey M 2-2 RUMS* GKT Hockey W 0-1 RUMS *GKT won on Penalties

for KCL. The second fight saw Parvez Samnakay defeated by Jonathan Pearson from UCL. Kirk Geier and Dominic Mee han fought out the third, and Geier quickly gained the upper hand with several rib shattering kicks. Although Meehan put up an extraordinary display of stamina, and ensured that Geier would walk with a limp for the next few days, Geier took the win to put King’s back in the lead. The next fight between Philip Strand and Freddie McNicholas, won by UCL on points, levelled the score once again, at 2-2. In the decider, Inti Raymi from KCL and Hong Chun Leung from UCL displayed the type of technique and talent seldom seen outside of professional competitions, The first two rounds were too close to call, but Raymi dug deep in the closing rounds to give KCL the victory.

KCL Hockey M 4 - 3 UCL KCL Hockey W 4 - 1 UCL KCL Netball 14 - 53 UCL KCL Muay Thai 3 - 2 UCL KCL Taekwondo 4 - 5 UCL KCL Waterpolo M - 6 - 5 UCL KCL Waterpolo W - 9-12 UCL KCL Fencing M 93 - UCL 129 KCL Fencing W 83 - UCL 135 KCL Rugby M 9 - 16 UCL KCL Rugby W 7 - 10 UCL

Bu Hat-trick sees off Vets Mitul Patel Sports Editor RUMS Hockey 1s fought out the BUCS SE Conference Cup Quarter Final against the Royal Veterinary College this month at Potters Bar. The game started off openly but RUMS’ quality soon began to show. A stream of passes into the RVC D gave Chris Bu a chance to slip the ball to returning striker Hamish Miller on the right post, making the score 1-0. This was followed by a flick to the top left corner, deflected in by Bu to give RUMS a 2 goal advantage before the end of the first half. The 2nd half continued much as the first with RUMS back

line encroaching on the halfway line, boxing RVC into their own D. Striker Adam Muse added a further 2 goals to the tally with both a straight strike and a deft deflection over the keeper’s stick. RVC were forced into the counterattack and at times the ball was aerieled high over the RUMS defence. However, RUMS GK Harry Bamber was quick to charge out to the edge of the D when necessary. A frustrated RVC looked out of ideas and captain Chris Bu scored another 2 goals, completing his first RUMS hat-trick in the process.

GKTWFC Denied contd from back page Secondly, BUCS offer a neutral ground in management. Leaving captains in control opens the door for strategic foul play as they aim to manage fixtures in a way that would benefit their own club in the long run. Thirdly, if BUCS were to allow captains to organise their own fixtures, it may be seen as a step back and would further call into question the integrity and reliability of the organisation, which they can hardly afford in the context of the ongoing furore regarding the medical school-parent institu-

tion merger. Lastly, there is of course an argument to say that captains are as likely to make administrative errors, if not moreso, than full time dedicated employees. Nevertheless, if the hard work of teams like GKTWFC continues to be undermined by circumstances such as these, which are largely beyond their control, it will inevitably affect players’ attitudes towards and participation in their respective sports, particularly BUCS fixtures. If the fair, correct and efficient management of fixtures is truly too big a task for a union to handle, on top of their other

responsibilities to each sports club, either more people need to be hired or the procedures involved in fixture management need to be overhauled. Furthermore, it is not reasonable for communication between teams and BUCS to be a limiting factor in their ability to manage fixtures. For instance, LUSL are aware of captains’ contact details and therefore communication is not limited to office hours in events that pose administrative concern. A similar arrangement with BUCS would not require additional effort and would be a prudent initial stage in moving forward in unison with sports clubs.

After a hard season, GKTWFC 1s are again at the top of their BUCS league and, if all goes according to plan with the administration, should obtain promotion. At the end of the season it is imperative that they, and all other teams, concentrate on the sport rather than administrative errors. If General Regulation 12.1 cannot be altered, BUCS need to find ways of improving their management of fixtures because the middle man currently adds more frustration and stress than value and assistance to university sport.

Write for Sport! The Sport section is always looking for more writers to contribute to the paper,: email us at sport.medicalstudent@ gmail.com

[SPORT]

theMEDICALSTUDENT / April 2014 Sports Editor: Mitul Patel

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ICSM Reclaim Historic UH Cup Mitul Patel & George Hill Sports Editor & Guest Writer The 128th UH Challenge Cup brought victory to ICSMRFC, who followed up winning the JPR Williams Cup by taking the oldest rugby trophy in the world away from holders Barts. The history of the competition dates back to 1874 when Guys RFC put their name on the trophy first ahead of Georges. In more recent history it has been a competition dominated by ICSM, with the West Londoners winning 11 of 15 titles since Imperial College devoured the St Mary’s medical school in 1999. Reigning champions Barts beat Georges in the 2013 final to become the first team apart from ICSM (or its historical constituents) to retain the trophy since the 1976/1977 season. They went into the final on a rich vein of form, undefeated for a large part of their season until a close 38-32 loss at the hands of a strong Brunel side prior to their Merger Cup fixture in March. The draw gave the holders a buy into one semi-final, as they awaited the winner of GKT and RUMS. The second semi-final drew ICSM against

Georges. The quarter final was delayed following the winter’s rainfall and waterlogged pitches, but finally took place on 16th Februaryat Blackheath Rugby Club. Sadly, it was far from a contest as RUMS demolished GKT 33-5. RUMS, whose only victory in the competition came from its constituent Middlesex Medical School in 1887, knew they had an uphill task against a strong Barts side. The semi-final at Chislehurst on 2nd March played true to form with a 35-15 win for Barts as they made it into their third final in succession and completed their second win against RUMS in five days. The second semi-final was a scrappy affair where the conditions and officiating had more influence than the players as neither ICSM nor Georges scored a point when attacking a strong wind. The talking point of the first half came as Georges broke the ICSM line by evading two slipping defenders and sent the ball down the left wing. With Georges 2 against 1, their number 11 thought he had gone over for a try only for the

officials to rule out the score for a forward pass. Georges were incensed on what must have been a close call given that the wind would have carried the pass forward, but finished the half strongly by adding two penalties, the latter a beauty from 40 yards. The change of ends brought a change of fortunes and ICSM made early inroads into Georges 9-0 half time lead with an early penalty. ICSM repeatedly kicked for territory with the wind and scored two tries, both of which were converted impressively by John Super. Georges were further frustrated as a second try was ruled out, and the closing stages petered out unremarkably; ICSM winning 17-9 to set up the final with Barts. The final was played at Richmond RFC on March 21st, the crowd roared on by the infamous Mary’s Fairy, who unfortunately failed to see the final whistle . ICSM started dominantly with an early penalty from the boot of Super, and scored the opening try through prop Adrian McGrath after some dominant forward play. Barts, ridden with inju-

ries, struggled to cope with ICSM and had their number 12 binned for persistent foul play. Things went from bad to worse, as veteran Jeff Hopkinson also had to leave the pitch for a blood injury. ICSM went into half time 13-0 ahead after the second try from number eight Marc MacMillan, the first of three fine solo efforts from the eventual man of the match. Barts rallied after the interval and scored two early penalties from range to make it 13-6. The lead threatened to get bigger as ICSM lock James Morris thought he had broken the line only to be brought back for a forward pass.

After a penalty from Super, MacMillan ended the game as a contest with two scores to complete his hat-trick, the third after a clever turnover following a solid spell of possession for Barts. At 30-6, the ICSM faithful were jubilant, singing ‘we haven’t even played Tom Rees’, the former Wasps and England flanker who was so influential, and as badly injured, in their recent Varsity triumph. The win was the 51st for ICSM and its historic constituents, eclipsing the record of 50 that was previously held by the cumulative total of Guys, Kings & St Thomas’.

BUCS Deny GKT Once Again Juli McCulloch Guest Writer Earlier this year The Medical Student reported on how administrative errors deprived ICSM of winning the UH Tennis cup in a farcical scenario involving the deadline for submission of results and allegations of foul play. Unfortunately, a similar situation has arisen for Guy’s King’s and St Thomas’ Women’s Football Club (GKTWFC), who have now been denied both league promotion and progression in a cup round because of administrative mismanagement by BUCS. Fixture management by BUCS is adjudicated by their sports management department, which means that competing teams do not actually communicate with each other

until the day of a fixture. Whilst it would seem counter-intuitive, BUCS’ General Regulation 12.1, states that administration of fixtures must be the responsibility of the “Athletic Union or equivalent bodies/person”. Whilst a single office handling fixtures for a single university may sound straightforward, in practice it does not always work in the way that BUCS intends. At King’s College London Student Union (KCLSU), the sports coordinators handle upwards of sixty BUCS-competing teams a week and the inevitable mistakes via human error are limited by the captains in question constantly staying in contact with the coordinators during office hours. However,

recent mistakes involving GKTWFC extend beyond the protection that human error may explain, and have had serious ramifications. In 2012/13, GKT ladies 1s were heading towards promotion from their BUCS league. Despite numerous reminders, the sports department at KCLSU failed to inform the opposition in question that GKT 1s were also playing in the BUCS South Eastern Conference Cup final, which clashed with the last BUCS league fixture of the season. Subsequently, a walkover was given and GKT 1s fell to 2nd place in the league following the docked three points, and ultimately missed out on promotion.

This season, GKT 1s were knocked out of BUCS South Eastern Conference Cup early, due to a similar administrative error. After the sports coordinators failed to confirm the fixture against Kent Ladies 1s, despite incessant reminders from GKTWFC, Kent showed up to play GKT 1s, without GKT 1s ever being informed. In a move that was rejected by BUCS, GKT WFC wanted to take control of their own BUCS fixtures, arguing that they independently manage their own London Universities Sport League (LUSL) fixtures without these administrative issues coming into play. Several other GKT teams and other UH captains feel the same frustration

as a result of the middle man. From BUCS’ point of view, relinquishing control over fixtures poses problems. Firstly, and most obviously, they would have no direct link to the management of fixtures, and would rely on captains themselves – and, as demonstrated by the UH Tennis scandal, would have no control if they were not contacted by one or both captains of a given fixture. | contd inside