MS_December_2011 by The Medical Student

the

medicalstudent The voice of London’s Medical Students

December 2011

International MedSoc Conference report Page 4

Civic Hospital - medical students in Pakistan Page 8

Summer in the Sahara - a heated guide Page 12

The NHS Strikes Back Rhys Davies

On Wednesday November 30th, two million (according to their unions) public sector workers went on strike to protest the government’s planned changes to their pensions. The changes include workers paying more into their pensions, retiring later, and only receiving a ‘career average,’ effectively reducing how much they will be paid. If the amendments go ahead as intended, a junior doctor can expect to pay in the region of £200 000 over their working life. These were the biggest strikes for a generation. The last time the nation witnessed strikes of this scale was back in 1979. The NHS is the one of the largest employers in the world and, for the time being, is still very much a part of the public sector. Ultimately, the

BMA decided not to strike but some hospital services were affected. Near- ly a quarter of all elective operations were cancelled and many nurses, ambulance staff, radiographers, porters and cleaners joined the picket lines. Hospital chiropodists also walked out but their absence was less noticeable. The strikes that took place in Lon- don and across the country were in response to proposed changes to most public sector pension schemes. The NHS pension scheme that doctors pay into was not included in these changes. However, they are subject to a different set of changes that are equally unpopular with the physicians on the ward. These changes still include the unpopular ‘career average’ pay-out. In response to these changes, at their annual conference in Cardiff back in June, the BMA voted overwhelmingly in favour of a referendum on wheth-

er doctors should strike. As a result of this, they will ballot their 140 000 members on their views on all forms of industrial actions including the extreme decision of striking. Doctors see no need to reform their pensions as currently the NHS pension scheme comes in under-budget annually, providing £2 billion surplus for the government. Many students may not have noted the recent strikes if, depending on their lecturers, their day carried on as normal. However, this is an issue that students should be concerned about. As the future workforce of the NHS, they will likely be affected by the changes first. With many personal pensions paying out more for less, the government-required pension is effectively a tax on the public sector. Medical students have already proven themselves keenly inter- ested in the political machinations

about them with the massive protests over tuition fee rises last year. These changes may not affect them quite so immediately or directly but they are still important. Doctors cannot in conscience abandon their patients in times of protest. However, a cynical government could use this as- pect of the caring profession against them, and strong-arm doctors’ leaders into unfair deals knowing that they have no threat of action to fall back on. Furthermore, strike action by doctors could lose them the trust of their patients and the wider public. This would be tragic as polls consistently place doctors as the most trusted profession. Whether or not it is ethical for doctors to strike, medical students must step in to support to their seniors and tutors. 2011 has proven itself to be a busy year for public demonstrations and protest. (cont’d on page 2)

Christmas in London - a guide to festivities Page 18

Can cancer cause a cackle? Page 22

December 2011

News

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News Editor: Ken Wu news@medical-student.co.uk M Alexander Shimmings GKT Medsoc President Things at GKT have been very busy of late. November saw the return of the much-despised-by-KCLSU event ‘Beaujolais Nouveau’. For those not in the know, this French event celebrates the bottling of the new Beaujolais grape, which at GKT (and previously St Thomas’) we traditionally celebrate by buying as much of the year old vintage we can find in the Hypermarches of Calais and shipping it back to London. Consumption of copious amounts of this wine, combined with french fancy dress and seemly endless quantities of cheese, bread, onions and garlic results in what can only be described as primi- tive biochemical warfare. All who at- tended left with a feeling of fulfillment and soft cheese clinging to their skin. St Thomas’ Rugby Club has recently been revived for a tour down to South-

Editor-in-Chief John Hardie on his last Medical Student issue

ampton to play their medics, which they won. GKT Hockey Club also man- aged the feat of a tour to Edinburgh. Progress is being made with KCLSU regarding increased health school representation in Student Council. Also on the cards is a referendum which should secure the future of seperate GKT sports teams, allowing us to focus our attention on the infamous BUCS issue

George Ryan BL President Last weekend Birmingham hosted the National Medsoc Conference, an event which saw medical Students’ Unions from all corners of the UK descend upon Birmingham Medical School for a weekend of key note speakers, hot debates and some good old fashioned debauchery. One topic was the movement towards implementing a national exam for all final year students, something the audience of medical representatives were unanimously in favour of. However, the practicalities have not yet been ironed out. Barts and The London is one of 13 schools involved in developing this exam. The first set of questions which could make their way into the exam were released to all 13 schools and the overriding feeling from BL is that these questions were below the standard we set for our final

year students. Agreeing to take part in the process as it is would only lower the academic standard of our students. Sunday afternoon of the conference saw both BL and ICSM make a bid to host the next conference and I’m very proud to announce BL were successful. This is a huge opportunity to bring medical representatives from all over the UK to London and showcase what we have to offer, I’m looking forward to it already!

and run off to become FY1s. Joy. By February the next year, the new team was assembled and ready to go. It was a miracle that the first issue got to print. After an all-night, eighteen-hour session, we sent the paper to the press- es an hour late. We were printing on the same press as the Daily Mail who were threatening to oust us entirely because of our apparent inability to function as reasonable human beings. The next day we fell asleep in our firms, our lectures, in the shower and our plates of food at lunchtime (seriously). But, despite the adversity, we’re still here a year later. Well and truly. We’ve distributed 35,000 print copies around London, had 164,010 unique online page views and printed 284 original articles. That’s quite an achieve- ment for a group of full-time students. On a personal level, there have been some major perks to being the Editor. Namely, the items sent to me to review. These have included brain tumour removal tools, Marx- ist propaganda, and a SheWee. Finally, I’d like to offer everyone who has contributed to the newspaper over the past year my sincere thanks, whether the contribution was small or large. It has been a genuine pleasure

working with you. Congratulations to Purvi Patel who has been elected Edi- tor-in-Chief 2012. Long may the paper continue to thrive under her leadership. Also, a little apology to the male members of the committee - I’ve sent a total of 10,168 emails over the past year, making such excessive use of your laptop’s Wi-Fi that your sper- matozoa DNA has possibly been damaged somewhat. Sorry chaps

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(cont’d from front page) protesting in Tahrir Square on January 25th. The wave of disenchantment with the rul- ing powers spread to Spain with protes- tors taking up residence in the Puerta del Sol f rom the 15th May. All summer, Greece has seen protests and riots in response to its government’s handling of their national debt. This autumn has been marked with Occupy movements camping out in the financial districts of the world’s largest cities. Closest to home, the Occupy St. Paul’s movement

Nana Adu SGUL President This week has been cold! I have no heating in my office and my ward- robe is full of shirts and light hoodies. Despite the cold, a lot has been going on at George’s. We have had our ‘Diwali Show’ and it was epic. The acting was superb, the dances were slick, the singers were in tune and the crowd were more than pleased. My next memorable outing was ‘The Battle of the Bands’ It’s amazing how for such a small university, we have more talent than the all the other universities in this spread combined. You would think the I’m jok- ing but if the talents of the other presidents are anything to go by, then let’s just say there is a lot to be desired for. ‘The Fashion Show’ is currently happening as I am writing this. Just like the Diwali Show they have been put- ting in crazy hours of hard work and

s this is my final column as Editor-in-Chief and the final issue of the year, I hope you’ll allow me a little in- dulgence. I also have a few confessions to make, but we’ll come to that later. In December 2010, I was appointed Editor-in-Chief of the Medical Student newspaper. The Medgroup president carried out interviews after a formal application process. He waxed lyrical about the grand history and successes of the newspaper. I was impressed. I had great ambitions. I was convinced that this publication would change the lives of London medical students forever. Two weeks later I sat there with nothing but a (broken) laptop, some hypothetical funds in the bank to ‘get us going’, and the offer of free black and white A4 printing. My brief was to ‘Produce an A4 newsletter… or something…by next month’. I had no idea how to use design software, I’d never written a journalistic article in my life, and thought that a ‘sub’ was something ordinarily confined to the bedroom. To top it all off, it turned out that the paper hadn’t actually been printed the preceding year or two at all as the previous team had stolen the contents of the bank account

it is nice to see everything come together to form an awesome show. To top off an amazing year, we have pure entertainment lined up by ‘The Revue’. So essentially, we have had a dancing, singing and acting galore at St Georges whilst I have been freezing! My only wishes this Christmas is that RAG goes well next term and that our sorry excuse for a website magically changes

the

has been protesting in the City of Lon- don for 48 days, at the time of writing. The strikes on November 30th mark the latest chapter in the book on dis- content with the UK government’s in- creasingly unpopular policies. We have already seen the dramatic student protests this time last year over the rise in university tuition fees. The government responded to this by doing what it always does, which is nothing at all. Earlier this year, thousands of people came out in force on the streets to

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defend the NHS from the proposed reforms of Health Minister Andrew Lansley. In response to this, the government convening a ‘listening pe- riod’ during which they…did nothing. It is all very well protesting for what we believe in;; universal, affordable higher education, free, equal healthcare for all and decent treatment of our workers and pensioners. However, these demonstrations will have limited effect on a government that persistent- ly proved itself deaf to all criticism

Editor-in-chief: John Hardie News editor: Ken Wu Features editor: Bibek Das Comment editor: Rhys Davies Culture editor: Kiranjeet Gill Doctors’ Mess editor: Rob Cleaver Assisstant editor: Amrutha Sridhar Treasurer: Alexander Cowan-Sanluis Sub-editors: Alex Isted, Image editors: Chetan Khatri, Purvi Patel Distributing officer: Sevgi Kozakli

medicalstudent

December 2011

News Gareth Chan RUMS Senior President

Imperial, UCL and King’s AIDS HIV with Pub Crawl Tobi Issac Obisanya Guest Writer Medsin Imperial have just finished running Positively Red Week 2011: ZERO. There were events every day of the week to engage, involve and mobi- lise students in the fight against AIDS. Monday marked the inter-university Central Line Pub Crawl, with students from King’s, UCL and Imperial bat- tling it out to raise the most money for the Terrence Higgins Trust. Starting from the South Kensington campus and visiting 12 pubs along the Central line money was raised for HIV/AIDS. King’s and UCL students, preferring to be in a lecture theatre rather than affecting tangible change in the world, raised the g rand total of £0. Impressive. Followed by a night out in Tiger Tiger with everyone coming on the Medsin guest list raising money for AIDS, the week started in style & somnolence. On Wednesday, a debate entitled ‘Do we give too much AID to AIDS?’ took place in the Imperial Tanaka Business School. It saw Medsin Impe- rial’s patron Professor Alan Fenwick, an advocate for Neglected Tropical Diseases, argue the point that a dis- proportionate amount of global fund-

ing is given to AIDS against three ex- perts in the field of HIV and infectious diseases. On Thursday - World AIDS Day 2011, a projection of the red rib- bon, which has become the symbol for AIDS awareness, was projected onto the iconic Queen’s Tower on the Impe- rial South Kensington campus. On Fri- day a special kind of auction was held in ICSMSU’s Reynolds bar, by friends auctioning off their particularly hot friends to be ‘slaves’ for the evening… Yes, you missed it. Finally, the week came to an end on Saturday with a smashing ‘Red Rave’ at Imperial’s new club, Metric. With many students de- bating and fundraising for AIDS over the course of the week this is just one of the ways in which we can contribute to the global struggle against HIV/AIDS. Positively Red Week was organised all in the name of raising awareness for AIDS and to dispel common misconceptions such as: ‘Do people still have that thing?’, ‘I thought it was some disease that they discovered in the 1980’s because people were getting frisky with monkeys?’, ‘Is it that the disease you get when you’re gay?’ Unfortunately, HIV/AIDS is a very tangible ‘human’ disease present within all socio-economic groups, sexual orientations and ethnicities that causes

a significant burden of disease within the developed, and most especially the developing world. Similarly unfortunate are that false ideas and preju- dices about AIDS and those who suffer from it still exist. Eliminating this, along with getting to zero new infections and zero AIDS related deaths is the theme of this year’s World AIDS Campaign. With 2011 marking the 30th anniversary of the discovery of the AIDS virus, there could never be a more relevant time to discuss and raise awareness and money for these issues. Since its discovery HIV has in- fected over 60 million people and 34 million people are estimated to live with the virus today, with 2.6 million new infections a year. In a recent press conference, Hillary Clinton, encouraged by the 96% efficacy shown by the newest ARV’s (Anti-Retroviral drugs), stated that we have an opportunity for the first time ever to create an ‘AIDS-free generation’. However, with the current economic climate and the pressures placed on governments to cut back spending on international aid paired with sentiments that AIDS is over funded (David Wilson, World Bank Global HIV/AIDS Program Di- rector), there is doubt to whether or not this will ever become a reality

By the time this edition goes to print, we will have kick started the festive season with our sell out RUMS Win- ter Masquerade Ball. I can confidently say that it will be the highlight of the year so far! Our RUMS Sports teams’ tours have also kicked off in earnest with hockey heading off to Bright- on, football to Sheffield and netball to Leeds. I hope life in our host clubs are slowly returning to normality! Back in Bloomsbury, work is continuing with the medical school on the Raising Concerns website which allows students to highlight cases of unprofessional behaviour. With an up- coming meeting with BUCS and all

the London Medical Schools in Car- diff, we will continue to lobby BUCS and our parent Students’ Unions for the continued presence and protection of medic sports teams and their independent participation in BUCS leagues

Suzie Rayner ICSM President November has been hugely busy amongst the Clubs and Societies of ICSM and thus I am dedicating this column to their activities. I expect that December will follow the trend of Imperial continuing to annihilate all other UH med schools in the sheer number of events that we manage to run. They are not only of magnificent quantity, but fantastic quality as well. Drama has been particularly active, managing to put on both the Freshers’ Plays and the Autumn Play of ‘Guards! Guards!’ within 2 weeks of each other and both to an impressed audience. Music Society has also been very busy, with both Choir and Orchestra concerts performed and the Carol Concert coming up on Sunday 12th December. Light Opera are rehearsing hard to put on ‘The Producers’. Fortunately the cast are not quite as un-PC as the show itself otherwise Fitness to Practise could definitely become an issue in the future. They will be performing from 5th-10th De-

cember at the London Oratory School. ICSM has also opened its doors this month by hosting international conferences in the form of ICSM Surgical Society’s Trauma conference as well as providing outreach to prospective students through ICSM Vision’s Junior Conference. So that you are all aware, it appears that future editions of this paper may have an ‘Imperial slant’ with the vast majority of the editorial team now coming from us – including the new editor-in-chief (congratulations!). The rest of you need to pull your socks up.

Jeeves Wijesuriya UH President

Human banner. Image by Tobi Issac Obisanya

2011 has been a mammoth year for the United Hospitals. It has seen the new 9k tuition fees, the Health and Social Care Bill, the new pensions scheme and possibly most importantly, the New Old UH relaunch. We have fought together against a BUCS bid to amalgamate medical and dental sports teams, fought for clarity on situational judgement testing, and increased allocation of services to medical students in terms of not just welfare support but financially. We are very proud of what we achieved this year and in fact are now consulting with Edinburgh, Glasgow, Cardiff and Swansea to create similar UH t ype organisations. We also headed to Birmingham for the National Med- Soc conference, acquitting ourselves well and setting the standard for other medsocs in terms of effective representative organisation. Sadly Nana,

our Georges president couldn’t be there: he cited ‘womens problems’ as the main reason. I would add my best wishes go out to Nana, I do hope the thrush clears up soon. Apparently it has been catching: Mark Shimmings had a similar problem, and I’m sure could provide both help and support. I look forward to seeing you all in the coming year, and hope you will all be getting engaged with the UH cam- paigns and BMA events coming up!

December 2011

News

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ICSM battles Barts at MedSoc conference

Birmingham: for one week only it’s the city of medics

Seetha Muthalagappan and Ali Hosin Guest Writers On November 26th and 27th the annual International MedSoc Committee Conference was held at the Birming- ham Medical School. The weekend was packed with useful lectures, discussion groups and workshops, all aimed at helping us to improve the running and organisation of MedSocs (and medical Students’ Unions) around the country. The ICSMSU sent five of its offic- ers to attend the conference weekend. They were warmly welcomed by Bir- mingham’s MedSoc, and the keynote lecture followed soon afterwards. It was delivered by Dr Adam Feather. Dr Feather is currently the Senior Lecturer in Medical Education at Barts - argu- ably better known as author of the hal- lowed ‘EMQs for Medical Students’ series. Topics discussed included the changing of final year exams and job applications. All medical students will be taking the Prescribing Skills As-

sessment (PSA). This will signify another step towards a national exam in addition to the standardisation work of the Medical Schools Council Assess- ment Alliance (MSC-AA). The Situ- ational Judgement Test (SJT), which is becoming a part of FPAS (Founda- tion Programme Application System), was also discussed at great length, with example questions provided. Dr Feather also emphasised the impor- tance of peer teaching and the necessi- ty of strong links between students and Faculty. It was noted that ICSM does this rather well with our comprehen- sive academic representation system and hard work carried out by MedEd, Muslim Medics and other societies. Everyone at the conference at- tended various workshops and discussion groups relevant to our Student Union roles. There were discussions and workshops on leadership, spon- sorship, Clubs & Socs, website design to name but a few. Most were led by leaders in their respective fields and others by ex-Presidents of Birming- ham’s own MedSoc. One of the design

workshops gave a special mention to the ICSMSU website as an example of a particularly well designed website.

“The MedSoc also introduced everyone to ‘Heidi’ - a concoction which was sweet at the time, but not the morning after!” The benefits of these discussion groups and workshops were vast – it gave everyone an insight into what other MedSocs are up to, as well as providing a platform to discuss issues or problems that people have been experiencing and also to find solu- tions to improve our own MedSocs. A medical student conference is not complete without it’s socials the this one was no exception. After a deli- cious dinner at Pizza Express on Broad Street, Birmingham’s MedSoc took us to Bliss, where all the participants received free champagne on arrival and

VIP entry and there was even a cam- era crew outside the nightclub. The MedSoc also introduced everyone to ‘Heidi’ - a concoction which was sweet at the time, but not the morning after! The night out further strengthened the ‘connections’ made between the different MedSoc members earlier in the day. The second day saw lectures on leadership in the clinical setting and men- toring programmes as well as speeches from GMC representatives. The talks were interesting and thought-provok- ing, and relevant to both our current representational roles and future jobs as doctors. A research opportunity was also advertised by a Birmingham medical student: ‘Do the number of hours spent undertaking extracurricular activities impact on g rades?’ Birmingham MedSoc are hoping to get data from all the medical schools across the country and then write it up as a publication. Throughout the second day, each MedSoc had to give a poster presentation in an inter-medical school competition. There were some very impressive posters and pitches by all of the medi-

cal schools but in the end, Birmingham medical school was judges to have delivered the best poster presentation. At the end of the conference, there was the all important decision of which medical school would host the next MedSoc conference. This resulted in an interesting UH battle between Barts and ICSM. Both medical schools gave very convincing pitches. Finally it was an- nounced that Barts had won the bid to host the next conference. Some specu- lated that a deciding factor was because the Barts campus is in East London, where the Olympics are happening. On the whole, this was a fantastic weekend, and a massive thanks and congratulations goes to Birmingham MedSoc for doing a such superb job in hosting the conference. The keynote lectures, discussions and workshops were hugely beneficial to everyone, and it was a really useful experience shar- ing aspects of best practice with one another. It was a genuine pleasure to meet everyone from the other MedSocs and hopefully everyone is already looking forward to next year’s conference

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December 2011

News

Diary of an FY1 Junaid Fukuta on 12 rounds with Mike Tyson

ith my first night on call looming, this pe- riod of the day usually reserved for partying and sleeping takes on a whole new feel. Many of my colleagues have already done their set of nights and I had asked around to see how they found them. The answers ranged from sleeping for six hours in the mess to feeling like you had just finished 12 rounds with Mike Tyson, so in summary it looked like anything could happen. So I changed into my scrubs, donned my stethoscope and loaded my folder with three cereal bars and stepped into the unknown. I entered the handover room with the day team handing over jobs to the night team and

started writing my ‘to do’ list. After 30 minutes it seemed more like a ‘never ending’ list as I entered the details of bloods to chase, patients to review and drugs to prescribe. Then in a flash the day team vanished and I was ready to hit the wards. Well I was until my bleep went off. As I responded to my bleep and take the details of yet another patient to see my bleep goes off again! I then spend the next hour an- swering bleep after bleep literally unable to leave the phone as seemingly every ward in the hospital needs someone to be reviewed. So as my never ending list gets even longer, I feel like I am going to have a night more akin to 12 rounds with Mike Tyson, and I have only just finished round one.

The bleeps finally finish and I dash off to hit the wards.

“I saunter off the ward with my head held high and my chest puffed out. I want to go tell someone what a good job I have done but as I leave I notice something about nights: the hospital is eerily quiet” When I arrive at the first one, the scene I am confronted with seems sim-

ilar to something from the 1800s. It is an open plan ward with rows of patients all sleeping, the lights are switched off except for one desk lamp located at the nurses’ station. All that was needed to complete the scene was a nurse with a candle to approach me. I squint my eyes as a nurse approaches out of the darkness, but rather than a candle, she is holding an obs chart for a patient very short of breath. Luckily my stint of nights have happened quite late into my rotation so I am now used to seeing sick patients. I quickly decide that this very short of breath patient has probably gone into flash pulmonary oedema, so the protocol now drilled into my head kicks in and I reel off my standard list of investigations and

Cereal bars: the food of champions

make a plan. The patient picks up and so does my confidence. I saunter off the ward with my head held high and my chest puffed out. I want to go tell someone what a good job I have done but as I leave I notice something about nights: the hospital is eerily quiet. Dur- ing the day there are literally hundreds of nurses, porters, relatives and doctors bustling about the hospital like a beehive but during the night, it feels like a ghost ship. So I saunter on like a shadow moving from ward to ward having to contain my little bit of pride as there is literally no one to talk to. 4:00am comes surprisingly quickly. The wards are all locked down, my jobs list is finished, and I haven’t had any bleeps for an hour. My body has stopped resenting me for not being in a warm bed and there is complete si- lence. I am unnerved and unsure what to do;; never in my past four months at work have I not had anything to do. I wonder through the hospital like a lost soul and this feeling of being alone is new and uncomfortable. 6:00am ar- rives and like a bear coming out of hibernation the hospital starts to stir. The nurses filter in for the start of their shifts and the traffic outside starts to build up and right on cue the bleeps start up again. Now, the problem with the early morning bleeps is that you are extremely cranky and with all the ward teams arriving soon it takes something very serious to get you to go and review something. I start to run something akin to an NHS direct service handing out advice over the phone and by 8:30am the cavalry arrive and I know I am on the home straight. Finally at 9:00 my shift is over and I handover my bleeps to the day team, head back to my empty house, chow down some cereal and then head to bed. There is a feeling of loneliness but there is also a g reat feeling as you know that whilst you are sleeping everyone else is at work. It’s the little things that count on nights

RUMS

SGUL

Calendar of Events

GKT

ICSM

Christmas Concert

ICSM Light Opera ‘The Producers’

8th December

5th - 10th December

Snow Party

9th December

Carol Concert

11th December Snow Ball

12th December

Xmas ‘Naughty or Nice’ Bop

16th December Ski trip

16th - 24th December

Winter Masquerade Ball

5th December

December 2011

News Saved at the ICSM Trauma Conference

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Research in brief BL: Researchers at Bart’s have discovered five new genetic variants associated with blood pressure. Analysing data taken from over 25,000 people, the group searched for DNA sequences that appeared to be associated with either particularly high or low blood pressure. One of the genes identified is linked to the production of nitric oxide, known for its ability to reduce blood pressure. GKT: Researchers at King’s, have discovered that a protein called TRPA1, present in nerve cell membranes, is key to paracetamol’s analgesic effects. Removal of the protein from mice made them unable to withstand heat-induced pain. However, it is in fact a toxic breakdown product of paracetomol, NAPQI, that activates TRPA1, and researchers also discovered non-toxic compounds that activated the protein, which could lead to the development of safer analgesics in the future. ICSM: A large-scale study of women with oestrogen receptorpositive breast cancer has shown a higher survival rate in those whose drug treatment is switched two years post-surgery. Currently, the ‘gold-standard’ is to treat with tamoxifen for around five years, but those who began treatment with exemestane after two years were 18% less likely to have disease recurrence and 14% less likely to have died than those who remained on tamoxifen. It is thought that some cancerous cells can become resistant to tamoxifen, and are subsequently killed by exemestane.

Sutures, beautiful sutures. Image by Alan Liu

Khizr Nawab Guest Writer The weekend of November 19th and 20th saw the sixth annual Trauma Conference hosted by Imperial Col- lege Surgical Society at the Imperial College South Kensington campus. A large-scale conference, Trauma 2011 drew in emminent speakers and a di- verse delegate pool from the far reach- es of the globe. The weekend included a combination of lectures on important aspects of t rauma medicine followed by several post-lunchtime skill stations. Lectures covered the basic tenets of Trauma and Emergency care with special emphasis accorded to airway maintenance, C-spine and neurologi- cal trauma, circulatory failure, chest, obstetric, paediatric and musculoskel- etal trauma, and burns. The speakers frequently found themselves having to curb their enthusiasm in order to keep to the strict time constraints necessary for fitting in such a large

number of specialist lectures in the space of two days. There were some particularly noteworthy lectures. Mr Hiettiaratchy, a consultant plastics and reconstructive surgeon promptly whisked the entire delegate population into the adrenaline-drenched, emotion- ally draining and high-stakes world of trauma surgery on the battlefield.

“The interosseus access station had delegates happily drilling small perfect holes into eggs to make elaborate smiley faces!” Indeed, his vivid and poignant de- piction of the trials and tribulations of trauma care at its very purest left all of us hungering for more. Later that same day, Mr Duncan Bew spoke at length of possible career paths to trauma surgery. It was particularly well-received

considering the meagre guidance trauma hopefuls receive in making career defining choices. Professor Boffard, the world’s most emminent trauma surgeon, delivered lectures at the end of both days. Having flown in from Johannesburg the night before, he pro- ceeded to offer us a glimpse into the future of trauma surgery, charting and sampling various landmark innova- tions in trauma surgery over the years. The practical stations, arranged over two days according to a strict timetable, involved various relevant clinical aspects of trauma care. High- lights included a chest trauma station which, after recapping some relevant clinical anatomy, demonstrated needle thoracocentesis and chest drain inser- tions. The demonstrators offered gen- tle support and encouragement and were always willing to cater to the delegate’s individual needs. The ratio of three delegates to a given sheep thorax was particularly helpful as it allowed delegates some much-needed time to hone their skills at their own pace.

The intubation station demonstrators were particularly enthusiastic and made it their own personal mission to ensure all delegates could confidently intubate if necessary! The interosseus access station had delegates happily drilling small perfect holes into eggs to make elaborate smiley faces! The FAST (Focused Assessment with Sonography for Trauma) scan station guided the delegates through the technique of using ultrasound probes properly to search for extravasated blood in four important regions: peri- cardic, pelvic, perihepatic and peris- plenic. Learning objectives were provided in the programme, leaving the delegates with a clear, reassuring re- minder of what they had been taught. Or- ganizers went so far as to recruit members of the London Ambulance Service to teach delegates the basics of cervical spine protection in a trauma setting. The weekend was thoroughly enjoyable and all the delegates left with a clear, enriched knowledge base on trauma medicine and surgery

RUMS: Scientists have discovered that optimistic people learn more from positive experiences than negative ones. Subjects were given a string of negative scenarios and asked to estimate the likelihood of such an event happening to them. They were then told the average probability of it actually happening and asked to re-evaluate. The subjects tended to only update their estimates if it worked in their favour, suggesting that the brain blocks out negative information. SGUL: Researchers have identified a mutated GATA2 gene can cause Emberger syndrome, which has symptoms including immunodeficiency, leukaemia, lymphodoema and deafness. A study of eight patients with the syndrome discovered that all had a GATA2 mutation. The discovery is important in the understanding the causes and mechanisms of lymphatic disorders.

the

medicalstudent online The latest updates from the voice of Londonâ&#x20AC;&#x2122;s medical students New website and mobile version coming December 2011

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December 2011

Features

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Features Editor: Bibek Das features@medical-student.co.uk

Civil Hospital In the first of a series of articles on perspectives of medical students around the world, Hafsa Hanif, a student at the Dow University of Health Sciences in Karachi, discusses the serious challenges facing medical students and women in a Gynaecology department which he believes is a microcosm of public healthcare in Pakistan

Image by Hafsa Hanif

ilapidated ancient struc- tures inhabiting a rowdy and polluted land, grum- bling of decades of ne- glect and scarcity of resources- Civil Hospital, Karachi is a meek testimo- ny of the plight of its visitors and in- habitants, besides the organizational and administrative anarchy that has plagued it and public hospitals of its

like in Pakistan. Catering to the provinces of Sindh and the neighbouring areas of Balochistan, 2 of 4 provinces in the country, it is among the largest public sector hospitals in the country. The Gynecology Department is di- vided into three independent functioning units crammed on the same floor of an obsolete edifice. The visitor entrance to the inpatient departments at the hos-

pital is through a rusted black gate tim- idly positioned in the midst of a rowdy downtown area in the ear-splitting noise of rickshaws, motorcycles and public buses besides the hustle and bus- tle of the marketplace. The filthy and garbage laden hospital ground is the unqualified complement to the polluted air from the combustion of low quality fuel by automobiles. A site too typical

for a Karachite is dull maroon spots on the ground as if remnants of dried drops of paint splashed on the ground. A witness to the socioeconomic class that the hospital caters to, these are spit- out products of ‘pan’, a local substance of abuse. The dirty walls bear ugly graffiti, posters, and political banners. The uneven g round and broken pavements harbor vendors offering a variety

of packed and unpacked cooked food in amazingly unhygienic conditions, that are sure to astound infectious disease control personnel. Their businesses, ironically, are inside a hospital. Flocks of people can be seen occupying the pavements of the hospital ground and passageways to sit and relax, because of the scarcity of waiting areas. There are no sign boards to guide visitors to

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the g ynaecology department;; they have to feel fortunate if they locate the department in ease, inquiring from doctors walking by on the way. The better and less congested of the two ways that lead to the department is through a narrow, ill-lit staircase that leads to a somewhat better lit, but nevertheless dirty and narrow passage way. The pas- sageway is part of the third Unit of the department. It leads to the Emergency section and Labour Room, besides the other 2 Units. The other route has a lift next to the staircase, a scarce entity in the hospital, allowing patients on wheel chairs and stretchers to be transported.

“Privacy is a luxury that the hospital does not provide even in the labour room, where women lay on beds next to each other watching each other as they bear labour pains.” Ill-ventilated and ill-lit as it is, as many as 16 beds can be crammed in a single room, besides a nursing coun- ter and bathroom. Other rooms can be relatively spacious, albeit dirty and lacking the very basic facilities a ward room requires. There is no outlet for oxygen gas with each bed, nor a moni- tor, nor any other technical apparatus.

The beds, positioned next to each other, with a bench intervening for attendants, have no curtain or other means of separation to allow for privacy. Nor do doctors possess the ethics to endow patients the blessing of confidentiality of their case, during ward rounds and otherwise. Alas! Privacy is a luxury that the hospital does not provide even in the labour room, where women lay on beds next to each other watching each other as they bear labour pains and deliver.

“These women have been living in horrible socioeconomic circumstances where even running water is a blessing to be valued.” The slow moving fans in the ward rooms are a test in patience for doctors and patients alike;; air conditioning in the ward rooms is out of the question. Cats wandering about the beds is a routine;; at times they are seen imping- ing on remnants of food in the metal- lic dishes patients are served lunch in. These dishes are washed and reused. The beds are not the kinds that would be comfortable to lie on. The mat- tresses are routinely contaminated with filthy discharges of women and the ex- creta of their newborns, not a surprise, considering the literacy and health

Features awareness of the patients. The bed sheets similarly contaminated cannot be changed daily because of the scarcity of resources. The bathrooms too bear witness to the deplorable sanitary conditions at the ward and the hygiene consciousness of the women who use them. And these women could not have been cleaner having lived in horrible socioeconomic circumstances where even running water is a blessing to be valued. The vast majority of women who visit the hospital can not afford pads for their menstrual flow;; they use pieces of cloth, wash them, and reuse them. Hence, as medical students, we are t rained to take histories of menstrual flow in terms of the material of the cloth used and how much it gets soaked!

“Medical students... also find an opportunity to practice... per vaginal examinations...the unfortunate patients do not have the right to object.” Medical students (third year on- wards) posted at the ward view it as an opportunity to gain a hands-on practice of giving injections, inserting IV cannulae and catheters, and draw- ing blood. There are no protocols for having been formally trained on the

procedures or performing a specified number under observation before doing them oneself. Students, however, prefer doing the first one or few procedures under supervision for fear of causing harm. Busy as they are, doctors may at times casually drop the re- sponsibility on students to draw blood or administer an injection, which they would themselves have to do otherwise, because of the shortage of nursing staff. Medical students on posting, also find an opportunity to practice per abdominal and per vaginal examinations, the latter, especially in the labour room, even on patients on whom they are not indicated. The unfortunate patients do not have the right to object.

“The doctors... scream at and humiliate patients, which at times is a very sorry sight to witness.” The hospital cannot afford packed alcohol swabs. So pieces of cotton, somewhat soaked in an antiseptic are kept in a jar. Hence, each time it is required, the jar has to be opened and piece of cotton taken out. As for tourniquets, which are also an expense the hospital can not bear, they are made by cutting used tubing of IV drips, at times after they have been dis- posed off. Lubricant for urinary cath-

eterization is also unavailable;; patients have no option but to bear the pain. A major issue the department faces is the offensive and brusquely manner- isms of its doctors and other staff. In their arrogant and conceited attitude they literally scream at and humiliate patients, which at times is a very sorry sight to witness especially in the labour room when patients are in pain. The patients well know this is something they will have to bear with, for they will not be heard, and the doctors are confident they will not be questioned. Doctors do not even have the etiquettes to talk to medical students;; I remember breaking down in tears once when one of them uncouthly reproached me for a fault that was not mine. Patients’ female attendants staying at the department are lodged in a single room where they all sleep and spend the day together. The room, which can be packed with as many as 50 women at the same time, is a real ordeal for attendants in the summer heat and humidity. The Labour Room, ER, and Op- eration Theatre, though ‘renovated’, face many of the same problems as the inpatient department. Civil Hospi- tal is not one of its kind. Other public hospitals in Karachi and other parts of the country may be functioning in even more grave circumstances. How- ever, in view of the crises that have loomed over the country in the past decade, the future of health services in the country seems very gloomy

Image by Hafsa Hanif

December 2011

Features

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Publish or perish? Katie Allan explores the issue of medical students and journal publications

Piling on the pressure. Image by Nadia Chaudhry

hile drama students dream of seeing their name in lights, medical students dream of seeing their name in The Lancet. For many of us, getting our work published in a peer-reviewed journal is high on the list of things we hope to achieve while at medical school. The ‘publish or perish’ culture of medical education pushes students to commit a huge amount of time to chasing the dream of publication;; this is an unu- sual situation compared to other academic disciplines, where research is

the domain of experienced academics and PhDs rather than lowly undergraduates. There is no doubt that there is pressure on us to publish early and often, but is it really worth the bother? The biggest reason most students strive for a publication is CV building. With immense competition amongst graduates for foundation training posts, students hope that a string of impressive citations will be the difference between getting their first choice post in a world-class London teaching hospital and their worst nightmare cot- tage hospital in the middle of nowhere.

Indeed, under the current foundation programme application system (FPAS), points are awarded for academic publications, but with a maximum of two points up for g rabs (out of a total of 100) it’s questionable whether all of the effort that publication requires is worth it. And even those who have a publication might not get recognition – only those articles with a PubMed ID are currently counted. One final year GKT medical student I know has a grand total of eleven publications from his previous degree and PhD, but none are on PubMed so they count for nothing

as far as his application is concerned. It is certainly demoralising for students that their hard work is counted for so little, but the application system is due to change, and it’s difficult to predict whether the weighting towards this sort of academic achieve- ment will alter in years to come. Of course there is more to life than point-scoring and CV building, and getting involved in research has many other benefits. Developing the ability to write clearly and concisely, and to critically analyse and review scientific papers, are vital skills that doctors need

throughout their entire careers. A publication allows you to develop these skills early on, and demonstrate that ability to others. If you already k now what speci- ality of medicine you want to go into, conducting research in that particular field gives you a chance to explore your area of interest in more depth, as well as demonstrating your commit- ment to the field from an early stage. So how does a medical student go about getting that all-important publication? The most obvious opportunity to participate in research is in an Intercalated BSc year. Many BSc

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programmes include a lab or library project, and having time specifically allocated for this makes it a lot easier than trying to balance it on top of the core curriculum. How- ever, not all BSc programmes include a research project, and not all students do a BSc;; fortunately there are still plenty of opportunities to get your name in print. Though it’s unrealistic to expect a medical student to complete original research on top of their studies, a good option is to do a systematic review of the research that’s already been done on a specific topic. Though still time-consuming, this is quicker and easier than carrying out a project of your own, and just as likely to get published. An ideal option for students in their clinical years is an audit. Unlike academic pro- jects, audits look at patient outcomes to measure a hospital’s performance against existing best practice guidelines. Audits tend to be on a much smaller scale than academic research, and you can use your time spent within the hospital to identify problems that might war- rant an audit, and an appropriate clinician to supervise your project. If published, an audit is given as much recognition (in terms of FPAS points) as a piece of academic research. It is also worth getting into the practice of conducting audits, as it is now a requirement of F1 and F2 doctors to complete at least one a year. Whether you want to do an audit or a piece of academic research, you must first identify an area of need;; there is no point wasting your

Features time on research that has already been done. Secondly, you need to find yourself a supervisor;; as always, it’s not what you know but who you know. Start sucking up to consultants or academics in your field of interest and make sure they know how keen you are to get stuck in. Ask around amongst your peers to find out who they’ve been doing research with;; their supervisors are likely to have more than one project in the pipeline. Once you’ve found your supervisor, make sure you clarify your role within the project and what support you can expect from them, and above all make sure your name will actually be on the finished paper!

than a professor, which means you’ll need to ensure your work is of the highest quality, and develop a thick skin for when they get back to you with ‘constructive’ criticism.

“Start sucking up to consultants or academics in your field of interest and make sure they know how keen you are to get stuck in.”

With all this talk of publishing, it’s easy to feel inadequate if you haven’t made it into the BMJ before the end of first year. The reality of it is. however, that only a small minority of students get published during their time at university. It is an unrealistic expectation for most students to publish;; it takes a huge amount of time and effort to produce work of publishable quality, and spare time is not something that most medics have in excess. Whilst certainly worth striving for if it is something that genuinely interests you, a publication is far from the best measure of success at medical school. We have the whole of our careers to do research, so if you’re not keen on the idea now there’s no need to let the publication pressure get to you just yet

Once you’ve actually done the research, you then have to get it published. You can only submit your work to one journal at a time, so choose wisely. The article is then reviewed sep- arately by at least two reviewers. This can be a long process in itself, with some journals having a ‘queue’ of over a year. For this reason, the earlier you embark on a project, the better. The submissions are anonymous, so no allowances are made for the fact that you’re a student rather

FPAS Scoring System (Taken from Foundation Programme Application Handbook 2012) Educational Achievements Section

“It takes a huge amount of time and effort to produce work of publishable quality, and spare time is not something that most medics have in excess.”

Part A - (max 5 points) Additional degrees (i.e. not your primary medical qualification). Part B - (max 5 points) Other educational achievements: - 1 point (up to 2) for each publication with a PubMed ID and with the required uploaded evidence.

- 1 point (up to 2) for each national or international oral or poster presentation with supporting evidence, where: a) you are the speaker for an oral presentation; or b) you are the first named author for a poster presentation. - 1 point (up to 2) for each educational first prize at a national or international level. In order to gain points for publications, the following criteria must apply: - The publication must be peer reviewed. - The peer reviewed publication MUST have a PubMed ID. Any publications without a PubMed ID, including those ‘In Press’, do not count.

Studying the effect of high-dose caffeine on medical student performance. Image by Nadia Chaudhry

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The Medical Student team 2011: Editor-in-Chief John Hardie News Editor Ken Wu Features Editor Neha Pathak, Bibek Das Comment Edi Image Editors Chetan Khatri, Purvi Patel Treasurer Alexander Cowan-Sanluis Assistant Editor Amrutha

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From Left to Right: Robert Cleaver, Alexander Isted, Chetan Khatri, Sevgi Kozakli, Rhys Davies, Amrutha Sridhar, John Hardie, Purvi Patel, Ken Wu, Alexander Cowan-Sanluis, Bibek Das

itor Sarah Pape, Rhys Davies Culture Editor Robyn Jacobs Doctorsâ&#x20AC;&#x2122; Mess Editor Abe Thomas, Robert Cleaver Sport Editor John Jeffery Sridhar Distribution Officer Sevgi Kozakli Sub-Editors Giada Azzopardi, Martha Martin, Alexander Isted, Kiranjeet Gill, Hayley Stewart

December 2011

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Comment Editor: Rhys Davies comment@medical-student.co.uk

A summer less ordinary An Imperial student recalls life and medicine in an Algerian refugee camp Ryan Tewari Guest Writer

Over the summer, 12 Imperial medical and biomedical students took part in the inaugural Sahara Health Initia- tive (SHI) expedition, working in the Saharawi refugee camps in the Western Algerian desert – the largest and oldest refugee camps in the world. SHI is an arm of GLAD (Global Action for Development), a charity set up by ex-Imperial student, Saba Shafi. The SHI aims to take medical and biomedical students to this neglected part of the world each year to aid health workers and witness the Saharawi way of life. More likely than not, you will not know about the situation in the West- ern Sahara. The Saharawi are the in- digenous people of the Western Saha- ra, which up until the mid-1970s was a Spanish colony. Following decoloni- sation by the Spaniards, the territory was occupied by neighbouring Mauri- tania and Morocco. The former with- drew their occupying forces in 1979 but the latter still occupies approximately three-quarters of the whole territory. In 1991, an UN-brokered ceasefire was declared between Morocco and the Polisario (the Western Saharan government-in-exile), and a referendum was to be held to determine the Western Sa- hara’s fate. To this day, this referendum has not happened and the situation has been swept under the rug and out of the public eye. According to some sources, up to 165 000 live in the refugee camps outside of Tindouf, Western Algeria, and have existed for over 35 years. The camps are made up of several districts (wilayas), named after cities in the Western Sahara (El-Aaiun, Daklha, Smara) and important dates in the history of the Saharawi people. We were based at Rabouni camp, accommodated with many other NGO aid workers. We were split into t wo g roups – clinical and public health. I was part of the clinical group, and mainly alternated between the national hospital at Rabou- ni Camp and the wilaya hospitals. I found myself surprised and impressed by how well organised the health system was, but it suffered from severe shortages. Firstly, healthcare in the camps is free for all. Each wilaya is made up of smaller villages (dai- ras), each with their own dispensary clinic run by nurses. These feed into the wilaya hospitals, which themselves vary greatly in facilities and staff. For example, El-Aaiun hospital had a small burns unit, an on-site pharmacy, an optometrist and two doctors. In sharp contrast, Smara hospital had only one

live-in doctor who was effectively on- we met were all very willing to teach call 24/7. The next level up is the na- and, in all honesty, were better teach- tional hospital at Rabouni camp, but ers than some of the doctors in the UK, even here they were severely under- despite the language barrier. We were staffed – a gastroenterologist, an urolo- accompanied throughout by excellent gist, a dentist and a handful of nurses. translators (including the deputy Sa- Often, the hospital administrator would harawi representative to the UK) who run a lot of the clinics, although he was were absolutely invaluable. My con- originally trained as an agricultural sultations would not have gone very far engineer. without them. My Spanish They have didn’t go far beyond ‘Qu- been un- antos anos tienes?’ (‘how able to per- old are you?’) and ‘Donde form any dolor?’ (literally, ‘where surgeries pain?’), and my Arabic for over six was even worse. months be- Overall, I feel that I cause there would have got more out has been no of the anaesthetist – all surgi- clini- There are around cal cases had to be sent cal ten doctors in the to the nearest Algerian work entire camp. Ten city, Tindouf. if I doctors serving There are around were up to 165 000 ten doctors in the entire to do refugees. camp. Ten doctors serv- this ing up to 165 000 refugees. after Much like how our clinical attach- my first ments back home differ between dif- clinical ferent placement sites, it did so here. year (so In some hospitals we sat in clinics, ‘ur- I could gencias’ and occasionally took the clin- consoli- ics ourselves. In Smara hospital, the date my lone doctor threw us into the deep end knowl- and would only confirm our diagnosis edge) and prescribe medications. The doctors rather

than before and have to learn things from scratch. Having said that, the fourth year medical students were excellent teachers themselves, and the experience gave me a running start in my third year. The public health group were kept very busy over the three weeks. They collected data on health (on behalf of famous eye doctor John Sandford- Smith) and on water storage tanks (the hope is that they will be replaced by plastic tanks, as the metal tanks rust and contaminate the water). Remark- ably, they were able to finish this mammoth task ahead of schedule, and had time to teach first aid in the Women’s Institute and work with some of the NGO workers. We met a lot of important people while we were in the camps, including the UNHCR team in the camps, the leader of the Women’s Institute and the Minister of Health. The Minister was one of the only healthcare professionals in the early camps over 35 years ago. When speaking to some of these individuals, I had a strange sense of g uilt because I couldn’t help them more. In response, they would tell us that we did have an important role;; we can tell others in the UK of their plight. Despite these circumstances, the Saharawi peo-

ple are among the warmest and kindest people I have ever met. A true testa- ment to how solidarity triumphs over such great adversity. They would wel- come us into their homes, share their meals and make us Saharawi tea (which tastes incredible). It is such a tragedy that their plight goes unnoticed by the world and their situation is without solution. Simply put, they cannot lay down roots in Algeria and will remain dependent on outside aid. It wasn’t all just work and tea however! We had plenty of time to explore the camps, visit Saharawi fami- lies and enjoy traditional activities, such as camel herding. On one of our last nights, we spent a night under the stars on the sand dunes. My most vivid memory of the camps is waking up at 4am and exploring the virgin sand dunes under the moonlight with nothing for miles and miles around. Truly breath-taking. Before taking part in this t rip, mind- numbingly dull epidemiology lectures had made me think twice about global health as a career. This experience has put it back on the agenda, and I plan to go back next summer with SHI. I would recommend global volunteer work to any medical student who hasn’t tried it yet! If you want to learn more about the SHI, please contact Ryan Tewari through the Comment Editor

The Sahara. Even in these extremes, people will find a way to live. And those people will need doctors.

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December 2011

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Doctor, remember thy patient! Purvi Patel laments the lack of patient-centred medicine on the wards

hen I started my first real clinical attachment at one of the most pres- tigious hospitals in the country, none of the doctors had any time for us. Four weeks on, nothing has changed but what’s worse is that I’ve noticed they don’t even have time for the patients. Ward rounds on this surgical firm start at grim 7.30am, at which time, for reasons unbeknownst to me, the patients are already awake – not that it matters. Consultants and registrars, who have performed surgery on a patient the night before, blindly follow the juniors around with the timeless phras- es, ‘who’s next?’ and ‘what’s wrong with them?’ as if they hadn’t just had their hands inside these people’s bodies. Once it has been established who we are seeing and what is ‘wrong’ with them, the consultant will stand right next to the patient, and completely ig- nore them. He and the registrars will have a conversation about the patient, while the patient himself looks on in bemusement. The juniors will be shout- ed at for not k nowing every detail about

the patient’s Hb, WCC, U&Es, LFTs, CRP and anything else in which the consultant might have a passing interest. He may at this point turn to us, the medical students cowering in the corner, t rying as hard as possible to appear as if we know what’s going on. Once we have been grilled (read tortured) to an appropriate level, it is time to move on. On to the next patient, ‘Who’s next? What’s wrong with her?’ This patient’s turn is up. He has had no opportunity to ask questions. Not only this but nobody even acknowl- edged him, despite being surrounded by up to nine medical professionals of varying levels.

“There might as well be no patients, just a set of notes outlining if this person has a fever, their drain output and their obs.” Surgery is possibly the most invasive thing you can allow someone to do to you. To let someone perform sur-

gery on you is to give them permission to slice you open, have a fiddle around inside your body, take out whatever bits they please and then put you back together again (or not), all while you are knocked out. So you wouldn’t let just anyone do it, would you? You would only let someone whose skills you had complete confidence in come any- where near you with a scalpel. So then when the surgery is over, you would expect these people, who have been messing about inside your body, to explain what they’ve done and why. You would not expect them to come to your bedside, perhaps throw a smile over their shoulder in your direction, and explain to what is essentially a group of complete strangers what they have done inside your body. To me, this would be completely unacceptable. I would be outraged! There might as well be no patients, just a set of notes outlining if this person has a fever, their drain output and their obs. There was one instance where the patient was in the bathroom when the doctors were at her bedside. The doctors followed the

same routine - discuss amongst themselves, chastise the juniors, interrogate the students. They didn’t see the patient and it didn’t make the slightest bit of difference to them. For them, a patient may as well just be a set of notes. A patient is not a tool for us to practice our skills on;; he is not an instru- ment we use to get better at taking histories, or carrying out examinations, or performing surgery. He is a person, a happily-married, father of three, who likes going to the gym, something he won’t be able to do for a while because you’ve just sliced open his abdo- men. She is a person, divorced and living alone;; having to go to work with a stoma bag because you told her it was for the best. They are people, real people with real lives outside the hospital. There is no point in going to review a patient without seeing them as a person first. At Imperial, we are made to sit through countless lectures on how to talk to people. My thoughts at the time were along the lines of what on earth is the point? How can people be doctors

without k nowing how to talk to people? This is the most idiotic thing I’ve ever seen. Little did I k now, the entire hospital environment consists of not talking to the most important people in them.

“There is no point in going to review a patient without seeing them as a person first.” The current generation of consultants and registrars have not had this drilled into them from day one. Per- haps they had some sort of teaching on how to communicate effectively and have simply forgotten what it means, maybe they don’t have the time for it, or maybe they just don’t care. Hope- fully, the next generation will actually talk to the patients instead of taking over them;; hopefully our generation of doctors will not be so callous. I hope I never forget that I am not t reating a disease, but a person;; I hope I never treat anyone the way I have seen people being treated

Lectures, stethoscopes and depression Zara Zeb discusses the medical student’s black dog

very student, before enter- ing medicine, will be warned about the negative side effects that come with doing a de- manding, high-profile profession. One such caution includes the word, ‘depression’. According to my scary sixth form teacher, ’many’ (she obviously didn’t do statistics) doctors end up depressed, and with that she told me not to even think about doing medicine. Be- cause you see, I suffer f rom depression. According to a recent survey undertaken by the Time to Change charity, an alarming 46% of mental health sufferers won’t tell their family about their condition, and 62% wouldn’t tell their friends because of the stigma attached. I used to think these things happen to other people, the sort of people who had a tough time scraping together enough money to pay the bills or who were in an abusive household. Being neither of those things, I denied for 18 months there was something wrong with me. A straight A student, with a loving family and lots of friends, what reason could I possibly have for not wanting to live? What I didn’t know was that one in four people suffer from a mental health illness, and we all will at some point in our life, unfortunately, need a little boost. For some lucky few, they have

a one-off illness lasting a few weeks or months, or a year, and then they are fine. For others, it lasts much longer. Symptoms are not so apparent either, because my sister ticks about ten of the classic symptoms but doesn’t suffer from any mental health issues – apart from maybe low self-esteem, but what teenager doesn’t? It took me to rocking myself in tears to finally admit, something is wrong.

“A straight A student, with a loving family and lots of friends, what reason could I possibly have for not wanting to live?” What it is like to be depressed is so difficult to quantify. It’s an ever-changing experience and unique to each individual. It’s not like the common flu where everyone will experience blocked sinuses and runny noses. Put it this way, depending on how bad a day or week or month it is, I could literally lock myself away from the world and do nothing but wonder why I’m even on this planet. On a good day, I can get out of bed on time, I can talk to friends, I can have a laugh, and only wonder for fleeting moments, when will I stop pre-

tending everything is OK? I don’t have a magic wand and I can’t make you or my family or my friends understand what it’s like to lose certainty, to lose my place, to lose the ground beneath my feet and never to regain it. What I can do is advise you on how to be a good friend, and not do what my friend of more than a decade did when she realised depression also included suicidal thoughts, which is stop talking to me because I disgusted her.

“What I can do is advise you on how to be a good friend, and not do what my friend of more than a decade did when she realised depression also included suicidal thoughts, which is stop talking to me because I disgusted her.” Firstly, it never goes away. It is always there, so don’t assume because someone has a good day or a few good days that everything is back to ‘normal’. Secondly, there is no reason for why.

It just is. Accept it. Thirdly, don’t say it’s going to be ok. No-one believes you and you’re just belittling the whole thing. What you should do is just listen and sympathise. Most often than not, the person just wants to talk and say they feel like shit and for you to say that they have every right to feel that way.

“Sometimes there are just no words, but sitting next to someone and doing your work makes a lot of difference. The companionship and presence may suffuse the bubble of loneliness most sufferers have around them.” Fourthly, sometimes there are just no words, but sitting next to someone and doing your work makes a lot of difference. The companionship and presence may suffuse the bubble of loneliness most sufferers have around them. Fifthly, treat us like normal. We can still do medicine, we can still have a laugh, we just have extra unwanted thoughts and feelings.

Finally, don’t always mention it or hint at it. Just ask, ‘how are you?’ and let us take it from there. Sometimes we might say ‘fine’ and that’s that, but if you wait 30 seconds, we might change that into ‘actually today is difficult and I feel vulnerable and I need a hug’. But most of the time we are ‘fine’ and coping. If anything, all I want to say is that having a mental illness shouldn’t be something to be ashamed of. It doesn’t stop you being just as capable as someone else. It doesn’t stop you being an amazing friend. And it sure doesn’t stop you from being a good Doctor. You just have to take care of yourself, understand the way you work, and never cross your limits. If you want to read the two-page results of the survey, find out more about what you can do, or mental health in general, go to - http://www.time-to- change.org.uk/ If you have any questions or com- ments about this article or depression, please contact Zara Zeb, through the Comment Editor. Mental health issues are common at university, affecting one in three students. Among medical students, this can rise to one in two

December 2011

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Storm in a C cup David Fisher Staff Writer

When car mechanics perform MOTs, it is quite common for them to alert drivers when they dis- cover damaged car parts. For example, they may issue a warning that the brakes may fail unless the pads are replaced. This is not to say that every driver who ignores such advice will experience a crash. Even if the majority of people with worn out brake pads did not experience crashes it would be absurd to say that MOTs are unnecessary. A similar argument has arisen with breast cancer screening. The detection and overtreatment of ductal carcinoma in situ, an early form of cancer that may not progress to invasive carcinoma, has led some to leap to the conclusion that the entire breast screening process should be questioned. The evidence supporting breast cancer screening is strong. The World Health Organisation claims breast screening reduces mortality by 35%. The National Health Service (NHS) main- tains 1400 lives are saved each year because of breast screening but recently this figure has been disputed. A paper published in the British Medical Journal puts forward the theory that reduction in breast cancer mortality has been due to improve- ments in t reatments rather than screening. The ro- bustness of the pro-screening evidence has been called into question amid suggestions the health service has been floating a lame duck all along. A related issue has also been brought to the surface in the recent storm of articles question- ing screening. The objective of screening women

aged between 50 and 70 is to detect carcinoma growths that would otherwise have not been de- tected and become harder to treat as the cancer progressed. The test is sensitive and is capable of finding small benign growths, ductal carcinoma in situ, less than half of which progress to a more dangerous form. An independent estimate pre- dicts that for every 2,000 women screened, only one life is saved who would otherwise have died. This is compared with the N HS claim of f ive lives being saved. A further ten women are treated unnecessarily for ductal carcinoma in situ, contrary to the t wo predicted by the N HS, and an additional 200 women receive false positive results that are mostly dismissed following biopsy. On the face of it, these pessimistic figures make screening appear helpful in a few cases and harmful in a great number more. However, if these statistics are as- sumed to be accurate and applied to a one million women screening population, 500 lives would be saved. Surely this is quite a significant number, sufficient to continue recommending screening. The confounding issue would be the 5000 women unnecessarily treated but this is a separate problem that can be remedied. What has really irri- tated researchers is that the public are not fully informed about the dangers of radiotherapy and mastectomies that may be used to unnecessarily treat harmless lesions. Essentially, there are three separate issues which are being mingled in the media hype but must be addressed individually. First, the question must be answered whether breast cancer screening results in reduced mortality. To suggest mortality has reduced but has done so because of improved treatment completely in-

dependently of early diagnosis from screening flies in the face of accepted dogma and is contrary to the conclusions from a heap of data that form the basis for screening. Conventional wisdom states logically that early diagnosis of conditions leads to better treatments. Second, are we responding correctly to the results of screening? The key statistic that has sprouted so much negativity is the number of women subject to unnecessary t reatment of ductal carcinoma in situ. When these lesions are detect- ed it is impossible to determine whether they will become malignant or not. A knee-jerk reaction encouraging treatment of every possible carcinoma has likely developed from fear of being sued for negligence after dismissing lesions that subsequently become invasive. Management of these cases seems to gravitate towards intervention on the basis of ‘rather safe than sorry’. Rebalancing the scales in favour of frequent monitoring of un- clear cases would help weed out overtreatment of tumours that remain in the benign state. Finally, the patient information leaflet is wholly inadequate. Mike Richards, a national director for the Department of Health has already an- nounced a second revision of the leaflet. No doubt it will be rewritten to include more comprehen- sive information about different diagnoses and the respective prognostic likelihoods which will enable more informed treatment decisions to be made. The current controversy needs to be calmed for fear patients will no longer believe screening is beneficial. The newly formed independent review must swiftly pour oil on the troubled waters that have been so violently stirred

Alex Warren Guest Writer

Any of our readers on undergraduate medical courses will know that an in- creasing number of their classmates are in fact postgraduates – people who have spent years studying a wide variety of disciplines. This represents a growing trend in medical admissions towards more mature students with a greater experience both of the academic world and life in general. Admissions are already moving in this direction - last year, a third of those admitted onto the undergraduate MBBS at Bart’s and the London already held a graduate qualification. Without doubt, it’s time to bite the bullet and adopt a more American-style system in the UK.

‘Their graduate brethren have put their money where their mouth is – what better demonstrates a passion for biomedicine than spending three years studying it?’

Despite his good intentions, the inventor of the mammogram was something of a misogynist.

So why are admissions tutors admit- ting more and more postgrads? Firstly, someone with a good degree in a hard scientific discipline (no underwater- basket-weaving BAs allowed) not only already has a wealth of scientific knowledge, but also a practical understanding of university life. They won’t flunk their mid-sessionals because they coasted their way through A-levels and don’t know how to study - they will probably already have performed some research. Whole units of undergraduate medical education will become unnecessary - those in medical statistics and interpretation of research, for instance. A graduate-only medical course would also act as a desperately-needed filter for the medical admissions system. Politics aside, the education system is ineffective at distinguishing the best candidates, given that 27% of examinations taken this year were given an A

medicalstudent

December 2011

Comment

Head to Head Should Medicine be a graduate-only degree?

YES

or an A*. Medical schools are swarmed with thousands of applicants, all with three As and an excellent repertoire of work experience, volunteering, playing the oboe to concert-performance level, captaining the hockey team and a gap year single-handedly thwarting yellow fever in Uganda. These students riddle their personal statements with phras- es like “passion for science”, yet their graduate brethren have put their money where their mouth is – what better demonstrates a passion for biomedicine than spending three years studying it? From a more holistic viewpoint, how many of us can t ruly say that at the age of 18 we were totally sure that we’re suited to a medical career? By intro- ducing a g raduate-only course, medical students would have three years’ more life experience when they start their course and three years’ extra matura- tion as professionals before they’re let loose on the wards. The transition from medical student to junior doctor is one of the most difficult times in any medic’s life, and would be much easier if done at 27 rather than 24. Having more mature F1s would make life simpler not just for themselves, but for senior staff and nurses as well, and might even do something to reduce the infamous F1- related ‘August spike’ in patient deaths at teaching hospitals. In summary, graduate-only medical education would make the process smoother for all. Graduates would handle the academic side easier, would have fewer professionalism issues during medical school, and would handle the transition from student to junior doctor much better than their three- years-younger colleagues. Our current undergraduate system is flawed and ar- chaic, and the sooner we rid ourselves of it the better

Yannick Derwa Guest Writer

One of the benefits of graduate medicine is that all hearing aids are half-price!

Graduate entry into medicine seems to be picking up steam across the UK;; at Bart’s last year, graduates comprised approximately 30% of total admissions to the five year MBBS course. This is not a negative development;; it simply illustrates that there were very many deserving graduates vying for entry. They earned their place at medical school, just like everyone else. The largest problem likely to surface when adjusting medical school admissions to ‘graduates only’ is the accumulation of debt that would face all prospective medical students. With the recent tuition fee hike, after a minimum seven years of study, student debt would run up to £63 000. Im- agine yourself to be a student from a family with a modest income. Even if your heart is set on medicine, you must first do at least three years of another course. That would put you at least £27 000 debt. And then you must apply to get into medicine, with no guar- antees of a place. The thought might be enough to dissuade many excellent would-be medics from considering medical school a viable option. It would be a travesty for modern medicine to become a field in which entry is dependant on one’s wallet rather than their ability. The most prominent example of a country where graduate entry is the norm is the United States. There, a student will typically first embark on a four year undergraduate degree. If the student does not major in a science- based program, he or she can still take the prerequisite courses needed for ad-

Next month, Comment asks; Is it ever right for doctors to strike? Send all articles to comment.medicalstudent@gmail.com Articles should be 500-1000 words in length

missions as electives (usually organic chemistry, biology, statistics and cal- culus, etc.). So it is relatively easy to change directions and head into a medical career. The system in place at the moment best meets the needs of how Britain’s education system is set-up - the six year course in which both undergraduates and graduates are able to familiarize themselves with the necessary tools to become skilled doctors, and the four year GEP course for the most driven and successful science graduates.

“It would be a travesty for modern medicine to become a field in which entry is dependant on one’s wallet rather than their ability.” Medical school in the US is usually four years, following on from an undergraduate course. That is eight years of study. However, in the States, there is no foundation programme. In Brit- ain, on top of the first two years in the foundation programme, most special- ties have an additional three to eight years of training attached. A doctor here will achieve her or his CCT at approximately the same age as their coun- terpart across the pond. The new addition of a compulsory three years to the already long path to consultancy seems unnecessary. It is true that not everybody is ‘right’ for medicine at the age of 18. Some may not be mature enough, while others have not yet realised that medicine is their true calling in life. That’s okay. Graduates add new perspective and experience to medical schools and it would be a damn sight worse without them around. But not everybody needs to have completed a previous degree to be ‘right’ for medicine. The fact of the matter is the vast majority of medics I know, be they graduate or not, will make for excellent doctors. And that is precisely what admission should be based on - an individual’s aptitude, not how many letters they have behind their name

December 2011

medicalstudent

Culture Culture Editor: Kiranjeet Gill culture@medical-student.co.uk

Christmas in London Here’s the Medical Student’s pick of the best places to soak up the Christmas cheer this festive season

Christmas Shopping

Pantomimes

Southbank Centre Christmas Market

Potted Panto

Perhaps it’s just the enticing scent of Gluhwein and bratwurst, but German-style Christmas markets have become big business in recent years. The best thing about this one though is probably the Chocolate Festival, taking place December 9th – 11th. Until December 24th, free entry.

Hyde Park Winter Wonderland

The ultimate destination for those wanting to indulge in the Christ- mas spirit, Winter Wonderland incorporates a Christmas market, funfair and more food stands than you can shake a stick at. Be- cause what more could you want from your Christmas fair than scary talking mannequins and a possible case of diabetes? Until January 3rd, free entry.

Wonder Hill Market

For something a bit off the beaten track, try the Wonder Hill Mar- ket. There are two Christmas markets coming up in December, offering an assortment of handmade and vintage goodies as well as student discounts and free mince pies. December 10th and 17th, The Miller Pub, Snowsfield Road. Free entry.

Ice Skating Somerset House

A prime destination for those wanting to u nleash their inner Torvill or Dean this Christmas. And if you don’t pose enough of a health and safety risk when balanced precariously on two razor-sharp blades, there’s also a bar serving mulled wine. Until January 22nd, student tickets from £8.50.

Can’t make up your mind which pantomime to see? The creators of this summer’s successful Potted Potter return, this time attempting to cram eight pantos into just 80 minutes. Vaudeville Theatre, December 18th – January 8th Tickets f rom £15.

Bollywood Cinderella

Comedian Hardeep Singh Kohli puts a new t wist on the classic fair- ytale. For anyone who’s ever watched the original and thought, ‘this would be better if she was called Surinderella…’. Tara Theatre, December 7th – 24th. Tickets from £12.50.

Music St Martin-in-the-Fields

The parish church for Buckingham Palace – complete with royal box – has a huge program of choir and orchestra performances in the run-up to Christmas and the New Year. Until December 31st. Tickets from £8.

St Paul’s Cathedral

The exquisite St Paul’s Cathedral Choir and the City of London Sin- fonia perform, plus celebrity readers. Attendees are encouraged to arrive early to be seated. December 15th, 6.30PM. Free entry.

Westminster Abbey

The Choir of Westminster Abbey perform a number of festive pieces, alongside Robert Quinney on the organ. December 13th, tickets from £10.

Zippos Cirque Extreme. Image courtesy of Matt Page

Circuses La Soirée

Not, strictly speaking, a t raditional Christmas actvity, but this critically-acclaimed show, which has recently taken up new residence at the Roundhouse, promises to be a great night, with its exciting mix of cabaret, burlesque and circus acts. Roundhouse, until January 29th. Tickets from £15.

Zippos Cirque Extreme

The grown-up sister of Zippos Christmas Circus, this steampunk- themed show is billed as a ‘jaw-dropping daredevil show’. If you want to see three men riding motorbikes inside a steel ‘globe of death’ then this is the one for you. Hyde Park, until January 3rd. Tickets from £7.50.

Alternative Christmas

If the thought of Christmas already has you wanting to hibernate until just after January exams, then that’s probably what you should do. Failing that, you could do worse than check out one of these events.

Bad Santa’s Grotto

The Graffik Gallery in Notting Hill presents an exhibition dedicat- ed to street art, based on the theme of ‘Santa’s Ghetto’. Expect g raf- fiti, photography and beatboxing, plus a small Christmas market. Graffik Gallery, Saturday December 10th. Free entry.

Sam Simmons - Meanwhile Ice skating at Somerset House. Image by Kiranjeet Gill

Multi award-winning Australian comic Sam Simmons takes on the Soho Theatre this Christmas. His mixture of stand-up, sketches and music received great reviews at this year’s Edinburgh Festival. December 14th - January 7th. Tickets from £10

medicalstudent

December 2011

Culture GKT Christmas Comedy Revue We take a look at the theatrical wonders taking place at a medical school near you... Frith Cull Guest writer

The plot followed first year student Geoffrey (Connor Cummings) at an early 20th century UCL medical school who, through a series of initiation tasks set for him by a trio of humorously-portrayed old boy Harley Street surgeons, is unwittingly sent to the present day RUMS through what else but a magic fridge. The audience saw Geoffrey on his way back to his own era, journeying through a series of inevitably awkward situations.

It could be worse - she could be from George’s. Image courtesy of Frith Cull

ICSM - Guards! Guards!

When the continual toils of being a medical student begin to get me down, I find there is no better rem- edy than a bit of Terry Pratchett. Ef- fortlessly readable, immensely hu- morous and with more than forty books to choose from, I will never tire of this medicine. Last week, this took the form of ICSM Dra- ma’s production of Guards! Guards! The story, adapted for the stage by Stephen Briggs, revolves around a 60 foot dragon terrorising the city of Ankh-Morpork. The only people who can stop it are the drunk, Cap- tain Vimes, and the incompetent men in his City Watch. As I took my seat, I did wonder how they were going to manage with that dragon. The show was student theatre at its

Following hot on the heels of such cult classics as ‘The Wizard of Obs’, ‘One Threw Up in the Doctors’ Mess’ and ‘Pirates of the Perineum’, this year’s MDs’ show - that’s the Manic Depressives to you and me - Back to the Suture did not disappoint. The final date of the annual allsinging all-dancing MDs’ show was full of catchy spoofs of popular songs - particular mention to the singing talents of Bethany Brockbank - including the toetapping “I Kissed a Corpse”, sendups of the fraternity of surgeons, and gratuitous knob gags that had the audience in stitches. Pun totally intended.

The annual delight that is the GKT Christmas Comedy Revue - a raucous collection of music, sketches and dancing which delight and offend in equal measures, not the for the faint of heart but definitely for those who enjoy humour, charity and gratuitous nudity aplenty - is back. This annual attempt to tickle the ulnar nerve reflexes of London Bridge and beyond this year had its directorship undertaken by Charlie Reeve and Sophie Strong and they have not disappointed. Unfortunately lacking in some of the cast members who have in previous years made this event an institution, the show made up for it with comedy that was more original than ever and a newer cast who gave it their all. With the reassuringly dark humour that medics are famous for, this year’s GKT show, ‘The Pseudopseudohypoparalympics’, made comedic use of obscure conditions and social situations seen all too often in South East London clinical practice. The audience was treated to the usual gratuitous nudity, this time with a monochrome twist, a friendly musical dig at GKT students’ King’s College foe at The Strand, and a phe- nomenal return to the 2010 UH Revue- winning form that GKT are capable of

Jack Bates Guest Writer

RUMS Show Back to the Suture

most enjoyable. It lacked the pol- ished finish of anything professional but the talent and enthusiasm of those involved more than made up for it. The special effects added an extra sense of whimsy. Instead of the pup- pet of cardboard and papier-mache that I had been expecting, the dragon was created from a red light and a well-placed smoke machine. Sim- ple but surprisingly effective. My favourite moment was when a two- foot plush dragon rose up against sprawling backdrop of Ankh-Mor- pork to the fanfare of the Dambus- ters theme. That, I was not expecting! Guards! Guards! was a wonderfully enjoyable way to spend an evening, in the spirit of Pratchett himself. It stayed true enough to the book to appease the rabid fan inside me but was accessi- ble enough for my less-read friends. Altogether, a good - and cheap, for London - night out

The two lead freshers carried the play very well, even managing not to freeze in the face of stiff opposition from the heckles of the doctors in the front row. Their Back to the Future-style love story came to a much anticipated kiss in the final few minutes, which was genuinely cinematic. Particular highlights were a faithful homage to Sir Malcolm Grant, the provost of University College London, reminding everyone in attendance of UCL’s status as “London’s Global University”, and one of the new cast members showing off his considerable acting talent - located between his legs. The show ended on a double performance of a wellchoreographed final dance, which featured the whole cast clad in shiny gold trunks so tight that some of the newly qualified doctors in the front row may have confused them with sparkly tourniquets. Worth the ticket price alone and surely the most fitting tribute to “I Like Big Butts” ever performed on a London stage. Alex Smedley - Guest writer

I ordered pepperoni, dammit! Image courtesy of Cheng Zhang

If you’re part of a performing arts society and would like to be featured in the Medical Student, e-mail culture@medical-student. co.uk

December 2011

medicalstudent

Culture Miracles and Charms

Been injured? Wasn’t your fault..? Image courtesy of the Wellcome Collection.

Kiranjeet Gill Culture Editor

Following hugely successful exhibitions on topics as varied as dirt, d rugs and the skin, the Wellcome Collection has once again excelled itself with its latest offering, Miracles and Charms. The muse- um has an uncanny ability to make a fascinating show out of the unlikeliest objects, and this two- part exhibition, which describes itself as an explo- ration of faith, hope and chance, is no exception. The first part of the exhibition, ‘Infinitas Gracias: Mexican Miracle Paintings’, looks at the centuries-old tradition of ex-votos - offer- ings made to saints to show gratitude or devotion for prayers that have been answered. In Mexico, they most commonly take the form of commis- sioned paintings on tin roof tiles and tend to depict a misfortune that has befallen someone, the saint to whom they prayed, and a brief descrip- tion of the event and outcome. If, for example, you were told in 1936 that you had an incurable ‘cancer of the face’, you might pray to the Holy Virgin of Zapopan. After your miraculous re- covery some years later, you might commission an ex-voto giving thanks to the Holy Virgin for sparing your life. This particular example gave thanks to the doctor as well. Which is nice. It is fascinating to see the evolution of Mexi- can ex-votos;; from a 19th century man saved from execution after being falsely accused of being a highwayman, to more recent ones depicting incubators, or car accidents. Newer inter- pretations are also beginning to emerge;; two that particularly stood out to me included one written on the sole of a baby’s shoe, and another on what appeared to be a takeaway box, which I can only assume was created by a hard-up student. What the exhibition emphasised to me was how, whilst the Mexican way of life has changed immeasurably since the early days of ex-votos, an

overwhelming religious conviction remains, per- meating through all layers of society. The paintings vary significantly in their quality;; they could hardly be compared to Rembrandt or Vermeer, but this is what makes them so – for want of a better word – charming. They represent the lives of ordinary folk. Every part of their lives is influ- enced by belief in a higher power, and this gives them strength in the face of enormous adversity.

“It is fascinating to see the evolution of Mexican ex-votos - from a 19th century man saved from execution after being falsely accused of being a highwayman, to more recent ones depicting incubators or car accidents.” The second part of the exhibition, entitled ‘Charmed Life: The Solace of Objects’, is a seemingly eclectic mix of amulets and charms from the collection of Edwardian businessman Edward Lovett. Curated by artist Felicity Pow- ell, all of the items displayed were once worn or carried by Londoners to protect them from the perils of everyday life. As well as displaying pieces of her own artwork, Powell has laid out her choices on a horseshoe-shaped table. Objects on display include fossilised shark teeth to help with toothache, a bottle of mercury wrapped in leather to ease the pain of rheumatism and even a stone that was tied to a cow to prevent fairies from stealing milk. Many will no doubt seem absurd to the modern viewer, and I am left won- dering which of our rituals or charms will per- sist and which will seem just as strange to future generations as cramp-curing mole feet do to us

Miracles and Charms is at the Wellcome Collection until 26th February 2012.

medicalstudent

December 2011

Culture 50/50: A Film So Good They Named It Twice Robyn Jacobs Staff Writer A film about cancer - something that you would never expect to laugh at. But this latest offering from director Jona- thon Levine hits the mark in more ways than one. With a stel- lar cast and an excellent script this film is a sure-fire hit. Based on the real life experiences of writer Will Reiser, we follow the story of Adam, a 27 -year-old diagnosed with a schwannoma. Lead Joseph Gordon-Levitt, the slightly geeky-looking kid who once starred in ‘3rd Rock From the Sun’ and ’10 Things I Hate About You’ has t ransformed into a young actor with a wealth of blockbuster f ilms behind him. After ‘500 Days of Summer’ and ‘Inception’, ‘50/50’ does not disappoint. Playing opposite him is Seth Rogen (‘Knocked Up’, ‘The 40-Year-Old Virgin’) reliving the role he played in reality for Will Reiser - the funny man dealing with a friend’s cancer. Although funny and heart-warming, this film opens your eyes to what happens outside of the examination room. It is easy to forget that although a patient can tell you that they are fine, you have no idea what they are dealing with in the weeks or months before you next see them. The storyline deals with not only the angst that Adam has to go through, but also that of those around him - his friends, family and loved ones. Anna Kendrick (‘Up in the Air’, ‘Twilight’) plays a young therapist helping Adam through his cancer journey. Although she is meant to have a PhD, it is made clear that she is at the very beginning of her training. How she is able to help her patients, despite her youth, is a reassuring image of how we, as medical students, could be. She opens up to him and shows her weaknesses which allows the patient to connect with her on a level that isn’t just on the superficial patient-doctor relationship. As much as I could praise this film, I did at some points

despair at the way in which they portrayed the medical profession. Although nobody is perfect, I very much doubt that a trained on- cologist, even if he was American, would simply dictate into a mi- crophone and then look surprised that his patient wanted to ask a question. With healthcare litigation becoming more common and faith in healthcare providers now almost non-existent, would it

Now, I’m not a betting man, but I’m not keen on those odds... not be better to portray doctors in a slightly less demeaning light? I am not going to spoil the film for you and tell you which 50 Adam ended up in, but I will tell you this. Do not go to see this with anyone you wouldn’t want to cry in front of. Even if you can cry subtly - or think you can

KCL Charity Diwali Show 2011 Jennifer Line Guest Writer

From bhangra to Bollywood, from ballet to breakdancing, the annual KCL Diwali Show, now in its 19th year, is an impressive display of culture from both sides of the globe. The event went off with a bang – quite literally – on Monday 21st November with an explosive showcase of music, dance, fashion and fireworks. Over 1700 attendees packed into the Barbican Hall to watch over 20 acts, all demonstrating the wealth of talent amongst King’s students. The committee, made up of six King’s students – Amisha Pa- tel, Suniti Marwaha, Anne Marie Watanabe, Kelan Patel, Mi- hir Patel and Janan Sakathevan – began preparing for the show in January of this year. Behind the scenes, choreographers were also working hard since before the start of the academic year, and were able to try out their routines at the Showcase held earlier in the term. There was also a sell-out launch party at Funky Bud- dha in October, and as though organizing these events wasn’t enough, the committee also put on an after-party, for which 1300 of the attendees headed to Proud at the O2 Centre where they were able to see acts such as Jai Khan, H Dhami and Kano. According to one committee member, one of the biggest challenges was in securing a venue, but this is an obsta- cle the committee clearly navigated successfully. He was particularly pleased with the use of pyrotechnics and fire in the show, a first for students in the UK. The commmittee was also thrilled to be filmed and broadcast by the Sony Entertain-

A glittering finish to the 2011 Diwali Show. Image courtesy of Janan Sakathevan ment Network. Another committee member said, ‘We as a committee are so proud of everyone involved in the show, from the choreographers and perfomers, to helpers for each event we held. The audience on the night were so supportive and encouraging to the performers, making the entire experience really enjoyable’. As well as providing a great night for King’s students, the committee also had more noble intentions, raising money for

four fantastic charities. These were the Bal Gopal Foundation, St. Christopher’s Hospice, Kidney Research UK and the Evelina Children’s Hospital. The charities were carefully chosen by the committee to help on a local, regional and international level to provide basic education and medical care, and to support cancer patients. Al- though it’s too early to tell exactly how much was raised, the committee estimates that it is somewhere in the region of an incredible £15,000

DOCTORS’ MESS Can Cancer Cause a Cackle? By Rob Cleaver We’ve all seen comedians skirt around jokes about illness, tentatively pressing their toes against the line before recoiling back to the safety of Michael McIntyres malleable face and useless impressions of nothing in particular. This week heralded the release of 50/50, a film written by a man wholly justified in finding the lighter side of a deeply unpleasant situation. Will Reiser based his hero in the film on none other than himself, and his best friend in real life, Seth Rogen, portrays the same best friend in the film. It follows the story of a young, healthy man, and his struggle with a rare form of cancer. It doesn’t sound like the most obvious source for a heartwarming comedy centred around a strong and lovable ‘bromance’, but it is. It’s not the sort of hour long tirade that Frankie Boyle would meander through, aimlessly pointing his gun in the face of anyone and everyone like along the way. Here is a comedy about strength through adversity, and how even the worst of situations can have it’s uplifting moments. There are moments of sadness, and of hopelessness, and they are portrayed deftly, believably and heartbreakingly by Joseph Gordon Levitt, but it’s the comedic moments that are positioned throughout to break up the tears with beaming smiles and outbursts of laughter that really make the film an instant hit. The scene where he goes out on the pull for example, is a sequence in film-making that should be looked back on as a masterpiece. It triggers in me a thought about the comedy in care. The bumbling medical student in the film who is so instantly recognisable could easily be me; struggling to know the difference between the creepy physical contact of a drunk wedding relative and that hand of reassurance we strive for throughout our clinical communication courses. Maybe the taboo on jokes about serious chronic illness should be

lifted, and that passing references to it could be expanded to scripts as equally applaudable as this. The hit and miss comedy in Scrubs often centres on extreme characters stolen from much greater comedies and dumped into scruffy medical gowns. It never deals the emotional punch, or indeed, for me, the emotional punchline itself. It’s pastiche and bland form of comedy is often void of any genuine humour not already seen in a superior form. We can all share invaluable anecdotes of moments in our medical education that are funny. Be it outbursts of panic in a clinic when a friend is shot down with a serious bout of Medical Student Syndrome, convinced that they’re suffering from

an incredibly rare form of familial illness. Or the hearsay story of a medical student who treated himself for alcohol poisoning on a particularly busy night at Guy’s Bar. Or the nights we’ve woken up shivering next to someone we think we’ve never met before. Then there are the stories of the patients themselves, speaking about times in their lives that you never knew you’d need to know about, but you feel strangely better for knowing it. There’s more than enough comedy in medicine to be mined, and it’s prime for the taking.

and instead give you an insight into the strange and wonderful world of ‘Lecturing: After Hours’.

Certain lines are drawn for a reason though, and I think that that is an important thing. There’s a balance between this film and other films that touch upon the topic of cancer. Wit (starring Emma Thompson), for example, is a heart wrenching tale of terminal disease experienced by a lonely intellectual, absorbed by books and her own extravagant mind. It’s dark, it’s moving and it’s powerful. Even this, though is not without it’s lighter moments, but it tips the scales and I’m not even going to talk about tugs the heartstrings in a different way those lecturers who are in such a to Will Reiser’s screenplay does. world of their own that they’ll forget to give the lecture they’re meant to, What 50/50 brings, above all other

things though, is the message that cancer can affect anyone, and that, although it’s hard, it’s beatable. As well as that thing that everyone goes through life looking for, companionship, and that friends are shown to be priceless when you need them more than ever before. It’s not just pain relief you need, it’s the comedic relief that only good friends can bring that keeps your spirits high.

Reckon you could do better? Email doctorsmess@medical-student. co.uk with ideas for articles and you could appear in the February issue!

Arterial Route Planning

Sudoku

Without these landmarks, where would we be? I’m as adept at reading a map as I am at cooking; reasonably useless, but I hear horror stories of people wandering wildly off course in a signposted, urban area. How is it possible to walk beneath a road sign, and then walk five miles in the wrong direction before stubborn abandon gives way to frostbite, fear and fast approaching fatigue? It’s not dissimilar to studying anatomy, where it’s so easy to be bogged down in the destination that you lose track of the vessel taking you there, before hurriedly clutching at the superior mesenteric artery dearly hoping you know which way to turn.

By Rob Cleaver Everyone has something they use to signify the home stretch on a long journey back at the end of an even longer day, or at least in my head they do. I look at people and decide they use Sainsburys Local as the final step on a quest for home. Others I reckon navigate merely by a set of traffic lights or the trampled remains of one of London’s many pizza boys, crushed to death by the sheer ferocity of bus drivers hurriedly ushering the five o’ clock scrum back home.

For me though, it’s Battersea Power Station. I live south of the river, but study north of it, so when I cross Chelsea Bridge all I can see are the power station’s four triumphant chimneys, like the upturned udders of a cow, milking coal for all the semi skimmed electricity it had. Dead and lifeless, they stand as an heirloom to a past we’re no longer connected to other than through the stories of the dead, and the buildings they created.

The art of map-reading is lost. Like the ability to tackle a fellow football player without being executed. Satnavs guide us to our destination, where our forebears navigated by the stars. If the three kings had used a Tomtom to get to Jesus, they’d have taken an ambitious shortcut, involving an ‘at the next possible moment perform a three point turn’.

Look for the answers in the next issue!

I would not hesitate to say that the human race has lost it’s way.

Kendoku A KenKen is the intelligent cousin of the Sudoku – each row and column is completed with the numbers 1 to 6. No number should recur in any row or column. Added to this, the numbers in the heavily outlined boxes should combine to give the value in the top left corner, using the specified mathematical operation. Have fun!

A N S W E R S

A N S W E R S November 2011 Answers!

medicalstudent

Sport

Hockey: GKT at top of table, Barts and St Georgeâ&#x20AC;&#x2122;s close behind

GKT heading for promotion

The GKT team know their way around a long stick of wood. Image by DSB

Dan Cromb Guest Writer

Barts

GKT

With Â heavy Â hearts, Â the Â GKT Â menâ&#x20AC;&#x2122;s Â hockey Â team Â travelled Â to Â the Â misty Â lands Â of Â Redbridge Â on Â the Â 16th Â of Â No-Â vember Â for Â a Â third Â consecutive Â away Â game. Â They Â came Â close Â to Â turning Â up Â a Â man Â down Â due Â to Â Harry Â â&#x20AC;&#x2DC;Rotterâ&#x20AC;&#x2122; Â Ed-Â wardsâ&#x20AC;&#x2122; Â devastating Â separation Â on Â the Â perilous Â central Â line. Â Selflessly Â put-Â ting Â the Â safety Â of Â the Â hydration Â station Â before Â his Â own, Â he Â failed Â to Â alight Â the Â same Â t rain Â as Â the Â rest Â of Â the Â squad, Â leav-Â ing Â him Â desperately Â mouthing Â to Â Jason Â

â&#x20AC;&#x2DC;deâ&#x20AC;&#x2122; Â Gupta Â through Â the Â departing Â trains Â window Â â&#x20AC;&#x2DC;Where Â do Â I Â need Â to Â get Â off?!â&#x20AC;&#x2122;. Â Jason Â â&#x20AC;&#x2DC;deâ&#x20AC;&#x2122; Â Gupta Â helpfully Â mouthed Â back Â â&#x20AC;&#x2DC;I Â donâ&#x20AC;&#x2122;t Â knowâ&#x20AC;&#x2122; Â as Â the Â carriage Â sped Â away Â into Â the Â darkness. Â Thank-Â fully, Â interjection Â from Â a Â kindly Â pass-Â ing Â stranger Â meant Â the Â team Â was Â re-Â united Â in Â the Â region Â known Â as Â Fairlop. Bartâ&#x20AC;&#x2122;s Â attacked Â from Â the Â off, Â partly Â thanks Â to Â some Â lack-Âlustre Â play Â from Â GKT Â and Â partly Â due Â to Â being Â encour-Â aged Â by Â their Â captain, Â who Â was Â quite Â possibly Â the Â angriest Â man Â GKT Â have Â ever Â played Â against. Â The Â fact Â that Â the Â game Â stayed Â goalless Â for Â so Â long Â was Â down Â to Â some Â poor Â finishing Â by Â Barts Â and Â bad Â luck Â on Â GKTâ&#x20AC;&#x2122;s Â behalf. Â However, Â GKT Â held Â their Â nerve Â and Â Charlie Â â&#x20AC;&#x2DC;Fat-Â boyâ&#x20AC;&#x2122; Â Reeve Â popped Â up Â to Â score Â his Â first Â JRDO IRU WKH Ć?V IROORZLQJ D EHDXWLIXO run Â down Â the Â wing Â by Â Jason Â â&#x20AC;&#x2DC;deâ&#x20AC;&#x2122; Â Gupta. Half-Âtime Â arrived Â and Â with Â the Â

score Â at Â 1-Â0, Â GKT Â knew Â they Â had Â work Â to Â do Â in Â the Â second Â half Â to Â secure Â the Â victory Â they Â needed. Â Again, Â Bartâ&#x20AC;&#x2122;s Â at-Â tacked Â from Â the Â whistle Â and Â only Â a Â display Â of Â extraordinary Â goalkeep-Â ing Â kept Â GKT Â in Â the Â lead, Â as Â Bartâ&#x20AC;&#x2122;s Â resorted Â to Â sitting Â on Â the Â GKT Â â&#x20AC;&#x2DC;keep-Â er Â in Â an Â attempt Â to Â stop Â him Â making Â saves. Â Needless Â to Â say, Â it Â didnâ&#x20AC;&#x2122;t Â work. Â

â&#x20AC;&#x153;The usual warmups and preparation ensued for a match which was a mustwin game if the GKT promotion challenge was to continue, especially after the disappointment of a 1-1 draw with Bartâ&#x20AC;&#x2122;s earlier on in pre-seasonâ&#x20AC;?

Minutes Â later, Â GKT Â finally Â put Â a Â well-Âpracticed Â short Â corner Â routine Â to Â good Â effect, Â with Â Fresher Â Alec Â â&#x20AC;&#x2DC;Un-Â believable Â Tekkersâ&#x20AC;&#x2122; Â Dawson Â step-Â ping Â up Â to Â fire Â the Â ball Â into Â the Â corner. The Â game Â was Â soon Â stepped Â up Â a Â gear, Â with Â GKT Â working Â several Â good Â opportunities Â to Â extend Â their Â lead Â but Â failing Â to Â find Â the Â back Â of Â the Â net. Â However, Â hilarity Â ensued, Â as Â the Â Barts Â captain Â took Â not Â one, Â but Â two Â attempts Â at Â striking Â the Â ball Â towards Â the Â GKT Â goal, Â only Â to Â swing Â hard, Â miss, Â and Â fall Â over. Â The Â rally Â of Â laughs Â from Â several Â players Â (including Â his Â own) Â said Â it Â all. Â GKT Â capitalised Â on Â this Â humilia-Â tion Â to Â score Â again Â â&#x20AC;&#x201C; Â this Â time Â it Â was Â Hassan Â â&#x20AC;&#x2DC;The Â Hulkâ&#x20AC;&#x2122; Â Raja Â who Â stole Â the Â ball Â in Â midfield Â and Â ran Â unopposed Â into Â the Â opposition Â D Â to Â fire Â a Â well Â hit Â shot Â into Â the Â bottom Â corner Â con-Â tinuing Â his Â rich Â vein Â of Â goal-Âscoring Â

form. Â GKT Â held Â out Â for Â the Â rest Â of Â the Â game, Â with Â notable Â mentions Â go-Â ing Â to Â Rich Â â&#x20AC;&#x2DC;Debu-Âtour-Ântâ&#x20AC;&#x2122; Â Cameron, Â who Â put Â in Â a Â flawless Â performance Â at Â the Â back Â and Â Greg Â â&#x20AC;&#x2DC;Body-Âon-Âthe-Âlineâ&#x20AC;&#x2122; Â Nussbaum, Â who Â performed Â several Â crucial Â last-Âditch Â tackles Â resulting Â in Â a Â well-Âearned Â Man Â of Â the Â Match Â award. With Â the Â game Â over, Â GKT Â donned Â headbands Â and Â assembled Â for Â the Â ritual Â team Â photo, Â managing Â to Â attract Â several Â DSBs Â to Â take Â it. Â A Â trip Â back Â to Â Guyâ&#x20AC;&#x2122;s Â Bar Â and Â the Â usual Â shenanigans Â ensued. Â Following Â this Â win Â -Â Â and Â only Â hav-Â ing Â lost Â one Â match Â so Â far Â this Â season, Â GKT Â mens Â first Â XI Â remain Â at Â the Â top Â of Â their Â league, Â with Â the Â St Â Georgeâ&#x20AC;&#x2122;s Â and Â Barts Â teams Â in Â 3rd Â and Â 4th Â places Â respectively. Â The Â RUMS Â first Â team Â is Â also Â 4th Â in Â its Â league, Â and Â ICSM, Â not Â having Â won Â a Â single Â match, Â is Â un-Â surprisingly Â bottom Â of Â the Â table Â Â