The Medical Student - Freshers 2013

theMEDICALSTUDENT

Freshers 2013

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

Welcome to London

Surviving Clinics

Picking your speciality

Living life in the capital >> page 14 How to make the most of it >> page 5 Have you chosen yet? >> page 8

Thank Eebowai

Mormons take over >> page 13

New London Medical School?

Peter Woodward-Court Last year a private medical school in Malaysia, the Allianze University College of Medical Sciences (AUCMS), purchased what used to be Middlesex University’s Trent Park Campus. The plot came up for sale in April 2012 when Middlesex University began to move all its operations to Hendon, North London.

The £30 million sale brought speculation as to what the intentions of the university were.

Last month, it was announced that 300 students from AUCMS will descend on the campus this October. The Chair of the university, Dr. Zainuddin Wazir, said “Our students in Malaysia will have the opportunity to study here for three to six months in another environ-

Win! Complete our new prize crossword to be in with a chance of winning a copy of Clinical Skills Explained (worth £28)

ment. This will enable them to enjoy a totally different experience and will give them further exposure under the guidance of foreign experts.” But in addition to this, it has emerged that the university intends to spend an extra £20 million renovating the site, and will apply for accreditation as a British university; it would therefore become London’s first private medical school.

In doing so it would be hot on the heels of Britain’s first ever private medical school.

On the 28th August the University of Buckingham confirmed it would be providing medical degrees for UK students, with the first cohort starting in 2015. Many are still reeling at the new £9,000 per tem fees, but to study medicine at Buckingham will set you back a lofty £35,000 per year, leading to a final bill of £157,000. The National Union of Students said the course would “rank among the most expensive on earth”. AUCMS has not announced what its fees would be, but it would seem likely to be a similar region.

As well reading medicine at AUCMS, students will be able to study a range of other courses in the life sciences.

“Our vision for Allianze University College of Medical Sciences London is a thriving modern university campus offering the very best of academic excellence for diploma, degree, masters and PhD studies.” As well as providing a ‘premier’ higher education establishment, Dr. Wazir hopes the acquisition will boost the North London economy by providing more jobs and investment in the local area. The university will work closely with Enfield Council when considering the future plans for the site.

London NHS trusts rated poorly by cancer patients Zara Zeb & Peter Woodward-Court A Macmillan Cancer Support survey of 68,000 patients has found nine of London’s NHS Trusts to be in the bottom ten of its annual patient experience league table of hospitals in England. Imperial College Healthcare NHS Trust was worst performing, amongst a list that included Barts Health NHS Trust, King’s College Hospital NHS Foundation Trust, Whittington Health London and St George’s Healthcare NHS Trust. 2013 marks the third consecutive year that London NHS Trusts have filled the majority of places in the bottom ten.

The survey compares the performance of hospitals across England on a number

of patient measures: whether their diagnosis and treatment options were explained clearly to them; whether they felt supported in their care; and whether they felt they were treated with respect. Many of the trusts include key London teaching hospitals, where the example of what constitutes good care will be tacitly passed to the next generation of doctors. Carol Fenton, Macmillan’s General Manager, said: “It is unacceptable that some cancer patients in London are being let down by hospitals failing to provide crucial support, alongside medical treatment. There can be no excuses - especially post-Francis and the situation at the Mid Staffordshire Hospital NHS Trust.”

Shelley Mason was one such patient who had a negative

experience during her stay in a London trust after she was diagnosed with breast cancer: “Some of my experiences in hospital were traumatic. I remember a drain being pulled out of me like I was a piece of meat, and staff talking about me just behind my bed curtain. I also felt that some of my questions were dismissed in a patronising way, which really upset me.

When I asked to be referred to a psychologist to help me cope with my rare cancer diagnosis, I was curtly dismissed with a ‘why?’ I was new to this world of breast cancer and needed someone to guide me, not dismiss my fears.”

As we are so frequently reminded, there is more to caring for patients than simply giving [cont’n on page 2]

[NEWS]

theMEDICALSTUDENT / Freshers 2013 news@themedicalstudent.co.uk

A

[Editor's Letter]

new academic year begins and it’s all go here at TMS. Many of you will have picked up this issue along with a plethora of other flyers, leaflets and pamphlets as you somewhat bewilderingly walked through the Freshers’ Fair.

Unlike a majority of this ephemera, I hope you will keep TMS away from your bin - we’ve got a packed first issue with sage advice for students beginning their clinical studies (page 5) as well as how to make the most of living in London (page 14). In comment this month we go head-to-head on the controversial Liverpool Care Pathway (page 10)

Editor-in-Chief/Peter Woodward-Court Features Editor/James Wong Comment Editor/Robert Cleaver Culture Editor/John Park Doctor's Mess Editor/Zara Zeb Education Editor/Shivali Patel Sports Editors/Mitul Patel Images Editor/Upi Sandhu Treasurer/Jen Mae Low

[Who are we?]

[Editorial Team]

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and learn about the worrisome study that found the risk of death from surgery is as much as 82% higher on the weekend, compared with the same surgery on a Monday (page 9).

The Doctors’ Mess section has undergone a complete redesign and as well as learning about London life you can learn about the intriguing history of vaccination and also get the grey cells into gear with our fantastic prize crossword.

Before we commence, I ought to introduce myself as the new Editor-in-Chief. Regular readers may recognise me as last year’s News Editor. I’m delighted to take on the position, but have big shoes to fill.

Katy, our previous Editor, has

moved on to the lofty heights of the student BMJ, another magazine that’ll doubtless be going through all your letterboxes over the next few days.

I’ve just entered the world of clinical medicine at UCL and, after three years of microbiology, physiology and immunology, my cack-handedness with even the most basic clinical procedure is all too obvious. Despite this, I’m delighted to start this more hands-on chapter of the medical degree.

Indeed, with the old academic year giving way to the new, we have had to say goodbye to a number of our old editors as they graduate as junior doctors and move

> [cont’n from front page] them the right drug or the right operation. Ill patients are more than a broken machine that needs repairing. Patients need support, to be informed of their treatment plan and to be treated with the human touch.

This is perhaps most evident in the treatment of cancer. London may house some of the world’s most expensive equipment and latest drugs, but this is not enough. Despite the negative results, there is reason to be optimistic. Shelley went on to say: “There were plenty of good experiences, too. It was reassuring to be able to see my

doctor at every appointment and the oncology team was outstanding, making time to understand my needs and answer all of my questions. Their swift action has undoubtedly saved my life.”

King’s College Hospital has published their own response to the survey acknowledging despite their expertise and “track record of delivering high quality cancer services”, they “also recognise that we must also strive to improve your experience of cancer care at the hospital” and have gone on to list action points to tackle some of the areas they fared worst

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on to other exciting things.

But from this sadness comes opportunity - the paper now has a number of positions waiting to be filled. If you think you’d be interested in writing for the paper in any capacity, be it a one-off article or as the next news editor, be sure to come to our ‘Meet and Greet’ which will be held at ULU o n the 8th October (see page 7 for more details). In case you needed a little more encouragement, free food and wine will be provided. Keep an eye on our Facebook page (www.facebook.com/MSNewspaper) and website (www.themedicalstudent.co.uk) for more details.

in, including direct contact information to a real human being at the bottom of the page.

Overall, cancer patients experience of care has improved with 88% of the 116,000 surveyed reporting their care was either excellent or very good.

Despite the balance needing redressing, Carol Fenton remains optimistic “Trusts across London, such as Imperial, are making enormous efforts to improve. They are working well with cancer patients and with Macmillan to address the problem. Improvements won’t happen overnight – they take time and rely on continued top-level commitment.”

editor@themedicalstudent.co.uk

[Vacancies] We have a number of open positions at the paper. Writing for TMS is very enjoyable, and takes up less time than you might think. If you’re interested in applying, or would simply like to know more, please contact: editor@themedicalstudent. co.uk or come to the ‘Meet & Greet’ - see page 7 for details.

We are currently taking applications for: News Editor The news editor is responsible for selecting, sourcing and commissioning the articles for the front page of the paper, as well as the news section. You would attend two meetings per month. The first is to discuss the upcoming issue, and what will go in it. At the end of the month, there will be a copyedit meeting to check over the whole paper.

Treasurer The paper is funded through advertisements and we require an individual to manage the payments into, and out of, our account.

[Follow Us] Online Editor We require an individual to maintain our web presence as well as to publish some articles on The Medical Student website.

Distribution officers [Distribution] Distribution officers are responsible for taking the papers from the delivery hub ofWe their need university distribution to the officers. places the If papers you are will be picked up by available the students. mid-week One is needed and onfor campus, each of the medical schools. This please position contact: takes up very little time, but is naturally very important. editor@themedicalstudent.co.uk Staff writers Staff writers form the body of the paper! If you contact us for this position we will place you on a mailing list. The editor for the section you are most interested in writing for will contact you at the beginning of the month with a series of articles proposed for the forthcoming issue, and you will be free to select and write them if they particularly appeal, or you can suggest your own article you’d like to write.

Follow us on Facebook and Twitter for the latest updates on the paper:

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[NEWS]

theMEDICALSTUDENT / Freshers 2013 news@themedicalstudent.co.uk

Medgroup Chairs Dheeraj Khiatani & Mark Gregory As your newly elected MedGroup Co-Chairs, it gives us great pleasure to welcome back all returning students. We hope you’ve had a wonderful summer break however long or short it was. To the many freshers starting this September, well done for getting in and congratulations on a superb choice of Med School…(insert witty Med School specific banter here).

The UH MedGroup comprises representatives from the five London medical schools and has been fighting our corner on many issues, not least the BUCS fiasco of recent years. More importantly we organise 999, the biggest event this term, so be sure to get your tickets early to avoid disappointment!

Last but certainly not least, we would like to congratulate the 5 new Medical Society Presidents as they begin in their roles. Whilst the enormous power may be quite the thrill, it’s never an easy job so be sure to offer them drinks/pro-plus/comforting hugs whenever you see them.

GKT President Juliet Laycock Hello, my name is Juliet and I am the Medical Students’ Association president at GKT. It is an absolute pleasure to be addressing the finest breed of medics this country has to offer. In particular, I would like to send a fond farewell to the departing doctors and welcome the freshers into the family.

GKT has a lot to look forward to this Freshers’ Fortnight; from the notoriously messy 4-legged pub crawl and beach party, to the ‘Floating Ball’ grand finale - it’s an extravaganza not to be missed! For our full list of freshers’ events check out the MSA Facebook page.

In other news, the repetitive effect of vomit, snakebite, and drunken rugby boys seems to have taken its toll on Guy’s Bar, so KCLSU are giving it a make-over this summer! Keep an eye out for the grand opening.

All the best for the start of term!

RUMS President Swathi Rajagopal A big hello to the new freshers and, of course, all our returning students! Welcome to RUMS (Royal Free, University College & Middlesex Medical Students), voted London’s finest medical school.

The newly elected RUMS executive, Will, Tom, Layth, Jake and I have been working incredibly hard to kick-off the new year with a jam-packed Freshers’ Fortnight. From a glamorous late-night cruise over the Thames, to a (slightly less glamorous) 3-legged pub crawl along the streets of Hampstead, we’ve got it all covered – supplementing the freshers’ journey with free wine and pizza to ensure you reach the survivors’ meal!

Our main aims through the year ahead are to look after and represent each and every member of RUMS - we work for YOU. Keep an eye out for taboo week, housing seminars, sporting events (Bill Smiths!) as well as the legendary Winter and sports balls.

Get involved, embrace RUMS spirit, and help make RUMS bigger and better than before! Looking forward to meeting you all soon!

SGUL President Mohamed Amer We finished the year with a long list of outstanding extracurricular successes. At the annual Face-off competition the SGUL team claimed ‘the double’ scooping both the music and dancing awards. Our hockey club has enjoyed successes, both the men’s and women’s teams BUCS leagues, while both our men’s Rugby and Football teams narrowly missed out on UH final success at the hands of Barts and GKT respectively (Grr). Our Bhangra team took to one of London’s largest stages, the Hammersmith Apollo, performing in front of 3,500 spectators, to push aside hosts Imperial (who put on a fantastic show), Kings and many other university dance teams from around the country, to finish second in the ever impressive Bhangra showdown.

So what of the coming year? We hope to keep on bringing trophies to the cabinet and aim to bring back our UH review title which was controversially taken from us (we’re coming for you GKT!) The next week kicks off with postgraduate freshers’ week with events such as a sushi workshop and a RAG casino night full of prizes, before we dive into undergrad fresher’s fortnight at the end of September with games night and ‘Lazerquest’ making a return as well as the classics such as Toga. All in all there’s a lot to look forward to over the next month and indeed the next year here at George’s.

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ICSM President Steve Tran Hi, Steve here! So I’ve officially started my ‘gap yar’. It’s a strange feeling as it’s meant to be the Summer holidays but I’m rushing around trying to ensure we have everything in place for the start of freshers’ on the 29th September. Sophie, our events chair, and her team have been slaving away to ensure that we will deliver one of the best Freshers’ Fortnights ICSM has ever seen.

Amidst all the chat about Charing Cross being closed down, our University has invested a large sum of money into developing our beloved Reynolds Building and this summer sees our Bar/Café being completely renovated so definitely watch this space!

In other news, Imperial are the lucky hosts of the MedSoc Committee Conference 2013, which is a conference for any medical students who support other students – visit our website for more information: icsmsu.com/medsoc

BLSA President Ali Jawad Hello from Barts and the London! A huge welcome to all of our new freshers, and a warm welcome back to everyone else! I’m Ali Jawad, president of Barts and the London Students’ Association. To the freshers: studying medicine in London is special (especially at Barts!), and we’re all very excited to have you join this amazing community.

With everything we do, we want you to enjoy the time you spend at university. Your course may seem long now, but it will pass quickly, and there are great opportunities that you should make the most of. One of the most important ways to have a great experience is to make sure you get involved.

There is something for everyone: clubs, societies, volunteering, music, faith, student politics, and so much more!

But that’s all from me, all the best with the year ahead!

[FEATURES] /5 Clinics - Making the Most of it

theMEDICALSTUDENT / Freshers 2013

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

James Wong Features Editor

C

ommencing the first clinical year is a milestone. Things will now be different as your student career steers straight into the unchartered waters of clinical medicine. New challenges and responsibilities lie ahead and not just in an academic sense.

After all this is the awaited moment, the start of the apprenticeship you have so desired and laboured for. It won’t be long before these clinical years like the preclinical years before them, will seem just as distant and insular, so why not make the most of it?

The first days hold so much excitation and promise and for many they deliver, however, it would be wise not to be too optimistic. I am afraid your firm head standing abreast the doors in a prophetic splaying of arms is an unlikely sight. In this new clinical environment, it is natural to be a little flummoxed. The quizzical looks of doctors and nurses as you first walk in, a sure sign of your unexpected arrival, is a recurring theme. If the wards are going to be your new hunting ground, proper introductions with the medical team are in order. This might seem like a task of Herculean proportions, particularly in large teaching hospitals. Everyone is busy; Junior doctors scuttling around the ward desks, job lists in hand, the registrar probably won’t have noticed you and as luck would have it your consultant firm head is away at a conference. Perseverance during these periods of frustration is a rewarding quality. Winning over the junior doctors with some keenness will help you no end. What I mean to say is that their role in our learning as students extends further than the security of sign-off signatures a week before the end of the rotation. They will give you opportunities. Take them! Although it never feels like it at the time, being a medical student does afford some privileges. The student

badge clipped to your new clinic clothes is a license to learn: to embark on undying streaks of false answers, to fail as many skills and clerkings as is required and to do so unabashed.

Unfortunately, the junior doctors are not there purely for your benefit, they cannot always spare the time to directly observe a history taking or an examination, instead you must report back. With practice this becomes more of a tick box exercise: gleaning as much information and then reconfiguring it into a structured presentation. However, the performance goes unseen and unheard. I do not need to iterate the inherent dangers of this practice. Possible solutions? Well receiving immediate feedback is more obtainable on GP visits or at outpatient clinics. They provide many opportunities to test your questioning style and bedside manner. Performing under scrutiny recreates OSCE conditions. Due to time pressure and no doubt the diagnostic cogs running overtime, it is fatefully easy to miss emotional cues or derail a conversation in a way which would be deemed insensitive.

Often it occurs subconsciously so take full advantage of a GP or a fellow firm mate’s presence when taking a history.

Self-directed learning will take on a new meaning. The expanse of clinical knowledge has a vertiginous effect. No longer is there a structured timetable of lectures as a guide; for the most part you are alone. Teaching will become a valued commodity, so no matter how sincere the promises, do not rest until the calendars are out and a mutually agreed time is settled. I would not encourage ambuscaded attacks on staff but taking the initiative to arrange dedicated tutorial time with your superiors is best started early. Consigning oneself to the library and ploughing through books might appear the obvious remedy, it has proven effective for the last 2-3 years after all. But unfortunately it cannot all be

“New challenges and responsibilities lie ahead and not just in an academic sense”

learnt with bookwork. Whether it is taking a psychiatric history, venepuncture or reading a chest X-ray, these are perishable skills and only repeated and refined practice will make them become second nature.

Balancing studying with time on the wards is a challenge.

Unsurprisingly, after a day spent on your feet, there is wavering incentive to merely open a book. Keeping it varied will prevent staleness taking hold. Attending a different clinic, brushing up on some pathology at a postmortem or group study sessions adds flavour to the daily routine. During the heated weeks before OSCEs, group study becomes very attractive.

While it does cement clinical skills, do not be fooled; your colleagues tend not to share the same examination findings you would encounter on an oncology ward nor the measured responses of professional patient actors.

So ward time is important but little exposure to all this clinical information will be gained by assuming a watchful presence. Simply attending every ward round, while a laudable achievement, will

not secure the knowledge.

Senior members of the team operate on another plane. It is a dazzling display of speed whenever a monster list of patients comes gushing out the printer. Before you have even registered each patient’s problem(s), the management plan has been dictated and written down.

There is little else to do but feed off scraps of information drawn from the junior doctors on the journey to the next bed.

Of course there will be lulls, when the pace falls off and there is ample time to digest a history. Although it is comforting to have the medical notes to check your findings once the round is over, it does diminish any element of mystery. The moment a patient enters the hospital is the best time to cross paths. At this point all the work is before the medical team, your initial guesses might be as good as anyone else’s. Visiting A&E of your own accord or as part of your medical team’s on-call rota is well worth the effort.

Being handed the initial A&E clerking and gingerly drawing back the curtain incur a chill-

“Balancing studying with time on the wards is a challenge. Unsurprisingly, after a day spent on your feet, there is wavering incentive to merely open a book.”

ing sense of responsibility.

Embrace it, it will solidify not only clerking skills but also put into practice the explaining of investigations or results as well as treatment options. If you are feeling keen you could present to the consultant on post-take.

Experiences like this become etched in your memory because of their proactive approach. You begin to remember conditions associated with patient cases you have seen before rather than the corresponding pages of the Oxford Handbook. And there is something about the small thank you by the F1 or perhaps finding your name alongside theirs on the new patient list the following morning, which rekindles your enthusiasm.

To be considered part of the medical team is the ideal position and a comforting thought.

Good luck.

Fancy a head start in your clinical studies? Enter our prize crossword in the Doctors’ Mess section for a chance to win a copy of Clinical Skills Explained!

[FEATURES] /6

theMEDICALSTUDENT / Freshers 2013

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

The Atkins diet: Four Decades Later Daryl Cheng Guest Writer When news of Robert Atkins’ heart attack broke in 2002, the collective schadenfreude of his critics was palpable. The restrained I told you sos, the eyebrow raises and the tuts all told the same story: here was the man who had advocated the impossible—that a diet rich in delicious, fatty meats was somehow better for your waistline and your heart (although not your wallet)—suffering the consequences of his folly. But as men and women of medicine and science, how much of the evidence both for and against this famed diet can we actually present to our lay friends, more than four decades after the publication of Dr. Atkins’ Diet Revolution?

Any biology student who has had to endure a lecture on human nutrition and metabolism has realised that the common sense notion of a ‘low-fat’ diet so desperately pursued by the masses, necessarily means a corresponding increase in other food groups. Assuming these health-conscious people aren’t starving themselves, the other

food group in question that they increase their intake of is more often than not carbohydrates.

And thus is the crux of the Atkins diet: that a high carbohydrate diet is the leading cause of the obesity epidemic and those hard to shed pounds. In particular, refined sugars encourage a chronic hyperinsulinaemia to try and keep the glucose levels down. In a nutshell, this hyperinsulinaemic state promotes an anabolic state in which patients make fat, and it doesn’t take too much to imagine how that might contribute to insulin insensitivity.

However you slice it, it seems like these low-carb diets seem to work. A 2003 study in the New England Journal of Medicine found that of 79 subjects with a BMI of greater than 35 randomly assigned to either a low-carb or a low-fat diet, the subjects in the low-carb group lost more weight, had a greater reduction in their mean serum triglyceride level, and in subjects without diabetes, had a greater insulin sensitivity. As strange as it seems, eating more fat means you lose more weight, have a triglyceride level which is prob-

ably better for your heart, and moves you back on the slippery slope towards diabetes.

Although the popularity of the Atkins diet waned (as fad diets are wont to do), it has found new life in more recent years as the so-called ‘Paleolithic’ diet.

And while both diets shun refined sugar as the villain in our society’s ever expanding waistline, proponents of the Paleo diet point to the fact that the environment in which our prehistoric ancestors evolved was pre-agricultural. As such, it was a culture and diet low in cultivated grains and high in foraged foods, fats and meat. The reasoning concludes that these ‘diseases of civilisation’ that we see today could be avoided if we reverted to that diet. But even a casual observer easily picks this argument apart. Besides the huge differences in the habits and environments of the two cultures, our current one has an invention that blows the previous one out of the water: evidence-based, scientific medicine that emerged post-Enlightenment. The fact that we may be adapted to our prehistoric diet is neither necessary or sufficient

evidence that it is better for our health.

The medical establishment has had a complicated relationship with Dr. Atkins’ diet.

His minority and dissenting hypothesis found itself at the sharp end of the community’s ridicule and dismissal, which continued to recommend, as it always had, that a low-fat diet was better for your heart, and that if you wanted to lose weight, then you had better be prepared to go hungry.

In the end, Atkins died aged 72 of head injuries after slipping on an icy pavement one snowy New York day. The heart attack he suffered the previous year was due to a cardiomyopathy, one that his cardiologist prescribed to some infectious agent, and unrelated to his cause of death. But as the obesity epidemic grips more and more countries, and the burden of obesity on their healthcare systems increases (together with its many associated metabolic syndromes), the question of its cause is more pertinent than ever.

It doesn’t help that so many things contribute to and cloud

the issue. With agricultural advances food is ever more refined, cheaply produced and of a more consistent quality. The glut that is available to us is tempered with the constant marketing by food companies of newer lowfat products, with promises of benefits to our health. And the production and consumption of fats, at least in developed countries over the past several decades, has been steadily falling.

It is a fact, a litany, known and repeated by many if not most, how fat will make you fat, how fat will give you heart disease.

It seems so simple and obvious to the point of tediousness, but as ever, it turns out the story is going to keep getting more complicated.

Unable to fit his death into a neat narrative, it may seem an unsatisfying conclusion for a controversial man. But as we argue, investigate and clarify our understanding of these diseases, the smiling portrait Robert C. Atkins, M.D. on his book looms over us: about his diet revolution that refuses to die, and asking us and the medical establishment to consider again our position.

Budding medical journalist?

Write for us!

Contact: Editor@themedicalstudent.co.uk

[FEATURES]

theMEDICALSTUDENT / Freshers 2013

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

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Good Afternoon, my name is John Smith, and I’m a 3rd year Street Doctor...

Suzanne Rayner, Odhran Keating, Mitul Patel This August students from all over the UK will have opened A-level or GCSE results letters and thought about their future. However one family will be opening their son’s results unable to look past what might have been. Ajmol Alom, a 16-year-old from Poplar, east London became the eighth teenager to be murdered in the capital this year, stabbed in the thigh whilst out with friends near his home.

He was described as an “industrious” and “thoughtful” boy, who “worked flat-out” to fulfil his dream of becoming a medical student. With an A* already in Maths, he was expected to sweep the board at GCSE but now his potential will never be realised. What is to be done about such a senseless waste of young life?

On the streets, the Metropolitan Police report that violent crimes in London are down 3% from 2012 figures.

However homicides are up in frequency by over 10 % which, alongside Ajmol’s story, should serve as an unfortunate reminder that violent crimes on our streets remain an important source of mortality in today’s community.

The GMC outlines in Tomorrow’s Doctors that we should be responsible for protecting, promoting and maintaining the health and safety of the public. This should not be constrained to the walls of

a clinic or hospital building, which is where the Street Doctors step in.

Street Doctors is a recently established charity which aims to save lives such as Ajmol’s.

Set up in Liverpool in 2008, Street Doctors aims to make a difference by teaching young offenders practical approaches to the acute management of gunshot and stab wounds.

Currently we are wholly run by medical students and junior doctors with branches in east and west London as well as Nottingham, Manchester and Liverpool.

Our focus is on providing interactive and simple sessions that can be recalled and utilised easily in pressurised situations where urgent action is required. That means no PowerPoints or lectures. Sessions usually involve a group discussion where we can have a bit of a laugh and hopefully teach a few useful skills.

Teaching young offenders may seem a daunting prospect for some students, and certainly out of the comfort zone of teaching your colleagues in PBL. In 2011/12, over a fifth of offenders admitted to youth offending teams (YOTs) were associated with violent crimes and common assault. So just how truthfully did you mean that ‘I want to help people’ on your personal statement?

Enough to sit in a room with four convicted youths and teach them life support skills?

The good news is that crimes involving youths are slowly on the decline. Gov-

ernment statistics show that proven offences committed by young people on the YOT caseload in 2011/12, fell 22% from the previous year. Street Doctors has recently established a research and development arm in order to assess how effective our sessions are in reducing crime, but everyone involved is confident that the effort put in by our members is making a difference.

Make no mistake; we do not aim for the youths to become paramedics overnight, but victims who receive basic life support until the arrival of an ambulance stand an infinitely better chance of survival. The attendees learn basic medicine, such as the need for urgent treatment following injury from violent trauma, the reduced chance of survival following excessive haemorrhage, and the signs to look out for in a victim entering shock.

Furthermore, Street Doctors teaches youths life saving skills such as the recovery position, cardio-pulmonary resuscitation, and haemorrhage control. Completion of such skills has now become a mandatory component of a youth’s rehabilitation.

In the future, as more young people go through the training, we hope to enable them, alongside medical students, to deliver the training to their peers as they will always have an insight into the reality that we as medical students do not.

One of the most valuable aspects of our work is the

Meet & Greet!

range of benefits for so many different groups. The young people we teach are empowered and given useful abilities.

The victims who are injured through interpersonal violence have a better chance of survival without serious injury. The NHS benefits from a “healthier victim” and the reduced costs of injuries from violence.

Medical students and junior doctors benefit from working with young people and learning from young peoples’ experiences. They gain skills in teaching, project management and have the opportunity to engage with this marginalised and vulnerable group, in a meaningful way.

Having only become a registered charity this year, we hope the increase in publicity

and funding will aid the efforts of our volunteers in ensuring decreased street mortality.

Closer to home, efforts are being made to develop north and south London branches, which will closely knit together Street Doctors and UH medical schools.

The annual Street Doctors conference is coming to London on 19th October. If you are interested in becoming involved in an existing branch or being involved in setting one up at your medical school please get in touch. We need enthusiastic and open volunteers who are keen to go out there and make a difference. To find out any extra information about the West London branch please email our chair Maria at maria. lobo09@imperial.ac.uk.

7 p.m. 8th October Room 2 Join the editors, see what TMS University of London is all about and get involved Union (ULU) Free Food & Drinks! with writing for the paper Malet Street, WC1E 7HY

[COMMENT] /8 A New Season’s Greetings theMEDICALSTUDENT /Freshers 2013

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

Rob Cleaver Comment Editor There are many complainants about the return of the football season after the summer break. They complain vehemently about how, even when Wayne Rooney is sunning his scalp in Spain, there are those that spend their days spinning a web of rumours to keep people chomping at the bit, to leave the football fanatics frothing for football come the autumn.

I guess this isn’t the same of comment writers. We still have comments and thoughts and those ideas for really great metaphors but we don’t send them out there into the ether. We keep them inside, dormant in hibernation, until the match ball is kicked at 3pm on the first day

back - and here we are, fresh of face and fresh of mind and hopefully freshly fuelled for a full season. The Out of Office lies sullen in the back of the net.

I am Rob and I’m the new comment editor, replacing the previous editor who conveniently was also Rob. A tad confusing, perhaps but we’ll muddle through like Chelsea and their managerial merry-go-round.

I’ve spent my summer contemplating the key questions that medical students ask when they get here - how can we save the NHS, how can we make a university education affordable for all and just how many levels are there on Candy Crush?

For the next few weeks you’ll be spending a lot of time between Freshers’ Week forays talking with people, quite literally commenting, and I am

keen to welcome those voices into these pages. Be them loud and baritone or quiet and falsetto, we want to know what you think and what you’re talking about and whether what we’re talking about is abhorrently askew.

So talk to me, to us, about things you have feelings about.

If you know how the Liverpool Care Pathway could be implemented without risk then tell us. If you know of a way to differentiate me from the previous editor then tell us. If you want consultants to work at weekends then tell us but don’t tell them, they might bother going bare below the elbow for once - perhaps even on a weekend and it won’t be their blood on the pitch once the ninety minutes is up.

So What Kind of Doctor Do You Want to Be? Rhys Davies Staff Writer It’s an innocent enough question and, after six years at medical school, one I have grown very familiar with. It can be applied to conversation with a medical student in any kind of social situation. Friends and family over rarefied Christmas get-togethers; friends at university when the well of discussion pieces dries up; doctors of every speciality, peering at you with the ill-concealed desire that you want to follow their illustrious footsteps into their chosen speciality. I have always disliked the inquiry because I have never had a good answer.

“People follow my reply by listing the specialities, trying to find the one that fits” For the first five years or so, I would mumble that I didn’t really know, that I enjoyed every

field of medicine I had tried so far, that I hadn’t had enough experience to make a decision yet.

But with the spectre of FPAS looming and the prospect of being a doctor becoming frighteningly real, this cop-out of an answer increasingly fails to impress. When I was younger, it showed openness and eagerness. Now it shows a lack of direction, and people follow my reply by listing the specialities, trying to find one that fits on the spot.

Thankfully, I was blessed with a very informative fifth year. Having had a series of attachments on a diverse range of specialities, for the first time, I can actually refine my tastes. I know that in specialities like obstetrics or orthopaedics, I would fit in as well as a mosquito at a malaria clinic. Conversely, I can see myself working in, and importantly, enjoying myself in other specialities.

So now when I am asked what I want to be when I grow up, I can confidently claim that

I like the cut of paediatrics’ jib.

It appeals to the generalist in me and I enjoy working with children. When I explain this to people, they all nod and smile approvingly. Everybody likes a paediatrician. By whatever metric they use to judge me, taking care of sick children is a ‘good’ job.

“Tenderness in the right iliac fossa can only prove novel so many times” However, I still dislike being asked the question because, even though my answer is honest, I feel like a fraud. I do really like paediatrics but it comes second in my affection after psychiatry. While I find paediatrics interesting, I find psychiatry fascinating. Tenderness in the right iliac fossa can only prove novel so many times but every presentation of issues of mental health is as unique as the patients they affect. I like that, if I am able to help someone, my impact on them

could be equivalent to treating meningitis. Psychiatry also offers a generalist approach in its holism.

But when I try and explain this to people, they nod curtly and the conversation wilts. Or they look at me askew and ask, ‘don’t you like medicine any more?’ or ‘I thought you wanted to be a real doctor?’ Trying to reach someone with suicidally deep depression or attempting to help a person with schizophrenia live a normal-ish life is, to most people, a waste of my talents. Psychiatry is a bad job.

Why is this speciality, under-appreciated and undersubscribed, so maligned? Is it because psychiatrists are agents of social control, policing the norms and enforcing rightspeak? Is it because they dole out powerful psychotropic medication (which is, at the same time, no better than placebo) like candy for what is just a case of feeling a bit sad or a rowdy child with bad parenting?

The Time to Change campaign aims to end the stigmatisation of issues of mental health, something I am so very keen on. Having witnessed the reality of mental health issues, both professionally and privately, the myths and assumptions I see stagger me. On the eve of my psychiatry attachment, my mum asked me if I was worried about catching schizophrenia from the patients. Yes, she thought it was contagious.

I think we need a parallel campaign to de-stigmatise psychiatry. We need to end the misinformation and hearsay that the likes of Giles Fraser and Ruby Wax replicate in the Guardian and on BBC Radio 4. We need to end the medical school cliché that psychiatry is a career for the crazy, eccentric and weird. We need to change things so that when asked what they want to do, a medical student can proudly reply, ‘Psychiatry.’

With the response, ‘Cool.

Good for you.’

[COMMENT] /9 Death Doesn’t Wait for Weekends theMEDICALSTUDENT / Freshers 2013

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

David Fisher Staff Writer Would you have a coronary artery bypass graft on a Friday 13th? What if you accidentally smashed a mirror on the morning of the operation? Would the sight of ravens precipitate a heart attack before walking through the hospital door? New evidence brings to light another concern which will strike fear into the hearts of surgical patients. Beware of the weekend.

A recent study published in the BMJ sought to establish whether the quality of medical care was inferior at the weekend as compared to the rest of the week. The team at Imperial College analysed data collected at the 163 English acute hospital trusts, looking specifically at the records for elective inpatient admissions over a 3 year period. They noted the day of the week the surgery was performed and whether mortality occurred within a 30 day period. It was hypothesised that mortality rates would be more pronounced among patients operated upon at the weekend and on Thursday and Friday because their critical 48 hour post-operative period, when serious complications are most likely to occur, would coincide with the weekend.

The results of the study were startling. The adjusted odds of death for an elective surgical procedure was 44% higher if the surgery was performed on Friday as compared with Monday and an even more disturbing 82% higher if carried out over the weekend. Perhaps less expected was the emergence of a linear trend of mortality correlating with the week’s progression. Monday was the safest day to have surgery. Tuesday was less safe, a 7% increase in the odds of death compared to Monday. Wednesday was even less safe, 15% more risk than Monday. The odds of death on Thursday were again increased at 21% more risk than Monday.

One possible explanation for the dramatically increased risk of mortality following surgery on the weekend is that patients needing weekend surgery might be more ill and therefore more likely to suffer from

Illustrated by Alexis Nelson

a complication. This could be supported by the fact that only 4.5% of elective procedures are performed at the weekend.

However, this explanation does not withstand scrutiny. The study organisers used a mathematical model to calculate a score for each patient depending on the co-morbidities. Interestingly, weekend patients often had less comorbidity, fewer recent admissions to hospital and underwent lower risk surgery compared to weekday patients.

Having closed this avenue of enquiry, the authors offered one other possible reason for consideration. They suggested that the increase in mortality could be linked to reduced or locum staffing and poorer availability of services at the weekend.

Certainly the association between less comprehensive care at the weekend and mortality is plausible particularly when considered alongside other reports. The most recently published Dr Foster Hospital Guide asserted that mortality rates were higher for patients admitted at the weekend in English hospitals in 2012 compared to those admitted on a weekday.

Additionally, hospitals with greater senior staff presence at the weekend have lower patient mortality figures. Pressing the dagger deeper into weekend elective surgeries, an editorial was published alongside this study. It questioned the sense of scheduling elective surgeries for the weekend, citing poorer outcomes as justification. This is surely a sensible and logical response to the results of the study but it ignores the primary problem.

“Reduced staffing at the weekend is incapable of explaining why a patient who has an operation on Tuesday is more likely to die than a patient who was operated upon on Monday” Careful examination of the data reveals that the primary issue is a constant upward trend in the odds of death throughout the week. Reduced staffing at the weekend is incapable of explaining why a patient who has an operation on Tuesday is more likely to die than a pa-

tient who was operated upon on Monday. Further, it is inconsistent with the finding that Wednesday is a riskier day than both Monday and Tuesday. The spiking of the odds of death on Friday and the weekend is the most glaring part of the data but presumably represents a secondary factor, such as reduced staffing, which is compounding the primary problem.

The marked increase in mortality as a result of weekend surgeries and immediate post-operative recovery on the weekend is certainly an issue that ought to be scrutinised

and addressed. Focussing complete attention on the weekend is however inappropriate. We should not bury our heads in the sand and pretend there is no other concern. Questions must be asked why there is a linear trend in mortality as the week progresses. More data should be accumulated. Is there a common cause of death? Perhaps a common cause could be linked to errors in medical care that become more frequent as the week progresses as staff become increasingly tired. What was the average amount of time the deceased patients spent re-

covering in hospital before being discharged compared with those who did not die? Maybe the pressure to vacate beds results in increasingly hasty discharge, particularly in the lead up to the weekend when few patients can be discharged.

We must tackle the immediate issue of understaffing at the weekend but at the same time not hide from the fact that there is another unidentified problem. Further probing may reveal a hornet’s nest of issues and if so, it is vital that we give it a stir.

theMEDICALSTUDENT / Freshers 2013

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

YAY! In July of this year, Baroness Neuberger concluded her review into the use of the Liverpool Care Pathway (LCP) for patients at the end of life. She recommended that the pathway be phased out in favour of personalised care plans for terminally ill patients. This came after a furore, largely stoked by the Daily Mail, over the mis-treatment of patients on the pathway.

There were reports that patients were denied food and water to hasten death, and that, instead of quality of life, the LCP was used as a tool to clear beds, save money and earn extra financial incentives. Previously, I have defended the pathway as a means of achieving a good death, the final chapter of a good life. I still believe in the LCP in theory, that minimising pain, distress and pointless or invasive medical interventions is what compassion looks like at the end of life.

However, compassion requires thought and in practice, the LCP appears to have been thoughtlessly used as a tick-box exercise. Someone’s final days, perhaps the most poignant of their life, cannot be managed on automatic. I want the LCP at its best, but I do not want it at the price of the LCP at its worst.

I hope that the end of the LCP can kick us into considering the spirit of the pathway, thinking intelligently and sensitively about death. But it will take more than newly considered guidelines and frameworks to ensure that. It requires a radical culture change. Our western capitalist societies tell us that we are invincible and we are immortal.

God is dead – Live in the now!

Tied in to this is the medical myth, that surgeons can excise any cancer, that doctors can cure any disease, and that death is always a failure. Death is not a failure, it comes to us all. Railing against it by assaulting the patient with heroic medical interventions is akin to a spoilt child’s tantrum, costing the dignity

of the patient and the doctor.

With the wane of religion in the nineteenth century, the doctor replaced the priest at the deathbed. However, while the preacher offered spiritual solace to the patient and the family, the physician is still left wondering what to do. Extending a patient’s quantity of life by a fraction is not worth savaging their quality of life but for anxious family members at bedside, this argument competes with ‘do anything, do everything.’

[COMMENT] /10 Within twelve months the Health Secretary, the not so honorable Jeremy Hunt, is to call time on the Liverpool Care Pathway. It has been given its terminal diagnosis, been offered condolences, support and a leaflet or two and been told to prepare for its final days. The irony in this is that he is giving the LCP a dignified end - it hasn’t been jabbed and poked or left to die prematurely without food, it is running its course without excess pain or intervention and there has been a plan in place to cover it until its final minutes.

I do not deny that the LCP has been implemented in an incorrect and unpalatable fashion but it is this that is the centre of my argument to continue standing by it. It isn’t the directions for

LET’S WALK AWAY FROM THE LIVERPOOL CARE PATHWAY! FOR - RHYS DAVIES [ICSM] -VSAGAINST - ROB CLEAVER [ICSM] What medicine hasn’t quite realised yet is that the act of dying is a group event. There is more than just the patient to consider. Including and supporting the family through such a pivotal event in their dynamic requires honest and sensitive communication. Communication is at the heart of the new recommendations.

In that regard, communicating to one’s significant others about one’s intentions at the end of life is as vital as wishes regarding organ donation.

The LCP was a good start to intelligent and compassionate care of the dying. But even excepting the emotional blackmail of the press, abuse of the pathway cannot be excused.

I don’t believe Baroness Neuberger’s recommendations will solve the broken culture of death we have but, along with the lessons of the LCP, they may be step in the right direction.

end of life care or the sentiment of the LCP that has been attacked so eagerly by the press, it is the people that have, in both definitions of the word, executed it.

It is similar to how we direct scorn and vitriol at those in the press - the Daily Mail, for example, for whom the LCP is a particular bugbear - but do not hate the idea of the free press itself, we are thankful for it. It

NAY!

is those irksome few within it that throw out opinions that we find most unsavoury. It is the same for the LCP; we can’t blame the idea and the logic behind a caring and nurturing end for our patients and their relatives in the correct circumstances if such a time should arise, but we can blame the way the irksome few have abused it.

What matters in cases where death is an overwhelmingly likely outcome is that the desires of all are met and an understanding reached. The patient, their relatives and the MDT should be involved in a plan so that nothing approaches that is unexpected. The LCP aims to provide this with a framework to neither hasten nor prolong death but to make it a more comfortable, better understood and rigorously monitored process. That isn’t an abomination, it is a reasonable expectation of top quality medical care that does not see death as a failure but as an eventuality.

I would argue, therefore, that what we need most is a reeducation on how best to implement the LCP to ensure dignity and peace. The Marie Curie Palliative Care Institute in Liverpool published follow up guidance on the LCP in 2010 entitled ‘What is the Liverpool Care Pathway’ and ended almost with a premonition of its demise.

“Since improvement depends on the actions of people, ultimately it comes down to winning hearts and minds,” they say, “and no matter how good you believe [the LCP] is; you cannot just expect others to do as they are told. The LCP is only as good as the people using it.”

Maybe we weren’t good enough for the LCP rather than the other way round.

[CULTURE] /11

theMEDICALSTUDENT /Freshers 2013

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

September 2013 at the Cinema It’s About Time

It’s the kind of trick everyone wants up their sleeves at times of real emergency. Quickly go back in time, rectify whatever error you just made, and life goes on…in a much better version than you had first hoped for. This little gift comes in very handy for Tim (Domhnall “son of Brendan” Gleeson), a “too tall, too skinny, too orange” young man training as a lawyer in London. Unlucky in love, he hopes to find “the one” despite his awkward social skills when it comes to approaching women.

This is where his family gift of time-travel, which works simply by him standing in a dark room, clenching his fists and imagining the moment he wants to return to, is a godsend. Whenever he says or does something that would immediately turn someone away, Tim will fix it, and all is well. There are some slight hiccups along the way: messing with time is never something that can be taken lightly. Change the past, you change the future. And the consequences he faces are sometimes challenging, but with his eyes on the final prize, he’s willing to do whatever it takes.

His final goal is Mary (Rachel McAdams), a sweet and adorable American girl he “meets” in a pitch black restaurant in Central London (N.B. this is a real place: “Dans Le Noir” – aiming to give you the dining experience of the blind). Yes he’s manipulating the events, and yes there’s something a little creepy about how this puppet master is ultimately controlling this poor unsuspecting girl but we decide to forgive and forget, because time-travel can often be oh-so-funny and moving, as this film has to show.

So it’s down to the two leads to

truly sell this story that has some dark undertones: and the good news is that they absolutely do.

Awkward and likeable, Gleeson fits comfortably into the role, embodying the everyday guy type persona as well as having some quirk of his own. Also immensely lovable as his on-screen love is the ever-so reliable McAdams who eases and breezes through the role. Together they become the perfect romantic comedy couple, with stunning chemistry, one that you’ll be rooting for no matter how somewhat inappropriate the wooing process may be.

But About Time isn’t just a story of how boy meets girl and despite difficulties they still manage to end up together. A different strand of subplot involves another memorable, highly effective performance coming from Bill Nighy. Although credited simply as ‘Tim’s father’, he has a considerably important role that suits an actor of his calibre. With Nighy, the film strikes comedy gold many times, and in its touching albeit slightly corny finale, the poignant scene does manage to tug at the heartstrings, exploring the father-son relationship between the two men sharing a family secret.

There is also the predictable but well thought-out, empowering message embedded in the plot that one should live his life to the fullest extent. Take every day as a gift; and that message, conveyed through Tim’s narration voiceover, is perfectly acceptable, but one that is not aiming for much originality.

But in a smart move to carefully follow every step of Tim’s travels through time, Richard Curtis delivers a smart, widely crowdpleasing feature that should be seen by many.

It’s all going down The White House is yet again under attack, with its hopeless defence systems (there are hardly any here by the way) and guards (again, hardly any) taken down effortlessly by meticulously organised bad guys who take control of what’s supposed to be one of the safest places on Earth in a matter of minutes, if not seconds. But fear not, for we have Channing Tatum on our side. There are of course, some very important-looking people in suits in a crowded room trying to do their best to save their country from collapsing, but ultimately, it’s Tatum and his oneman army that you know will protect the President of the United States.

Perhaps keeping in with the state of affairs in the current White House, Jamie Foxx plays the President, trying to sign a peace treaty and pull American troops out of the Middle East. It’s not a wildly popular move, which explains the attack later on.

So how does Tatum’s character fit into the whole thing? John Cale (Tatum) is ex-military and tries to join the Secret Service, and enters the White House for an unsuccessful job interview. With him is his estranged daughter Emily (Joey King), a politics-obsessed young girl who is over the moon about her little trip to the President’s home.

Ruining this family day-out and father-daughter bonding experience is Emil Stenz (Jason Clarke),

who eases past the security posing as a video technician, and gets to work. First the Capitol building is blown up; but never mind that… we only care about the White House. And when the Secret Service detail of the President is immediately wiped out, it’s time for Cale to step up to the plate and smartly take down the bad guys, protect the President, make sure his daughter stays alive, and also uncover the deep dark conspiracy that reaches the highest levels of the government responsible for today’s attacks.

And what follows is a series of ludicrous but entirely enjoyable scenes of bombastic action. The louder it is, the sillier it is, but ultimately where director Roland Emmerich, who has some first-hand experience when it comes to destroying the White House, excels in is providing as much fun for the audience as possible. When the big guns come out (both Tatum’s, as well as the military weapons), there are very few moments where the film takes a breather, which is perfectly fine, for a film that wants to fully embrace the stupidity of some of its ideas. There are missiles, helicopters flying as low as they possibly can, a car-chase on the White House lawn, bombs, grenades, brutal fist-fights – it’s almost as if the White House has turned into a gladiator ring and you almost expect Tatum to go around yelling “ARE YOU NOT ENTERTAINED” to all those suits

watching/listening from afar, not really doing anything.

Tatum, who has a knack for headlining a film as an action hero who is also capable of comfortably delivering wisecracks and gags, is very strong in the role, and it’s difficult to imagine anyone else in it.

As likable as Will Smith once was back during the Independence Day era, Tatum is the one easily interacting with everyone in the cast, and the chemistry that the film benefits most from is the one Tatum shares with Foxx. Cale, in this situation of national emergency, isn’t too bothered about speaking with tact and caution to the leader of the free world. And together they have their share of bickering, with an entertaining bromance forming along the way.

As America’s most iconic landmark starts getting taken apart, the film can’t resist its strong patriotic tone when it comes to the finale. It lays it on slightly less thickly than the cheese-fest that happens in Olympus Has Fallen but nevertheless finds its moments of absolute hilarity whilst looking to be taken seriously.

The rather dismal numbers this has been posting in the States may have you believe that this is a complete failure of a film. But of the two White House destruction films released this year, here is a far superior one – a film that knows its target audience, and really plays on piling on the fun for us all to enjoy.

[CULTURE] /12

theMEDICALSTUDENT /Freshers 2013

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

R.I.P. to the monsters you used to see Just because a film flops at the boxoffice doesn’t necessarily mean that it’s a bad film. But in the case of R.I.P.D. it doesn’t have anything but itself to blame for the dismal numbers it’s posting around the world. It’s a huge silly mess of a flop, and it would only be natural to question just how on Earth something like this managed to attract the attention of two big movie stars.

A dirty but repentant cop Nick (Ryan Reynolds) decides it’s time to go clean, something his partner Bobby (Kevin Bacon) isn’t very pleased to hear. After getting betrayed and gunned down, he dies, only to find himself getting transferred to and joining the “Rest In Peace Division” or more simply known as the “R.I.P.D.” a secret programme full of afterlife cops pulling their weight in killing monsters who are supposedly destroying the planet bit by bit.

Partnered up with Roy, an old laid-back sheriff of the wild west who’s been doing this since the 1800s (Jeff Bridges), Nick doesn’t

have much time to come to grips with his impossible situation as well as track down and hunt these giant monsters.

These “dead” cops come back to Earth using avatars, taking control of a human form. Nick is a Chinese man, Roy is a hot blonde woman.

Attempt at comedy? Yes. Funny?

Not in the slightest.

The buddy-cop chemistry between the mumbling Bridges and the usually-sharp-but-now-understandably-confused Reynolds isn’t entirely a disaster, but when a film as confused as this can’t make up its mind on whether it wants to be taken as a big blockbuster action picture, or a light-hearted comedy, or perhaps even both, the stars are completely wasted to say the least.

Even more distracting are the ludicrously designed monsters, looking like the cheap, knock-off versions of what they managed in the Men in Black franchise, running around in action set-pieces that never truly impress.

All in all it’s a dismal failure, and even with Kevin Bacon in the villainous role the film finds very little salvage in the midst of much chaos and wreckage. It would be best to forget about this one.

Any Day Now

Baseball’s racial integration Gay adoption - it’s a sensitive topic today, so imagine what it would have been like in the more conservative 1970s.

Rudy (Alan Cumming) is a struggling musician who gets by as a drag act in a gay nightclub.

One day he finds Marco (Isaac Leyva), a 14-year-old boy with Down Syndrome, wondering around his apartment building.

Turns out he has been left all alone after his mother had been arrested.

Enlisting the help of Paul (Garret Dillahunt), a closeted district attorney, the two of them are able to gain temporary guardianship of the boy, keeping their relationship

and sexuality hidden. But once the courts start suspecting the true nature of the two men’s living arrangements, the bitter legal custody battle ensues, shattering what was once a happy, loving home.

It’s a real tear-jerking family drama, one that doesn’t apologise for pulling out all the stops to have that desired effect. But it’s the heartfelt performances of its leads that will finally win you over no matter how corny the dialogue and scenario may get.

Predictable, yes, but its harsh, unflinching portrayal of the narrow-minded past is one that is impossible to overlook.

42 tells the inspirational (most films dealing with racism are, or they try to be ) story of Jackie Robinson (Chadwick Boseman), who became the first African American baseball player to take part in Major League Baseball (MLB). With the help of Branch Rickey (Harrison Ford), General Manager of Brooklyn Dodgers, the two men help break the baseball colour barrier that existed in the 1940s.

This bold move is not at all something that is warmly received: the public boos them, the press doesn’t have a kind word to say about the two, and when it comes to bonding with fellow team players, Rob-

inson faces struggle and scrutiny because of his skin colour. Having courage, determination and belief in his talent is the film’s major dramatic selling point, and in his first major screen role, Boseman successfully portrays exactly that.

It’s also nice to see Ford in a more restrained, grounded role, in a warm and embracing father-figure type character who sticks to his instincts and follows through on his tough decision.

Any sports movie is a tough sell in countries where that particular sport isn’t popularly played, but much like Moneyball, understanding the sport doesn’t play a huge

part in how enjoyable the film turns out to be. When the sports commentators are yelling away and people are discussing tactics it might be easier to tune out than to try to understand every single word, but the overall rousing result is never diminished.

Given that there’s obviously a limited amount of running time and a lot of material to cover, it makes full use of convenient fastforwarding and time jumps. This results in the biopic looking far too simplistic and straightforward, but thanks to the endearing storytelling, you’ll cheer when the predictable end comes.

[CULTURE] /13

theMEDICALSTUDENT /Freshers 2013

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

Thank Eebowai for Mormons

Mormons have taken over the West End by storm - and thanks to the creators of South Park (Matt Stone, Trey Parker), London can enjoy what can easily be called one of the best musicals the world has ever seen. There is a reason why tickets are booking until January 2014 - it’s that popular, and all those glowing 5-star reviews you see on its many, many promotional posters around the London Underground and buses are not exaggerating. This show is simply that brilliant.

Elder Price dreams of spreading the word of Jesus...in Orlando,

Florida. So imagine his surprise and disappointment when he’s shipped off to Uganda, Africa instead, with a less than satisfying mission companion, Elder Cunningham, an over-enthusiastic little child-like man.

The local villagers, struggling with poverty, famine, AIDS, as well as a terrifying warlord (a general with a rather inappropriate name that cannot be written down here, even with asterisks), who wishes to circumcise any woman he can lay his hands on, aren’t interested to hear what Elder Price has to say. The local mission cen-

tre, led by a flamboyant closeted gay man and his group of freshfaced recruits, doesn’t help things one bit: rubbing salt in the wound is the sudden unexpected popularity of Elder Cunningham - with his imaginative mind and tendency to make things up as he goes along, the villagers are taken by his use of the words Mordor, Starship Enterprise and Eewoks, among others.

As you might expect from the two creators, it seems they fear very little when it comes to offending a group of people. Their bold, offensive, dark humour sets out to spew out the filthiest, most

shocking gags you will have heard on a musical stage. There is a particularly jaw-dropping song in which the Ugandan villagers express their unhappiness with God. Never has a song that contains the F word as well as “God” been shouted so loudly to the audience.

Who can forget that “baptism” is used as a very suggestive euphemism for sexual intercourse, and how about the little tour we’re given of the Spooky Mormon Hell where not only Catholics and Jews are reside, but also historical figures who have committed various crimes?

But whilst trying to offend, the musical never loses sight of its core plot, and with a simple yet effective narrative, the finale finds a positive emotional note to end on, with an uplifting and rather smart message that no matter how misguided certain individuals may view the concept of “religion”, it may not be such a bad idea after all.

Excellent tunes, a countless number of laugh-out-loud moments, never-ending energy: everything a smart satirical piece needs and then some. Here is an unmissable show that deserves to be seen.

And Rachel Marron will always love you As beloved as it was back in 1992 by audiences worldwide, the fact of the matter is that The Bodyguard is not a good film, nor will it ever be. A chance to showcase Whitney Houston’s star quality as well as show off her singing skills and power ballads, the film’s appeal was limited at that, and its stag-

geringly long running time, telling a stale love story between Rachel Marron, the international superstar and her bodyguard Frank, was a bit of a dud; and yet a runaway success at the box-office.

Which explains this screen-tostage transition. And this time, as a point in favour of the musical,

the entire Whitney Houston song catalogue is at its disposal regarding song choices. Aside from the hit songs that were used in the film, we are also treated to the excellent rendition of ‘One Moment in Time’ and ‘Saving All My Love For You’, among others.

The plot remains largely as generic as ever, and to force a love triangle between Rachel, her sister and Frank is largely misjudged although because of this ‘Run to You’ becomes a rather memorable duet sung by the sisters rather than just staying as a solo.

Houston’s songs are not easy to handle, but Heather Headley has enough power to belt through the hits with utmost confidence, almost always dressed in the most glittery costumes that help her stand out even more in her big numbers.

The technical achievements here fare better than what they managed to do with the story. With long curtains decorating the stage, giving off an elegant vibe whenever we enter Marron’s home, clever uses of stage screens, some unexpected action benefiting from strobe lighting, and the impossibly quick costume/hair changes look like a work of a magician.

But really, you need to love the music to sit through this one. Any non-Houston fans will find it a struggle to watch the disjointed love story of Rachel and Frank going through the ups and downs of getting involved with the wrong person.

The Doctors’ Mess Welcome to London - Now Move Zara Zeb Doctors’ Mess Editor Being a Londoner is a metamorphism which happens unconsciously but surely to all who live in the urban jungle.

Fresh faced and eager in your introduction into the City, you will hold up commuters as you dig around in your oversized pockets and bags for your Oyster card which you will refuse to zap until the barriers have closed behind the person in front of you; you will carry a tube map and plan your journey days in advance not realising commuting in London is easier than finding a star at night; and you will stop in the middle of a street to take photos of buildings you will walk past every day for the next three/four/five/ six/etc years; all to the dismay of Londoners who have places to be.

Don’t get me wrong: moving to London is one of the highlights of my short life

thus far. I wouldn’t want to live anywhere but in this city, which many people only see on their TV screens. True to its reputation, there is a lot on offer: there is culture to experience, history to learn, things to do, buildings to see, streets to walk, people to meet, university to attend, and life to experience. But being a true Londoner requires an etiquette many comedians have poked fun at (Michael McIntyre’s few jokes about using the underground spring to mind), many people write articles about (and it is something worth writing about), and many students learn in their first month in this new city of ours.

London moves fast, and your setting will be bumped up to match every other Londoner. Move forward one month: your skin will be covered in zits and blackheads with the air pollution. You will silently fume at the person who doesn’t stand on the right of the escalator, throw daggers at the person who hasn’t

perfected the dance of moving in between commuters, and curse when you miss a train that comes every three minutes. You will stare at shoes, carry a book, and no longer snap photos of the Shard when you spot it on the horizon. You

will have imprinted the tube map in your mind, run for a bus you know won’t wait, and have perfected the art of doing everything at the same time.

You will go back to your hometown and find everyone moving inanely slow, groan at the

lack of stimulation your town of 150 000 has to offer, and itch to be back in London. Love it or hate it, London will live and breathe with you forever more.

Welcome to London. Welcome to your transformation.

History Corner - Lady Mary Wortley Montagu and the Path to Vaccination Alex Howells Guest Writer Vaccination has been heralded as one of the most significant medical developments in all of history. Some of the biggest success stories as a result of widespread vaccination programmes include the eradication of smallpox and lowering the worldwide incidence of polio from 350,000 cases in 1988 to only 223 in 2012 (a reduction of 99%). The first successful vaccine to ever be produced was in fact the smallpox vaccine in 1796, pioneered by the physician Edward Jenner.

However, this was by no means the first instance of providing immunity towards a disease, with the process of inoculation preceding vaccination by many hundreds of years. The differ-

ence between the two is that inoculation requires a patient to be exposed to a low dose of the living pathogen, whereas vaccines only use dead or weakened pathogens. Inoculation therefore comes with a greater risk of infection than vaccination, and has since been phased out, but the process was an important precursor to vaccination.

Up until 1718 the people of the West had no means of producing or boosting any immunity towards smallpox, and the disease was rife. This is where Lady Mary Wortley Montagu (1689 – 1762) comes in. Lady Montagu was a well renowned writer and was the wife of the British Ambassador to the Ottoman Empire. During their travels around the Empire, Lady Montagu came across the Turkish process of inoculation

against smallpox (known as variolation). Lady Montagu’s life had been greatly affected by smallpox, suffering from it herself in 1715 and also losing her brother to it. She could see the potential of the process, and upon her return to England in 1718, she attempted to publicise inoculation against smallpox.

However, she had to contend with the xenophobic nature of 17 century English folk, as they were fearful of adopting what was seen as an “Oriental” process. All was not lost though, as she had at least introduced the idea of inoculation to the West.

Aside from the xenophobia and some religious opposition, the greatest difficulty she faced was that she had to convince the wider medical profession that the procedure was worthwhile and could save many lives. Her

position as an aristocrat aided her in this. During an epidemic of smallpox in 1721, she inoculated her daughter, and widely publicised the success of this.

She was also able to convince Caroline, Princess of Wales, to test the treatment. Six of her prisoners had the death penalty revoked in exchange for being used as test subjects for the inoculation, and all six survived.

Princess Caroline also tested the treatment on six orphans and they too survived. This was evidence enough to convince Caroline to use it on her own children as protection against smallpox, with the consent of King George I. To further convince the sceptics of the benefits of inoculation, Lady Montagu anonymously published “A Plain Account of the Inoculating of the Small Pox by a Tur-

key Merchant” in a London newspaper.

These events set the ball rolling for inoculation, and eventually Lady Montagu was prophetically eulogized for “bringing into her own country a practice, of which ages to come will enjoy the benefit”.

Not only had she succeeded in spreading the practice of inoculation throughout the country, she had changed the opinion of the medical community and greater public, and made them realise that methods such as inoculation are highly effective in eliminating the risks of outbreaks of disease. It was this general acceptance and understanding of the importance of such procedures that paved the way to development and eventual widespread use of a smallpox vaccine in 1796.

An Introduction To be cheesy, DM is your space, so please do send any contributions or comments to mess.medicalstudent@gmail.com. What I’d really like are your completed crosswords so I can award expensive books as awesome prizes, your elective photos so I can get jealous over all the fun you’re having, an article on someone noteworthy for the history corner, and any articles that make DM that extra-amazing.

For all those who wanted an

Elective

introduction that said something more about me: I am intercalating in Philosophy having done two years of Medicine at King’s College London. I never know what facts to share about me in these little snippets; instead I shall challenge you to make my first year as DM editor a hectic, yummy one by flooding my inbox with your messages, and the TMS post box with tons of Lindt chocolate.

Love and peace, Zara x

Prize Crossword Complications of diabetes mellitus

Hannah Keen in Ekumfi District, Ghana As the children were on their summer holidays, we got them all together for Public Health sessions. As part of the section on water, they have made collages about the water cycle and are showing off their work! Spending time with the children was the most fun of my elective!

Been on your own exciting elective?

Email us a photo and short paragraph to: doctorsmess@themedicalstudent. co.uk

Diagnostic Corner

4. Ophthalmic complication, seen on fundoscopy as new, thin, fragile blood vessels (13, 11) 5. Name of neurological feature of postural hypotension, impotence, urinary retention and gastroparesis (9, 10) 6. Skin pigmentation disorder associated with autoimmune disease which can be seen in diabetes mellitus (8) 7. Skin sign due to fatty deposits on the face present in diabetics (11)

8. Fatty lumps that develop at the injection sites (15) 9. Neurological symptom of diabetes affecting the wrists (6, 6, 8) 10. Mononeuropathy affecting a cranial nerve seen in diabetics (10, 5, 5) 11. On fundoscopy, an eye complication with dot and blot haemorrhages, and hard exudate deposits (10, 11)

DOWN 2. Asymmetrical wasting of quadriceps muscles of the legs (8, 10) 3. Painless punched-out lesion with thick callous found in the lower limb (4, 10) Take a picture of the completed crossword and send it to doctorsmess@themedicalstudent.co.uk to be in with a chance to win a copy of Clinical Skills Explained (rated 5 Stars on Amazon and currently costing £28!) provided

by Scion Publishing

Regarding a normal kidney, all are true except: 1. Erythropoieten is secreted by peritubular cells in response to hypoxia 2. The kidney hydroxylates 1- hydroxycholecalciferol to its active form 3. Renin is secreted from the juxta glomerular apparatus 4. Locally produced prostaglandins have a very important role in maintaining renal perfusion 5. 90% of the erythropoietin comes from the kidneys and 10 % from the liver.

Questions from http://www.aippg.com/

Answers: 4, 2

ACROSS 1. Raised, yellow, waxy lesions over lower part of the legs (8, 9)

Regarding the liver, all are true except: 1. 15% of the liver is composed of cells other than hepatocytes 2. Clearance of bacteria, viruses and erythrocytes is done

by Kupffer cells 3. Ito cells have a role in the uptake and storage of vitamin A 4. Vitamin K and folic acids are stored in a huge amount 5. Hapatic synthesis of urea, endogenous proteins and amino acid release by the liver all are suppressed during fasting

[SPORT]

theMEDICALSTUDENT / Freshers 2013 Sports Editor: Mitul Patel sport@themedicalstudent.co.uk

/16

UH Debutants at Henley Royal Regatta Show Promise Mitul Patel Sports Editor Summertime as a medical student is not usually reserved for sport. The vacation period is more often spent finding oneself under a full moon in Thailand, undertaking underpaid work placements to pay for extortionate London rent, and maybe even monotonous pipetting-based research opportunities to pad out CVs. However, away from the boundaries of the socially normal or acceptable, UH rowers spent the early months of this year’s academic break attempting to qualify and obtain glory in the sports cornerstone professional event, Henley Royal Regatta.

This year’s edition of the Royal saw men’s crews from Barts, Georges and ICSM attempt to qualify for the eight’s category in the Regatta for the first time in their histories, having all achieved standards higher than what is routinely witnessed for UH crews in the 2012-13 season. Their challenge was to finish in the top fifteen of the forty-two qualifiers from around the world.

Imperial College also entered 3 medical students as part of their flagship men’s four crew, who were aiming to finish in the top eight of a field of twenty eight to make the main event in the four’s category.

Barts’ men’s fielded a scratch crew into Henley Qualifiers, which was a pity after strong showings in the summer UH Bumps races.

The result of finishing slowest of all qualifiers was not representative of the successes of a crew that marked Bumps weekend by ending years of finishing second to ICSM2, and also closing in on RUMS1 on the final race.

Away from the men’s first eight, Barts have enjoyed a

Bart’s Mens 1st VIII. Photo courtesy of Sarah-Anne Milne productive year across all categories, with BL men’s captain Tom Diffey claiming, ‘the appointment of Richard Ayling as our coach and the squadwide commitment to training throughout the season were key to the club’s improvements this year.’

End of year exams may have

forced the men’s 1st crew to break up and thus derailed preparations in the build up to Henley, but Diffey was optimistic of an improvement in the 2014 qualifiers, ‘Despite being one of the smallest UH clubs we have begun to close the gap and we hope to continue to build on last year’s

success.’

The winners of Bumps 2013, St Georges, were also forced to change their winning crew as the academic year drew to a close. Preparations were far from ideal with commitments outside of rowing limiting the crew’s training time as an eight. The challenge of

Imperial College men’s four, Prince Albert Cup Winners. From left to right John Rankin, Henry Goodier, Ben Spencer Jones, Tim Richards, Ellie Smith. Photo Courtesy of Imperial College Boat Club

qualifying proved one step too far, although the crew can take heart out of finishing 9th quickest down the mileand-a-quarter stretch of all non-qualifiers.

ICSM captain Josh Tognarelli and coach Alexander Simmons stretched every sinew to keep their men’s crew together in the build up to Henley. After just one change, the ICSM men’s first eight embarked on a month of training that culminated in qualification for the Regatta.

The news of qualification was greeted with wild celebrations as a crew who had worked relentlessly since the turn of the year reached the target they had set out to achieve. Coach Simmons, who was brought to tears by the news, could barely utter his celebratory message to the crew, a muffled ‘you’re all a bunch of c***s!’

The scant reward for qualification was a first round draw against second seed Harvard University, who motored to a four-and-a-half lengths victory over the boys from West London and finished runnersup in the Regatta to Delftsche Studenten Roeivereeniging Laga of Netherlands. Having made history with a young crew, there is expectation for ICSM to repeat, if not better, their feat in the 2014 Regatta.

The honours however, must lie with the Imperial College men’s four who qualified for, and won the four’s category, The Prince Albert Challenge Cup. Jonathan Rankin, alongside the three medics Henry Goodier, Ben Spencer Jones and Tim Richards, coxed by Ellie Smith, saw off Bath University, Imperial College ‘B’ and Durham University to reach the final in which they beat Isis Boat Club (Oxford University) by three lengths to take home the trophy.