the
medicalstudent The voice of London’s Medical Students
March 2012
Interview with Sameer from BBC Junior Doctors Page 6
Healthcare in Ghana - an exploration Page 8
History Made By BMA Ballot Rhys Davies
On 25th February, the British Medical Association announced that it will hold a ballot, the first one in 37 years, on industrial action. This is a response to the government’s latest proposed changes to the NHS pension scheme. The last time a ballot was held was in 1975, nearly out of living memory of most current doctors. The possibility of industrial action has been suggested since then but it has never reached the stage where a ballot was necessary. The industrial action would be protesting against what is seen as unnecessary reforms to the NHS pension scheme. The government’s current offer includes raising the retirement age to 68, increasing the proportion of contributions to the pension fund and switch the pension from a final salary scheme to ‘career average re-
valued earnings’ for hospital doctors. For junior doctors and medical students, this could mean that they pay an extra £200,000 over the course of their career. For students starting their education this year, that would be on top of debts of around £70,000. In January, the BMA surveyed its 130,000 members, both doctors and medical students, for their views on the proposed changes. Of the 46,000 who responded, more than 80% thought that the government’s offer should be rejected and nearly two thirds stated that they were willing to take industrial action in order to secure a fairer deal for doctors. It will be interesting to see how many of those respondents maintain this commitment in the upcoming ballot. Dr Hamish Meldrum, chairman of the BMA Council, speaking at a press release on the decision to ballot, emphasised the gravity of the action. ‘The decision to ballot for the first time in 40
years has not been taken lightly. Doctors and medical students have overwhelmingly rejected the current offer, and we’ve pursued every avenue we possibly could to bring the government back to meaningful talks. With no signs of movement, we simply cannot ignore this strength of feeling by medical staff. We therefore have no other option but to ballot on industrial action.’ The BMA has stated that its priority, and the purpose of the protests, is to urge the government to resume negotiations over changes to the pension scheme. The BMA has ruled out the possibility of a full strike, out of concern for patients’ welfare and safety. Industrial action could then take the form of ‘work-to-rule’, where doctors adhere religiously to the conditions of their contracts. For junior doctors, this would mean actually leaving work at the end of their shift - and complying with the European Work-
ing Time Directive for once. This was the form the protests in 1975 took. The government’s response to the BMA’s decision has been one of disappointment. They are of the opinion that their proposals are generous to NHS staff but fair with consideration to other public sector pensions. Andrew Lansley, the health secretary, speaking in an interview with Sky News, said, ‘it's a matter of recognising that given the financial circumstances of the country and the pressure on taxpayers we always have to look carefully and ensure that we have a pension scheme that is generous for NHS staff. We want to make sure they have a good, high-quality retirement but at the same time, making sure that it isn't unaffordable in the future.’ After consulting its members, the BMA has roundly rejected the government’s proposed changes, (cont’d on page 2)
Is it right to strike - an in depth discussion Page 12
East Meets West - the review Page 18
Why London is superior to everywhere else Page 20
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March 2012
News
News Editor: Ken Wu news@medical-student.co.uk
Editor-in-Chief
M Alexander Shimmings GKT Medsoc President What a busy month for GKT! February 13th - 17th saw the KCLSU Sports Referendum take place across KCL. The question posed - 'Should KCLSU continue to support separate KCLMS and KCL sports clubs?' (unfortunately we had to use the title 'KCLMS' to avoid confusion across campuses, a name which is now being addressed). The results - 'Yes' 2504, 'No' 147, abstentions '14' - a roaring success for GKT and KCL sports teams alike, both of which were potentially threatened by a merger. Most thoughts are now turning to why a referendum was held in the first place given that 94% of the vote was for the 'Yes' campaign. Some argue that with such a result we can now wave it in the face of BUCS whilst others say it proves how out of touch KCLSU are with their student body, and wonder why we have wasted seven months of valuable lobbying time against BUCS. What is certainly true is that the future of the
Purvi Patel on effort, sarcasm and the joys of March
GKT sports clubs at KCL is secured. RAG week also took place, kicking off with a reportedly 'out of hand' RAG Raid down to Brighton. The resurrected RAG Ball was titillating to say the least, with a burlesque dancer and an incestuous RAG committee making the senior tutor present rather hot under the collar. While the total collected has yet to be announced, it was without a doubt a roaring success, and a good time was had by all. March looks to be just as big, with the Halfway Dinner on and the UH semi-final against ICSM. Guy's for the Cup. Shit on Mary's
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George Ryan BL President Democracy is alive at Barts. This years elections saw a record number of applicants for our Student Presidents Council. A grand total of 44 people competed for 24 spots, up from last years measly 17! With a brand new council elected for next year we also have a new Mr President. In fact next year's President will be a Dr President. Finalist Andrew Smith won a gruelling battle for the position whilst juggling his revision for finals this month. Being a man of many talents Andrew is the one to watch out for next year as he leads BLSA sailing past London’s other medical schools. RAG have also started the year strongly with a charity art auction held at The Great Hall at Barts hospital. It turned out to be such a successful event that they were in fact asked to plan another one for the whole school. Their next event will be the infamous Den-
tal Beer Race. It is the one night of the year when you will see a dentist out on the town. This promises to be a huge evening racing up and down the Mile End road. Sadly the beer race will not finish at the mighty GriffInn as it is still closed for refurbishment. With works being delayed until early May we hope the opening party will fall just before our freshers' end of year exams so all will be down to see our new restaurant by day, wild bar by night
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Nana Adu SGUL President In my last post in the February issue of The Medical Student I described how the majority of our Student Union time has been spent on RAG. Just to update you, even more time has been spent on RAG this month as well. My personal favourite event so far has been Take Me Out. We had picky ladies, shameless guys as well as great banter from our resident Doncaster lad. Still upcoming is the Pram Race, Superhero Disco and a performance of The Crucible by Playsoc. Outside of RAG, upcoming events include the UH revue, Musical, Tooting show and Face off. So as per usual things at St Georges look very busy. We are also looking towards the future with events in the summer. Our
medicalstudent
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nd here we are again. Another month’s Medical Student brought to you effortlessly by London's medical students. Well, when I say London, what I really mean is Imperial, with a few GKT drifters thrown in there. And when I say very little effort, what I really mean is sleepless nights and panicked last minute phone calls, with columns and articles being written hours, and in some cases, minutes before the print deadline. However, in the grand scheme of things, very little effort was involved. If we had filmed eight people in an attempt to give the wider population an idea of a particular profession, say junior doctors, for three months, day in and day out, and constantly following them everywhere, documenting every move they made and interviewing every person they spoke to, then that is a lot of effort! Although that sounds very interesting to us medical students, it doesn’t sound particularly interesting to the general public. So to make it more sensational, we would probably need the narrator to dramatise every scene and then selectively broadcast the ones that make our subjects look like complete and utter fools.
This was done regardless of the fact that they were all brilliant enough to be accepted into, arguably, the most competitive foundation programme in the country. Very accurate, that would be. Sometimes sarcasm is lost in the written word, so for those you of that didn’t quite catch it that was sarcasm. This has been an educational month for the copy room. We have learnt that Imperial has its own water supply. This is to prevent the entire population of London turning into grossly disfigured mutants in the event that the nuclear reactor that is hidden away spontaneously implodes. We have also found that lack of sleep results in breakdowns at the hairdressers, as well as strong urges to commit violent crimes targeting innocent sixth-formers. On a brighter note, March has begun, and the daffodils are out - it is officially Spring. Of course, the more traditional of you will disagree with this statement, but in my humble opinion, the most cheerful of seasons cannot begin soon enough. Of course, this beautiful weather – which we all know isn’t going to last (at least the snow is gone!) – is just another reminder that exams are just around the corner and that the nice weather will have been wasted
medicalstudent newspaper
(cont’d from front page) maintaining that the current NHS pension scheme is both affordable and sustainable. The current scheme was implemented after a major reform in 2008. This increased the retirement age for NHS staff from 60 to 65 and also increased the contributions doctors make to 8.5%. Meanwhile, the government’s proposed changes would see this rise to 14.5%. The previous reforms also placed a cap to employer contributions. Thus the taxpayer, as the doctors’ ultimate employer, is protected against increasing pension costs. In fact, following these
reforms, the NHS pension scheme is very healthy indeed, delivering £2 billion annual surplus to the Treasury.. Whatever action the BMA decide to take, they must be cautious. Dr Richard Smith, former editor of the BMJ, spoke to The Medical Student and has commented that ‘the BMA has to be very careful. Currently, they are not viewed by the public in the same way as the National Union of Miners. They are not seen as a trade union. Wisely, they portray decisions that are good for doctors are good for patients. The possibility of indus-
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annual summer ball is fast approaching. Without giving too much away, it is shaping up well and it is set to be one of the most spectacular event of the year. So on all in all, the Student Union and the students at Georges are busy ploughing through the year
by days spent cramming in revision. Never fear, all is not lost! There is still plenty of fun to be had before we all metamorphose into the studious scholars that we convince the rest of the world we are - well, before 'Junior Doctors' anyway. Next month we will look forward to Varsity at ICSM, The Macadam Cup at GKT and bucket loads of RAG, literally. Until then, we’ll make do with the possibility of strikes, opinions on academic attendance, student shows and anything else we think is worthy of your attention
@msnewspaper
trial action could change that image.’ The government’s proposed changes to the NHS pension scheme apply to the NHS in England and Wales. However, it is highly probable that similar proposals will be made for the pension schemes in Scotland and Northern Ireland by their respective governments. The BMA ballot will only involve doctors. Unfortunately, medical students currently registered with the BMA will not be able to vote. Similarly, other trade unions of health professionals are also considering their positions on the proposed pension reforms
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Contact us by emailing editor@medical-student.co.uk or visit our website at www.medical-student.co.uk
Editor-in-chief: Purvi Patel News editor: Ken Wu Features editor: Bibek Das Comment editor: Rhys Davies Culture editor: Kiranjeet Gill Doctors’ Mess editor: Rob Cleaver Image editor: Chetan Khatri Social Media editor: James Turbett Sub-editors: Alex Isted, Keerthini Muthuswamy, Ashik Amlani Distribution officer: Sanchit Kapoor Consultant editor: John Hardie
medicalstudent
March 2012
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News Love was in RAG's Air at ICSM Valentine's Ball
Neil Chowdhury RUMS President A plethora of events are coming up for RUMS. As AGMs unfurl for different sports teams, nominations are being made for sports colours. This always culminates with our sports ball, which remains a highlight of the year. We are also preparing for our own AGM to decide the fate of RUMS and make sure we remain the best medical school in London. Finally, we have our annual Spring Break party at Kona Kai, which is set to be a sure-fire success. Our welfare series is still working out very well. We are also at a good point with regards to BUCS as we start our negotiation to ensure that we at RUMS remain a strong force against all our competitors in the league. Work spaces are being set up at all home site hospitals to medi-
Yin Yin Lee Guest Writer It was that time of the year again. Love was in the air and all that jazz as ICSM RAG hosted the annual Valentine’s Ball on January 13th at Kanaloa Club. The whole medical school came dressed to impress and to boogie the night away at this snazzy, swankadelic, tiki themed venue in the heart of Chancery Lane. True to the tiki theme, the ‘treetops’ - a rainforest style retreat with giant palm trees, tropical leaf patterned walls, and rustic wooden planking, was enjoyed by the final years as they sipped their way through the deadly sounding Mani’s Chest of Fire. Other drink deals were available all night and featured exotic cocktails that Kanaloa is known for. The night was a rip-roaring success with over 300 people attending. Although it is situated near The City, it is renowned as the playground of celebrity A-listers such as Nicole Scherzinger, who was present just the night before, and Harlequins RFC. ICSM lit up the venue with their own unique mix of eccentric charm and esoteric dance moves that would no doubt put even the Pussycat Dolls to shame. Music was provided by Kanaloa’s resident DJ and featured a mix of old and new that
cal students. Charity-wise, we are linking arms with Spectrum to hold a charity raffle alongside our Sportsnight charity event. We shall be doing something more original than Shimmings’ worn out quips about RUMSnaked charity. Playing cards shall be sold at our Balls to raise money
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Suzie Rayner ICSM President
So Ronery. Image by Giada Azzopardi drew the masses to the dance floor and invited to them dance the night away. All in all, it was a highly enjoyable night for everyone in attendance as well as being very successful for RAG and their chosen charity this
year - Teenage Cancer Trust. Many thanks to Kanaloa for their wonderful hospitality throughout the night and a special mention to Giada Azzopardi and Emily Hutchinson for organisng such a spectacular event
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For the last month, every activity at ICSM has revolved around RAG. After a slow start with participation on RAG Dash, the RAG Valentines Ball, held at Kanaloa, proved to be a sell-out event. It provided a great opportunity for a catch up after the final elective group had returned as well as an excuse (not that we needed one!) for a night out for everyone else. I am writing this at the end of our RAG week, and what a week it has been. From collecting at 6am on Monday morning, to performing tasks around London dressed in a variety of Olympic themed attire, and completing the Circle Line Collect - the week had all the beloved favourites and some new twists. The week alone raised just under £30,000. Congratulations to Lizzy Kostov, ICSMSU RAG Chair, and all of the RAG team for organising such a smooth running, enjoyable and profitable week. All the proceeds from ICSM
RAG this year go towards supporting the Teenage Cancer Trust who I am sure will be hugely pleased with the efforts. In other news, nominations for ICSMSU Exec 2012-13 are nearing the end and we look forward to the campaigns of the new potential committee, the more inventive and memorable the better! Hustings will be held on the 5th March and 9th March to give you the opportunity to ask the candidates what they will offer you. Voting is open from 12-16th March
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Jeeves Wijesuriya UH President
Cocktails galore. Image by Giada Azzopardi
I hope everyones enjoying the slow - and I mean slow start of Spring! As we drift on through the year UH is still battling away on the BUCS issue by trying to find new middle ground, and working on its Mental Health campaign as well as a brand new website. We are really pleased that GKT have won their referendum - and I mean won, showing that GKT sports teams are an important part of the KCLSU and they should be maintained and supported. Well done to the Shimmings' team for winning this whilst still carrying Mark through his presidency. In other news, the BL president has been busy attacking graduates whilst conversely RUMS president/ postgraduate officer Neil Choudhury has been busy denying their existence. There were some questionable
behaviours all round. Lets not forget Georges, where Nana, the current pseudo-president has been lost for days in the bean bag room - also known as the Mayday hosptial ITU. ICSM had their famous Circle Line pub crawl this week, a great day out enjoyed by all of the Imperial medical students, though probably the only one they will spend out of the library this month
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March 2012
medicalstudent
News Redundancy Risk for Barts Academics
Research in brief BL: Researchers have made a significant step towards understanding the complex hypoxic response in humans, which, when it malfunctions, causes and affects the progression of serious diseases including cancer. The absence of LIM domain containing proteins, which have been found to regulate this response, allows angiogenesis to occur in cancer, facilitating progression. Targeting this deficit could pave the way for new drug targets in treatment. GKT: Clues regarding the aetiology of schizophrenia and autism have been uncovered by researchers, who have found a relationship between IGF2 methylation in the brain and the weight of the cerebellum, which is altered in those suffering from neuropsychiatric disorders. DNA methylation is known to affect gene expression, but this is the first instance in which IGF2 has been studied in detail and linked to cerebellar size.
Academic battle at Barts
Ken Wu News Editor Barts and The London School of Medicine and Dentistry has written to all of its Higher Education Funding Council for England (HEFCE) academic staff to inform them whether their academic post is at risk or not. At present, there are 43 HEFCE-funded posts which are at risk and all of the staff who are affected have already been contacted and follow up meetings with them have been arranged. These ‘at risk’ notices were sent after the completion of a thorough review and form part of a wider program of restructuring which is aiming to save £3 million for the medical school. Professor Richard Trembath, the Vice Principal (Health) of Barts said that ‘We have now written to all HEFCEfunded academic staff at the School. In the vast majority of cases the letter confirms that their post is secure, but in some cases we are writing to say that there is a risk of redundancy.’ The letters were finally sent after months of delays despite extensive lobbying by members of the BMA, spe-
cifically the BMA medical academic staff committee (MASC), who were initially concerned about the redundancies. The original plan was to send the ‘at risk’ notices before Christmas.
"Maintaining and improving the education we offer has been paramount throughout the process. We are confident that students will not experience any deterioration in the quality and quantity of their time with teaching staff" However, delays in the process, which included several meetings between the management staff at Barts and the trade unions have meant that the issuing of letters had to be postponed until February. Richard Trembath said that ‘the process is inevitably time-consuming but our primary concern is ensuring that the review process is thorough and fair.’
Barts announced that there were plans for 43 potential redundancies as a part of its restructuring program back in December after a consultation period with the recognised trade unions. The program was implemented after cuts in HEFCE funding by the government’s higher education reforms. Richard Trembath said that the possible redundancies ‘are the result of a thorough and painstaking review. This review looked specifically at contribution to education as one of the criteria. Although recent and significant changes in university funding have made a restructure necessary, maintaining and improving the education we offer has been paramount throughout the process. We are confident that students will not experience any deterioration in the quality and quantity of their time with teaching staff.’ This move has come under sustained criticism and lobbying from the BMA. The MASC co-chair Michael Rees has already written to the medical school, outlining the concerns the BMA has with the proposed redundancies and urging them for a rethink on the move. Rees has said that ‘this type of restructuring has proved to be extremely
counterproductive in very many cases. It disrupts the work of the school, causes significant staff anxiety and illness, and leaves a long-term legacy of bad relations.’ Furthermore, there are additional concerns regarding the teaching of medical schools and the prospect of working in academic medicine. Other members of the BMA have questioned the validity of the funding crisis, especially since Barts is planning to charge the maximum £9000 when the university tuition fee rise comes into place. It is important to bear in mind that the letters sent to staff only detail which posts are ‘at risk’ and that there have been no reports of any confirmed redundancies. The whole redundancy process will take time, with the first stage of the process not considering the clinical academics’ NHS work. It will in fact use a criteria based on their research and teaching. Interestingly, Barts have announced that it is recruiting 35 academic staff. Professor Trembath has stressed the importance of continuing to recruit new posts, especially ‘where alternative funding and a strong business case exist. This is essential to keep the school moving forward.’
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ICSM: 'Popeye' proteins help the heart to adapt to stress; a finding by Imperial scientists that could lead to the development of new treatments for abnormal heart rhythms. It has been discovered that Popeye domain containing proteins (Popdc) mediate the response of cardiac myocytes to adrenaline. Lack of it has been demonstrated to be associated with a poor response to stress, being unable to respond to adrenaline. Addressing this could form the basis for treatment of stress related rhythm disturbances. RUMS: Scientists have made a step towards making intestinal transplant using one’s own cells possible. They have demonstrated in rat models the previously impossible task of preserving the complex villious structure of the intestine, an important clinical advance in the treatment of those requiring a transplant. Through tissue engineering of the donated organ using the recipient’s stem cells, the risks posed by conventional methods are alleviated. SGUL: Women with pre-eclampsia in the first 37 weeks of pregnancy are more likely to develop left ventricular dysfunction in the future, compared to those who acquire it in the final weeks. In the study group of 64 women, the risk for those with preterm preeclampsia increased significantly in the two years after birth, whereas it decreased in those with the condition at term. Early identification could therefore allow preventative treatment.
medicalstudent
March 2012
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News
Diary of an FY1 Junaid Fukuta on the infamous cardiac arrest
T
he year is quickly moving on and before you know it, the winter drudgery has made way for a more summery feel. In a flash, the hospital takes on a whole different air. Tired looks make way to airy smiles and everyone heads off to the pub after work. As we were sitting in the garden of our favourite pub for our mandatory after-work drinks and recounting tales of both heroic feats and unbelievable ineptitude, I realised that I have so far missed out on one of the rites of passage that all my fellow F1s had gone through. ‘Seriously you haven’t be to a crash call yet?’ my best friend stares at me incredulously, and as I try to recall all my shifts I cannot
for the life of me remember a single crash call. So either I have not been to one or I did and it was so horrific that I have blanked it out of my memory! I was 99% sure it was the former and went home to ponder how I have managed to get through ten months without experiencing that moment which seemingly defines us as a doctor. Strangely enough I did not have to wait long. The very next day I was on an oncall evening shift chasing some bloods when my bleep goes off like a bomb, scaring the bejibbers out of me. ‘Cardiac arrest team to ward X, level 6. Cardiac arrest team to ward X, level 6.’ Now I stare at my bleep in disbelief, partly because of the conversation I had
had the day before thinking about the irony of the situation, but also because ward X was the ward next to me. My hospital is big, and I mean really big. It’s so big in fact that I sometimes think that I have walked through a wardrobe and entered Narnia on my walk to work. I calculate that by running (like we all really want to because they do that in the movies) I will arrive first, and in all likelihood I will be there for about ten minutes before the cavalry arrive. I then do exactly what I did not expect: I sat motionless. My legs actually won’t move, my heart is thumping, my breathing is getting shallow in anticipation but my legs won’t bloody move. I was like a rather strange mar-
Locked, loaded, charged and ready to shock
ble statute in a half sitting half standing position with a pained expression on my face which Michelangelo would have been proud to have sculpted. Helpfully a nurse walks over to me and says ‘that ward is just across the corridor, my dear’ not knowing that my painful inability to do anything is exactly because of that fact. As beads of sweat run down my face, I take a deep breath and snap out of it and I head off running to the relevant ward.
On arrival to the ward there is a nurse pointing to the cubicle where the arrest is, so I went barging in, praying that another doctor is there or that it is a vasovagal and not a real cardiac arrest. I obviously did not pray hard enough because as I enter I quickly asses that: a) there is no other doctor, b) the nurse was doing compressions on a lifeless body so this is a real crash and c) I really need to go to church more. The nurses all look at me in anticipation to spout some magical, doctor-like authoritative words, but I actually stood there and said ‘Right, A is for airway’. It’s probably not exactly the commanding statement I had always dreamed of saying at my first crash but it actually helped. By going through things methodically I was able to bark out instructions to the nurses to get the relevant monitoring on and create some order from all the chaos. We were about two minutes in and the cardiac monitoring was just go-
ing on when I almost cried with joy as the rest of the arrest team arrive. And just like that this huge weight of responsibility was lifted off my shoulders and I feel as if I have just surfaced from being underwater for about ten years - I can breathe again. Every hospital has a cardiac arrest team, the composition of which differs depending on the hospital but it usually involves the anaesthetist (known as the airway person), a medical registrar (often the team lead), senior nurses (go-getters) and then random hangers-on like me. My hands were all wet and I had huge sweat patches under my armpits and as I made room for the actual arrest team. I slinked into the background and became part of the furniture as I watched the drama unfold in front of me. Never have I felt more like a fraud as I watched the professionals take command and work seamlessly together. I watched what can only be referred to as one of the greatest examples of human efficiency - everyone knows exactly what they are doing and what is coming next. I watched cycle after cycle of CPR, cannulas going in, bloods being taken, fluids being squeezed in, but with no response. Finally the medical registrar calls it all to an end. The thing that gets to me is that as soon as the call has been made not to carry on, the people left just as quickly as they had arrived. I was literally expecting tumble weed to roll through for the scene that is laid open to me. Me, alone, staring at a person, a corpse on a bed and for the first time this year I felt shame - shame for my initial inaction, for my lack of knowledge, and for the first time, shame for the death of a patient, despite having never met this patient alive. I have more feelings about this person’s death than many of my own patients. I slunk away down hearted feeling that in this defining moment I finally realise the responsibility a doctor has
RUMS
SGUL
"For the first time this year I felt shame - shame for my initial inaction, for my lack of knowledge, and for the first time shame for the death of a patient, despite having never met this patient alive"
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Calendar of Events
BL
GKT
ICSM ICSM Drama: 'Some Like It Hot'
Spring Break Party
UNICEF Fair 2012
ICSM Choir Concert
Naked Charity Sportsnight
Sports Medicine Conference
ICSM Orchestra Concert
Sports Colours Nominations
SGUL Ski Trip
7th - 10th March 10th March
17th March
Varsity Day - IC vs ICSM
21st March
Shrove Tuesday Final Year Dinner
31st March
19th March 21st March 6th April
7th March
21st March 6th April
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March 2012
medicalstudent
News An Insider's Look at the BBC 'Junior Doctors' Program Purvi Patel interviews Sameer Bahal on the pressures of being a junior doctor on TV
A
s the second series of BBC's 'Junior Doctors' program draws to a close, The Medical Student's editor-in-chief Purvi Patel caught up with Sameer Bahal to ask him about his time on the show, doctor stereotypes and whether cannulas are really that difficult to put it.
What made programme?
you
join
the
For me, it was the fact that it was a unique opportunity and something that wouldn’t really come around again. I thought I’d give it a go.
What did you want to get out of it? I wanted to find out what it was like to be in a TV show, and I was actually more interested in the cameras, how you create a show, and how you film a story. I did look forward to living with eight other medics, and being able to share stories about our experiences. You don’t often get to do that. I also thought I’d find the added challenge of having a camera crew exciting.
Were you intimidated at having a camera crew document your first days as a doctor? What was stressful about it was that it was like being in an exam situation all the time. That was stressful, especially when there were awkward situations. There was a real pressure to be perfect at everything you do. However, I was generally good at cannulas and bloods, so that part didn’t faze me. I also had a good and supportive team on my ward so I was quite lucky. A lot of how you come across depends on what your workload is like and therefore how much time you have for the cameras.
How did you find living with your colleagues? I got on with them so well. We all had different personalities, and we weren’t people who would ordinarily be in a house together, but nevertheless we got on very well. We soon became very good friends. I think the situation of being in a reality show and being filmed constantly brought us together.
Do you think that the show played up the stereotypes? Yes, if the show didn’t play up the stereotypes and was less trashy it would be on BBC4. The fact is, it does manipulate your characters to make you into people that are larger than life. You just have to trust that people realise that when they watch it and they don’t take it too seriously.
Is it an accurate representation of
Broken and Made in Chelsea. Image by BBC
the life of a junior doctor? You have to remember that it’s designed to get viewers; it’s not, in any way, what we do on a day-to-day basis. They very rarely concentrate on your paperwork and the day-to-day challenges of the job as well the organisational skills you need. This is a big part of the job and I think it is important for those who are thinking about medicine realise that.
How do you feel being on the other side? Now that I’m a doctor there is a lot of hard work and I don't mind that, because you feel more like you have a purpose and you earn money of course, which is very welcome.
What advice would you give to medical students? Just be helpful, and just know that even though the doctors sometimes seem busy, they still all love
to teach and if they seem a bit distant and they don’t want you to bother them, don’t be disheartened.
"Watching the show back and seeing yourself on TV is easily the worst part. If I did the show again I would probably do things a bit differently. I’d be a bit more careful with what I said and give more time to the cameras, because I think that had a lot to do with how you come across." Ask if you can help and most of us will give you stuff to do. It's important to try and become part of the team – I know it’s difficult because you always rotate around – but when you
get the chance, really get involved. You will learn so much more from being a mini-doctor than an observer.
Would you do the show again, knowing what you know now? I would because of the three months that we spent together were generally quite fun. The cameramen were really amazing, and we all got on really well. They would go through the same sort of journey we did, and we would often share the same experiences so we became close. Watching the show back and seeing yourself on TV is easily the worst part. If I did the show again I would probably do things a bit differently. I’d be a bit more careful with what I said and give more time to the cameras, because I think that had a lot to do with how you come across.
What was your best moment during the filming? All of my best moments didn’t make it
on to the show! I think there was one scene where there was a patient that no-one could cannulate, and I’d had a bit of luck with cannulas, so I tried and I got it. The daughter was really surprised that I succeeded, and gave an interview saying that I was really good. Even though that sounds trivial it made me feel good. I generally found that the stuff you weren’t too keen on makes the show, but the stuff you thought went well doesn’t.
Do you regret that you weren’t portrayed in the way you felt you should have been? I think all of us, and anyone doing a show like this, would have regrets about it. You just have to trust that you made the right decision and concentrate on the positive aspects. Although it didn’t always go perfectly on camera it could have been a lot worse. There are always going to be people, who criticise you.and you can’t do anything about it. You just have to not worry about it
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March 2012
Features
medicalstudent
Features Editor:Bibek Das features@medical-student.co.uk
Ward rounds: shifting dullness? For many medical students, there are limited opportunities to learn or be taught on ward rounds leaving many to wonder what there is to gain from attending them. David Fisher contrasts the hasty ward rounds of the UK to the 'art' of ward rounds in Ghana.
Image by David Fisher
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f asked to describe the perfect ward round, doctors and patients will paint very different pictures. Doctors usually prioritise examining the patient and interpreting test results to inform the clinical status. Patients, on the other hand, are often anxious and seek reassurance about the consequences the pathology will exert on their life and the interruptions it will cause in the near and distant future. Essentially, three groups of people
may gain from the ward round. First, patients have the opportunity to directly interact with the doctor responsible for their care, to voice their concerns and ask questions to better understand their condition. Ideally, this caring relationship will infuse the patient with confidence. Second, the multi-disciplinary team, comprising a collection of professionals become fully aware of the diagnosis and treatment. This spares possible confusion that may
arise because of illegible notes. Last, the ward round provides an opportune time to teach students. The opportunity to learn from patient cases is crucial and students gain invaluable experience presenting and examining patients in the presence of a doctor. Comparing and contrasting the functioning of ward rounds in a different country is a fascinating exercise I was privileged to perform last summer. I travelled to Ghana amongst a
group of students volunteering for the UK based charity Tzedek. Each student was allocated a placement and both a nursing student and I were assigned to the Shekhina Clinic. Shekhina, meaning divine presence in Hebrew, is a medical centre in Tamale, Northern Ghana. It uniquely provides free medical care for people unable to afford national health insurance. Shekhina provides a home for ill homeless people. Non-uniform huts
and buildings are scattered around the clinic’s grounds, having been built at odd times whenever funds became available. One collection of huts houses patients suffering from Human Immunodeficiency Virus (HIV). Another complex built of brick contains rooms occupied by people with leprosy and those who are blind. Other random residences house patients who are mentally ill. Some patients have obscure habits and enjoy the freedom to live
medicalstudent
March 2012
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Features
Image by David Fisher as they desire. One man insists on collecting his food and eating it amongst animals whilst a woman busies herself hoarding thousands of garments. The patients are for the most part medically stable and their progress is monitored during the weekly ward round. The ward round occurs every Friday morning. Dr Abdulai, the founder and sole doctor at the clinic, encourages the patients who live permanently within the clinic to seek an occupation. Some pick fruit such as oranges and bananas to sell. He begins the ward round with a visit to one such patient, proceeding to purchase her entire stock of fruit and subsequently distributing the fruit among all the patients to foster healthy eating. The ward round resembles a social visit to each patient and is occasionally interspersed with medical examination. He talks at length with the patients and inquires about their gen-
eral welfare and happiness, seemingly unrestrained by time commitments. Ward rounds in this country are rather different. The consultant, flanked by an entourage of multi-disciplinary team members, visits each patient and ascertains any clinical changes. The patient case must first be presented and is sometimes followed by physical examination and scrutiny of test results. Following dialogue with the patient an updated treatment plan is decided upon and the parade of people progress to the next patient. Many patients report high satisfaction with the level of care they receive but some experience ward rounds to be impersonal and intimidating, particularly when doctors appear more concerned with the pathology than the patient. When doctors communicate amongst themselves and to students they often use medical jargon
which patients find disconcerting. To decide upon the ideal way to conduct oneself during ward rounds, it is relevant to question whether medicine is a practice of science or art. Centuries ago, medicine convincingly appeared an art due to the absence of sound science. Doctors often prescribed hopeless remedies for ailments but skilfully compensated with care to inspire confidence. The ability to communicate and connect with patients to reassure their fears is undoubtedly the art within medicine. Over the last one hundred years, scientific advances have had a tangible effect on healing pathological states. Doctors that consider curing the condition their principal role, have a polarised view of medicine, favouring the science over the art. In the United Kingdom, science often dominates ward rounds as doctors are forced to ration their limited time in
favour of treating the pathology rather than treating the patient. Doctors have little time to juggle many commitments including the ward round. The European Time Directive limits the number of hours a doctor may work in a week to 48 and is enforced to maintain the health and safety of doctors. At Shekhina, I noticed an extraordinary contrast. It was clear during ward rounds that medicine was practiced more as an art than as a science. Shekhina is maintained by charitable donations and does not enjoy the equipment and drugs supplied to state hospitals. Medical care at Shekhina has not benefited from all the scientific advances that have swept through modern medicine. On the ward round, Dr Abdulai artfully compensates, as much as possible, by loving his patients. He prioritises devoting time to patients even when there is nothing he
can medically impart, only the knowledge that he cares. Nothing may fully substitute for adequate patient services and therapies but he is still rewarded with affection and gratitude. The advanced standard of medical care offered in this country must be praised and preserved. The practice of modern medicine is a pendulum swinging between the science of medicine and the art of patient care. The happy medium is surely in the middle. If our pendulum has swung too far towards science at the expense of patient happiness, we may learn from Shekhina and infuse emotional sensitivity into our ward rounds to return the pendulum to centre. The influential nineteenth century French physician, Armand Trousseau, summed up the balance: ‘The worst man of science is he who is never an artist, and the worst artist is he who is never a man of science’
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Image by David Fisher
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March 2012
medicalstudent
Features
The Right Honourable doctors Historically, doctors' unions have tended to attack most health legislation passing through Parliament, from the creation of the NHS to the current Health and Social Care Bill. Zara Zeb asks whether more doctors entering politics and shaping health reform as government ministers could be a solution.
House of Commons Chamber. Parliamentary copyright images are reproduced with the permission of Parliament
D
avid Cameron recently announced that nursing care, for the elderly especially, was below standards and vowed that nurses will perform hourly rounds, every ward will have a matron and the public will be able to inspect hospitals. Critics say
care has fallen below standards as some nurses have become too busy or detached from patients. One must ask, what led to nurses becoming too busy or detached in the first place? The public have always assumed the nurses’ key role is the patient: to ensure the patient is comfortable, well
"One must ask, what led to nurses becoming too busy or detached in the first place?"
fed and taken to the toilet whenever needed. But initiatives introduced by the government and the way the NHS is run has meant that nurses to ensure their patient is their key role, have to sit behind the desk filling in charts of every conversation, every drug given, every drop of drink drunk, every
bowel movement and every wink of sleep slept. With a typical bay having six patients and a typical ward having four bays, that’s twenty four patients already whose notes need to be written up. Moving onto a larger hospital with larger wards, it can mean up to sixty patients whose notes need to be
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Image by iStockphoto detailed and concise. With nurse staff shortages, it means that the few nurses available for a large number of patients are tied to their chairs with a mound of paperwork to get through before they can go and see to their patients.
"With their patient being side-lined to heaps of paperwork, the majority of a doctor’s working hours are behind a desk." The same initiatives also affect doctors. With their patient being side-lined to heaps of paperwork, the majority of a doctor’s working hours are behind
a desk. In order to ensure the quality of care a patient receives meet the expected standards, doctors have to work later and later, sacrificing their life and sanity, in order to keep up with the government demands of paperwork. With initiatives drastically impacting the way the healthcare team do their job, and therefore the quality of care patients receive, politicians need to hear from the workers on the ground in order to understand better the reality of what is really needed. A current ‘listening programme’ involving politicians talking to GPs is involved in the initiative of dissolving primary care trusts meaning GPs are increasingly becoming involved in discussing budgets, local healthcare needs, service planning and de-
livery. Some GPs think this will result in dramatic improvements in services. However, Dr Stoate, an ex-Labour MP has claimed that David Cameron uses the NHS as a ‘political football’ and taken his views out of context.
"Politicians need to hear from the workers on the ground to understand...what is really needed." Dr Stoate had written he had ‘overwhelming enthusiasm for the chance to help shape services for the patients they see daily’ but said Mr Cameron took his words and applied it to the
impending national NHS shake-up. Dr Stoate defended his comments as merely referring to GPs in south London where GPs have been commissioning health services for the past four years and have the experience they need to step up to the new initiative. With politicians involving doctors, but not relenting on their own pre-conceiving ideas and notions that they know best, it becomes a power play. Rather than thinking about the majority of the healthcare and the public’s interests, politicians find the minority to back their agenda in order to implement it or give distorted impressions as done in Dr Stoate’s case. So is it hopeless to get involved in politics when a doctor’s voice will not be heard? Or is it necessary to
keep banging heads against brick walls hoping to make a difference?
"With politicians... not relenting...,it becomes a power play." So let’s put the question to you, how can a doctor sit by whilst someone not on the ground dictate what they think is best and when it doesn’t work, blame the hard working people who are merely following their orders? Doctor’s should get involved in order to enlighten those who think they know best of the reality doctor’s face on a daily basis. Only then can a doctor truly say their patients are their number one priority
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Image by Sam Spokony
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March 2012
Comment
medicalstudent
Comment Editor: Rhys Davies comment@medical-student.co.uk
Is it right to strike? In light of the BMA's decision, Rhys Davies questions if it is the right thing to do
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ast month, history was made. On 25th February, the British Medical Association (BMA) decided to ballot its members over the possibility of industrial action in protest over proposed changes to the NHS pension scheme. For many doctors, this is the first time this has happened in a generation. The last time the BMA balloted its members like this was in 1975. Regardless of whether or not industrial action goes ahead, this move raises the question, is it ever right for doctors to strike? Firstly, it must be said that the BMA has ruled out a complete strike by medical staff, over concerns for patient safety. However, there are still other methods of protest, to make their collective feelings known. Historically, doctors have formed one of the professions most trusted by the general public. This is felt at the individual level at the respect received and authority attributed to doctors, and in a diluted form, medical students, by their patients. Striking and industrial action, especially if presented in a clumsy manner, could irreparably harm this golden reputation doctors enjoy. Some may argue that a scarred public image is an acceptable wound when fighting for doctors’ rights but this view is short-sighted. Patients trust doctors and value their opinions.That is why they adhere to the treatments they suggest and undergo the surgeries they recommend. Damage to the professional image damages the role of the doctor and threatens the integrity of the doctor-patient relationship. The immediate effect of industrial action is a denial of service. In the case of doctors, this puts patients at a very real, very clear risk. Though the message sent would be powerful indeed, it is categorically unacceptable to sacrifice patients in this disagreement. Dr Hamish Meldrum, chair of the BMA, stated this very clearly in an interview with the BBC, saying, ‘Our fight’s with the government. We don’t want to harm patients.’ Instead of a full strike, doctors could ‘work to rule’ whereby they work in accordance with their contracts and official guidelines but no more. Much of medicine depends on the unsung extra effort doctors and nurses dedicate to their patients. By working religiously to their contracts’ stipulations, many junior doctors may find themselves leaving work while a mysterious burning sphere still hangs in the sky. However, though it is evident that doctors fulfil a necessary role in maintaining society, ruling that they cannot strike would be draconian. There are many other jobs and profession vital for society to function such as; police, fire services, postal workers, shop workers and rubbish collectors. Though these
Dr. Hamish Meldrum, chair of the BMA and the Alan Rickman of the medical world services are just as essential as medicine in their own way, their front-line workers are far less privileged than doctors. Barring doctors from industrial action could lead to preventing these professions from striking, removing the valid right to protest against unfair and unjust treatment. This could, in effect, throw the dynamic between workers and their employers back two hundred years to the industrial revolution. If doctors were not able to strike, they would lose an influential ante at the negotiation table. Their refutations and rebuttals to proposals would lack the sting of influence and the power in the negotiations would be displaced against them. Potentially, this would leave doctors’ groups powerless and
subject to increasingly unfair demands by government. However, with no bastion of industrial action to fall behind, doctors’ leaders would be compelled to pursue negotiations tenaciously, a paragon of reasoned argument.
"Some may argue that a scarred public image is an acceptable wound when fighting for doctors’ rights but this view is short-sighted." The decision of the BMA to ballot on industrial action is not one that could have been taken lightly. The fact that this is the first of its kind in nearly
forty years means that industrial action by doctors still carries immense gravitas. This is in contrast to RMT, the transport workers’ union, whose regular bouts of industrial action are viewed as an annoyance more than anything else. Fully aware of the harm they could do to their professional image and to patient care, industrial action by doctors powerfully demands the attention of a government that has repeatedly demonstrated itself deaf to all dissent and opposition. But is this fight, to the point of industrial action warranted? Andrew Lansley, the health secretary, doesn’t think so. In line with belt-tightening elsewhere in government spending, he told Sky News that the proposed
changes to the NHS pension scheme were to ensure that, ‘[doctors] have a good, high-quality retirement but at the same time, making sure it is not unaffordable in the future.’ To this end, changes include raising the pension age to 68 in line with other public sector jobs, increasing contributions to the pension fund, with top earners paying 14.5%, and switching the basis of the pension from a final salary scheme to career average scheme for hospital doctors. General practitioners already use this scheme. What this means for current medical students is that, once they graduate and begin working as a doctor, they will have to pay on average an extra £200, 000 over the course of their working life. Essentially, they will have to work longer, pay more and get less. The BMA is particularly aggrieved at these changes as the NHS pension scheme was overhauled only four years ago as so not to be a drain on taxpayers. They maintain that the current scheme is neither in deficit or unsustainable. Indeed, in its current state, the NHS pension scheme generates a surplus in the region of £2 billion, which is fed back into government coffers. Doctors are also working through the fourth year of a pay freeze. The BMA feels that the current situation is healthy for both the government and doctors and that the changes proposed are entirely unnecessary. It is not unheard of for doctors to strike. Although mercifully rare in this country, across the world, where doctors are not treated as fairly as there are here, strikes are a semi-regular occurrence. 160, 000 doctors in Chennai, India, refused to work in protest over the murder of one of their colleagues by the aggrieved husband of a patient. To conclude, the ability for doctors to pursue industrial action is a critical tool in the negotiation process, one which should be singly viewed as a last resort. Hasty or flippant use devalues its impact and will only harm the medical profession and, more importantly, patients, both in the short and the long term. Industrial action must balance these consequences against the defence of doctors’ rights. The thoughts of this piece were most succinctly and eloquently expressed in a forum on thestudentroom.co.uk. Asked if doctors have a right to strike, the first response simply replied, ‘Yes. But it’s a bit of a dick move.’
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What do you think? Are doctors valid in moving towards industrial action, or will the move irreparably harm our collective reputation? Whatever your opinion, join the debate at www.medical-student. co.uk
medicalstudent
March 2012
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Comment The Chinese Room will see you now Robert Vaughan Guest Writer
John Searle – ring any bells? Recently, whilst reminiscing over the joys of A level philosophy with an ex-peer, we gleefully chuckled over the aforementioned crackpot, and one of his more meaningful arguments – ‘the Chinese room’. It was drawn up by Searle to help peddle his only, frankly shoddy, viewpoint known in the world of philosophy of mind as ‘biological naturalism’. It was an ideology so backward that any attempt to reason for it in an examination paper was impossible, a mistake I realised all too late last June. The Chinese Room demonstrates its point like so. Imagine a red square room, inside of which is a man who sits at a desk. On the desk is a sizeable book, to which the left and right pages of every spread contain reams of Chinese symbols. Throughout the day, Chinese symbols on a piece of paper are slipped under the door of the room.
It should be said that the man does not speak Chinese, so instead of reading them, he matches them to symbols in the book. He then transcribes the corresponding symbols from the adjacent page of the book onto the paper, and slips it out underneath the door. Now, it just so happens that by this method of communication, the ‘room’ speaks perfect Chinese, every input of language is met with perfect output. To every sentence that you feed to the door, you’ll be given a wonderfully normal answer. Simple enough, yes? At this point in of recounting the proverbial pornography for our past mental masturbation, another friend walked in and made a frank comment over whether GPs actually understood anything about medicine at all. Maybe they were just matching patients to symptoms, symptoms to treatment, and sending them off to Boots with their prescription slip. Searle with his ‘Chinese Room’ argument was really trying to undermine the idea that systems, or rather machines, can, or ever will, actually
‘understand’ the data they process, and that as humans seemingly do ‘understand’ things, attempting to define consciousness functionally is a fruitless exercise. Fair enough, Searle. Its just a shame the rest of your ideas are so utterly terrible.
"another friend walked in and made a frank comment over whether GPs actually understood anything about medicine at all. Maybe they were just matching patients to symptoms, symptoms to treatment, and sending them off to Boots with their prescription slip." Now the interesting question I drew from these two discussions is that, if something, or now ‘someone’, doesn’t ‘understand’ the content of their discipline, but is still seemingly perfect
whilst practicing it, why does it matter? The quality of service for the end use is the same, and the basis of the syntax can be expanded endlessly so that say, junior doctors, know how to handle even the most complex clinical disasters without even the slightest idea of what is going on scientifically. I think these are the keywords in society, not ‘knowing’, but ‘knowing how to’. Maybe that's why medicine is perceived to be so bloody useful compared to its BA or BSc siblings. Think about it. When you read the employment prospects section of a standard Art History degree’s prospectus, it will say something like ‘transferrable skills include time management, visual and reading skills’. I mean, granted, you acquire these skills through learning the actual subject, but the worth of the actual knowledge of art history is only ever going down. The more careers I think about, the more I realize that society is based on and values an ability to deal with syntax, or knowing how to do things. Doctors, bankers, tinkers, tailors, soldiers,
spies, all of them. All of them are based primarily on inputs and outputs. I don’t want to underplay ‘understanding’s’ role from all careers however. There are plenty of jobs based around the idea of ‘creating’, or ‘changing’ the way things currently work that indeed require understanding. It’s just that this kind of work is running out. Science has practically run out of things to discover, what with theoretical physicists only being a Higgs Boson away from a theory of everything. Although the creative arts solely require ‘creativity’ - an application of understanding perhaps, there’s really not much money or space in it anymore. It’s a somewhat depressing realisation that all the hard work we put in to understanding concepts in our degrees isn’t much more than an optional counterpart to the syntax of matching symptoms to treatment. Insert some witty quip about PBL here. The thing to remember is it’s because we can understand our disciplines that we do. I’m not a Chinese room, and neither are you. Now go read a book
RCP medical careers day 28 April 2012 A one-day event offering expert careers advice, guidance and support aimed at medical students and foundation doctors, plus a networking and social drinks event afterwards. RCP medical student members are eligible for significantly reduced rates. Member tickets: £5, non-member tickets: £20. Join RCP as a medical student member and for £1 per month receive career planning info on the 30 medical specialties the RCP represents, learning tools, discounts and networking opportunities. Find out more and register for the RCP medical careers day: www.rcplondon.ac.uk/medicalcareersday
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March 2012
medicalstudent
Comment A grim spectre
Head to
Should academ be comp
Oliver Woolf Guest Writer
Registration is an evil word, one that is the bane of a medical student’s life with relentless monitoring from medical schools and the General Medical Council becoming an increasingly important issue. But is this obsession really improving our education? Does it really offer a true indicator of how well we are performing? And perhaps one could argue that this contradicts the ethos of mature learning and self-direction.
"Administration staff's time could be better spent ensuring that timetables are accurate and that lecture content is available to students promptly. I am frustrated that lecturers and clinicians are not treated in the same manner when they are either late or don’t show up without any notice." Staunch supporters of the attendance register would claim that students would never turn up if there weren’t registers and I would agree that monitoring this does provide a motivation for attending activities. However, when it comes to assessing a student, I don’t believe that attendance equates to participation and engagement. Whilst I can see that turning up shows a level of commitment and professionalism, I would not go so far as saying that it gives any indication of what the student is actually achieving. One could argue that administration staff’s time could be better spent ensuring that timetables are accurate and that lecture content is available to students promptly. I am frustrated that lecturers and clinicians are not treated in the same manner when they are either late or don’t show up without any notice. If we are being welcomed into a profession surely we deserve similar respect?
"Logbooks provide an excellent guide as to what is the minimum expected but ultimately the drive to learn comes from within." My final point is that as so much of a medical degree is self-directed, and we are constantly reminded that we are in charge of our own learning there should be some flexibility in the activities we engage in. Logbooks provide an excellent guide as to what is the minimum expected but ultimately the drive to learn comes from within. There is no harm in occasionally spending a few hours in front of the books so that you don’t look a complete dummy in front of the consultant – it is even better if you read them as well
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This is one way to keep an eye on students.
YES Dominic Cottrell Guest Writer
Imagine it. You are about to enter a lecture hall, a world of knowledge awaiting you, your thirst for learning about to be slaked. Then suddenly an ID card or a signature is demanded of you. This happened to me only last week and even now, after all this time, I find it strange. I am, to quote The Lonely Island, an adult. Surely I can be relied upon to ensure my own attendance, and even if I can’t, surely this is my problem? Well, let’s not be too hasty. I can think of several reasons why lectures should be compulsory. Waking up in those heady first few weeks, it was only the thought of a register that dissuaded me from catching up the material later. While I’m sure I would have made my way through the textbooks, lecture slides and articles on my own, there is much I would have missed out on. It is a very attractive argument that medical students, by virtue of being medical students, probably already have a reasonable idea how to study. Being forced to sit in a lecture theatre when they could be reading the course material, ticking off the learning objectives or sleeping off the energy-drink fuelled power-learning from the night before may run counter to how they learn. However, coming to university in general, and medicine in particular, necessitates a change in learning style. Not only is the volume of knowledge greater, but the depth required is often only properly indicated by a lecture. Ignoring this, there is still the issue of content. The amount one needs to know to get through university is dwarfed by what could be learned. Lectures focus students towards areas of importance in a way rarely matched by a textbook, a focus further sharpened by the lecturer’s own perspectives and suggestions. In many instances, the first indication that a given topic is worth learning is a lecturer describing how it was of use in a clinical setting. The second opportunity to appreciate a subject’s relevance is all too often upon
opening an exam paper. Furthermore, compulsory lectures act as a reasonable safety net to catch those who might otherwise be struggling. When starting a medical degree, the risk is always there that someone may not be able to handle the workload or may have some other, deeper problem they are dealing with. However excellent personal tutors, welfare officers and all the other safeguards may be, for those only just settling into university these may seem distant and inaccessible. Consistently failing to show up makes for a serviceable early warning system that there are problems that need to be dealt with.
"In many instances the first indication that a given topic is worth learning is a lecturer describing how it was of use in a clinical setting. The second opportunity to appreciate a subject’s relevance is all too often upon opening an exam paper." The final benefit may be the most important, but also the hardest to describe. Lectures force a culture of communal learning to grow. Without being forced to sit in a massive room with my peers, all of us battling together in the face of a particularly opaque slide or fact, I might never have properly developed that most vital of skills—asking my neighbour what the hell was just said. This culture pervades medicine: from firms and practicing for OSCEs, through to grand rounds and journal clubs. See you in the lecture theatre
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The lecture in lightweight aerodyna
Next month, Co Should students be reg
Deadline: 25th March. Send all articles to comment.medicalst
medicalstudent
March 2012
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Comment Half-time score
o Head
mic attendance puslory?
amics was very informative. Image by Chetan Khatri
Zara Zeb Guest Writer
NO Rhys Davies Comment Editor
After a long night of getting lashed/ playing Skyrim/revision (delete as appropriate), it can be hard getting in to a central London campus for a 9am lecture. Many times, as I’ve driven my biro into my thigh to maintain consciousness, I’ve wondered what is the point of lectures. Surely, we can do without them.
"Compulsory attendance treats us like sheep and not like the driven, mature learners that we should strive to be." Without exception, everyone in medical school should be, technically, adults. Questions about maturity aside, in the eyes of the law and society we are viewed as adults and should be treated as such. We are repeatedly told that we are responsible for our own learning. As adult learners, that is fair enough. The buck stops with us. But the importance of self-directed learning is undermined if we must attend didactic lectures all day. Self-directed learning should be the ethos driving our education, not the cherry on the top. Another problem with the necessity of lectures is that it forces everyone to learn in the same way. Admittedly, some people learn best by listening to knowledgeable and interesting (one would hope) tutors. However, it is important to recognise that this is not true of everyone. Others learn better by camping down in the library and digesting textbooks. Other benefit from
omment asks; gistered with the GMC?
tudent@gmail.com Articles should be 500-1000 words in length
smaller groups where there is the possibility for more back-and-forth discussion, transforming teaching from didactic to Socratic. We are all different and we all try to meet our education needs differently. Ignoring this, by mandating that all attend lectures that only benefit some, is foolish. Furthermore, attendance should not be viewed as an end in itself. It is only a step towards participation. In the same way that a textbook cannot be learned by osmosis, a lecture cannot be learned by surreptitiously playing Angry Birds on your iPhone. Compulsory attendance will bring to the lecture hall students who, for one reason or another, will not learn. Instead, they will chat, text their friends or play on their phones, often in the murky recesses of the back rows. Their attendance does them no good and can be disruptive for those around them, including students who do want to learn. Compulsory attendance can therefore damage the ability to learn of students who do want to attend lectures. At Imperial, you will occasionally see members of the administration at the lecture theatre, scanning ID cards as a form of registration. These lectures are, understandably, better attended than most. However, the main goal of this exercise is not to encourage attendance. Instead, it is, bizarrely, to fight terrorism. After arrests of (incorrectly) alleged terrorists were made at Nottingham University in 2008, the UK government demanded that British universities keep closer tabs on their students. The logic being that if a student is not in class, the only other thing they could be doing is making a home-made bomb. It is understandable that a university wants to keep tabs on it students, but corralling them into one room like cattle is not the answer. A better solution would a general ‘campus-wide’ sign-in, which would allow students to go where they study best. In short, compulsory attendance treats us like sheep and not like the driven, mature learners that we should strive to be. It does not further the education of those who do not want to attend and can damage that of those that do
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Five months as a fresher and I haven’t yet managed to tick off anything on the mental list I created at the excitement of studying in London, the heart of the UK and the world. As medics, we all have a lot more to do than any other fresher on any other course. Even so, we all find plenty of time to play hard. So why haven’t I crossed off anything on my ‘must do’ list? First of all, let’s review the top five on this list. 1. Go sightseeing. 2. Go to the big museums. 3. Go to the West End. 4. Play a sport. 5. Find ‘the One.’ I will admit I used to be a bit of a saddo. I did go sightseeing but British weather meant I would be scurrying back to my room as soon as I could. To be honest, once you’ve seen the buildings on TV, you’ve pretty much seen them in real life and there is no need to get caught up with all the tourists. As for the museums, I must have been kidding myself. I’d still like to do visit the big ones when I get a chance but I’d need a whole day for just one museum, and I’d actually have to be interested in the museum. Sculptures just don’t do it for me so the V&A is out. As for the West End, student finance just about covers my essentials. I don’t think spending forty quid on tickets to see a show is exactly worth it compared to 40 quid on food or several days out. And sport? I’m afraid a leopard doesn’t change her spots! On that final one – have you seen the people at university? None of them could ever handle my exuberance and ‘unique’ qualities.
"Sculptures just don’t do it for me so the V&A is out." What exactly have I done in the five months since I’ve been here, outside of the curriculum? Well, I haven’t failed a test yet (scraping passes are still passes!). I’ve bought lots of stuff, mostly gloriously indulgent items I need to hide from the parents when I move back home. I’ve written for The Medical Student. I’ve joined a few societies that provide lots of yummy food and good conversation. I’ve watched a lot of TV on my laptop, including the entire ‘Big Bang Theory’. I’ve started ‘Dexter’, ‘Breaking Bad’, ‘Chuck’, ‘Being Human’ and there are still many others I need to watch. I made soup from scratch – my first proper meal! I’ve become a ‘commuter’. I’ve been to a lung cancer clinic. That’s a pretty impressive list in itself.
"And sport? I’m afraid a leopard doesn’t change her spots! On that final one – have you seen the people at university?" So at half time, I think I should review my ‘must do’ list. I thought about what I’d like to achieve in my remaining four months of being a fresher. This time, let’s be realistic. 1. Lose the stone I’ve put on since I came to university (but first I have to eat my way through my stash of junk food). 2. Go to one museum. 3. Make a proper meal for myself instead of relying on Mum’s frozen dinners and my simple recipes. 4. Cancel my membership with the gym. 5. Actually explore the area I’m living in. I’m sure I saw a sign for a lake nearby. And next year, maybe I’ll get around to joining that sport society, and know the London Underground like the back of my hand, and develop a sense of style that doesn’t make me look like a frumpy granny. Maybe...
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March 2012
Culture
medicalstudent
Culture Editor: Kiranjeet Gill culture@medical-student.co.uk
A Dangerous Method Akin Sowemimo Guest Writer ‘A Dangerous Method’ is a film by David Cronenberg, based on the historic meeting and relationship of the psychologists Carl Jung and Sigmund Freud, and a patient, Sabina Spielrein. Lacking the requisite credentials of a historian I can’t fathom a guess as to how accurate the events portrayed in this film are to reality. However I would heartily recommend ‘A Dangerous Method’ as a very entertaining piece of cinema which provides insights into the lives of these two great men. The film revolves around the complicated relationship of two of psychology’s greatest minds - Carl Jung, the founder of analytical psychology, and Sigmund Freud, the father of psychoanalysis, and their relationship with a young and beautiful - as is always the way - patient of Dr Jung’s, Sabina Spielrein. We encounter Freud and Jung at the time of the birth of psychoanalysis, which Jung pilots on the raving Sabina. The remarkable ‘talking cure’ works and the improvement in Sabina’s condition leaves her free to pursue her dream of becoming a doc-
tor herself. Freud and Jung meet and it is thrilling, from a medic’s point of view, to watch as these two legendary men discuss ideas and exchange theories that would impact psychiatric treatment for generations to come. Eventually however, this close relationship ruptures as differing opinions cause an irreconcilable rift. Between and furthering the discord is the torrid affair which springs up between Jung and Spielrein. Freud learns of the relationship and is appalled by his colleague’s conduct. As a medical student one can certainly understand Freud’s reaction at the decidedly unscrupulous behaviour of Jung; though I can vaguely sympathise with Jung however, as Keira Knightley is as gorgeous as ever. While the film is worthy viewing in itself, it doesn’t hurt that Keira Knightley plays the role of Sabina. She is flanked by a handsome Dr Jung played by Michael Fassbender and a peculiarly attractive Sigmund Freud played by Viggo Mortensen who is never without Freud’s trademark cigar that would unfortunately turn out to be the cause of his death. The simple, scenic locales serve as a delightful, quiet backdrop that accentuates the turbulent and difficult interactions of Freud and his
would-be protégé. The affair between Jung and Sabina is tortured and as such disturbingly romantic. Despite the entertaining and poignant performances of her co-stars, Knightley is far and away the most captivating part of the film. From the film’s first scene which opens with her face pressed against a carriage window screaming and frothing at the mouth right up until the credits roll, we are drawn in by the strange allure of Sabina, who long after she is ‘cured’ seems to teeter on a fine line between sanity and insanity. Her performance though a little overwrought, manages to give an unsettling glimpse into aspects of mental illness, and is in my opinion her best to date. Overall ‘A Dangerous Method’ is dramatic, entertaining and beautiful to watch, although as it has probably taken a lot of liberties, anyone intimate with Freud or Jung’s work or with knowledge of what really transpired might find that this film has glamourised the characters and their ideas. And finally, I will offer a word of warning - the nature of Sabina’s illness and her relationship with Jung often result in some slightly disturbing sexual references and scenes and this might prove a little distressing for the faint-hearted
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Image courtesy of Sony Picture Classics
Vintage Film of the Month A Clockwork Orange (1971) Durria Rubat Guest Writer
A Clockwork Orange.
The director Stanley Kubrick has defined his career by creating cinematic paradigms and 'A Clockwork Orange' is no exception. Extraordinarily controversial when it was first released, it is a futuristic psychological thriller, high-drama and social commentary combined.Although over 30 years have passed since its release it remains relevant, even today. It is for these reasons this piece of cinema, born to the novelist Anthony Burgess will be remembered as Kubrick’s X-rated child. The film stars a young Malcolm McDowell as Alex, a fiendish psychopath with manic buddies who terrorise the streets of a socially-compromised future England. Despite this, his eyelash framed, wide eyed manner would be charming if his behvaiour were not so revolting. The movie is full of rape, violence and crisp cinematography which shove the reality of sadistic aberrance in the face of the viewer, making it impossible to romanticise the protagonists. But the language and poetry with which a murder occurs force
us to peek out from behind our hands. The film is less entertainment - although it remains gripping to the very end - and more art. As the protagonist is caught and punished, it provokes questions about rehabilitative institutions in civilised society, the nature and price of morality and wonders whether socially sanctioned torture is any better than the self-indulgent cruelty of a madman.
"The scenes are often close up and inescapable – our reactions inform us of who we are when we are faced with these choices" Most pertinently it highlights the role of the doctors who administer this questionable therapy for the 'greater good'. It is a testament to the film, that our heart goes out to Alex as his love for Ludwig Beethoven is sacrificed in this Pavlovian experiment and it is with a flourish that one by one all his victims turn villain, even dishing out their cold revenge from wheelchairs.
The colour schemes are browns and beiges which lend themselves well to the philosophically droll tone of the entire movie. They also help set it into an abstract distance, kindly mitigating some of the discomfort the audience feel. Most thrilling is the score which is both backdrop and cornerstone of the film. The overtures which provoke emotion are also those which resonate with Alex and despite his 'evil', sacrificing this paradoxically removes the only humanity in him that the audience has been able to empathise with. Although most superficially and famously it is a movie about mental health, society and how people should be managed on closer scrutiny we are the subjects of examination. The editing leaves the film bereft, the scenes are often close up and inescapable – our reactions inform us of who we are when we are faced with these choices and these acts. That is the beauty of the production, it is a film which asks questions and simultaneously pushes you to ask your own. It is seriously a satire, a beautiful tragedy and amongst all these paradoxes is the music which binds together the genius of Stanley Kubrick's vision
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medicalstudent
March 2012
17
Culture
Here Comes Good Health!
Cooking With Meat By Yin Yin Lee (ICSM) So, another issue and another article aimed at making the most out of our miniscule student loan. Whilst the last article concentrated on restaurants that offered the best value for money, the reality is that not even the richest, most spoilt, hedge fund daddy, public school-going student can afford to eat out all the time. This week, I have some money saving advice for the home cook.
Hayley Stewart reports on a new exhibition about public health propaganda
Currently, a large quotient of my food cost is skewed towards meat and alcohol - a healthy use of money I’m sure you’ll agree - but being a costconscientious/cheap-ass student, I am constantly looking for areas to save on. This week we look at beef. Without a doubt the most expensive choice of meat of the big four, there are as many breeds of cow as there are cuts and their prices fluctuate accordingly. You have the fillet which is the most expensive cut, prized for its tenderness and scarcity. As a result this seems to be the default cut of choice for those looking to satisfy their hedonistic need for steak and chips. They would argue that you ‘get what you pay for’ and so the fillet is their one and only choice, but I beg to differ. Personally, I believe there are cuts of meat out there that are cheaper, but most importantly more flavourful. First off, there is the rib-eye, a slightly tougher cut that is interspersed with strands of fat that not only flavour the meat, but keep it moist during cooking. Though not what you call an ‘obscure’ choice, this ensures that it is readily available at most supermarkets should your lust for bloody meat overcome you.
T
Dentistry 101- there's a five year course for this these days. Image courtesy of Southwark Local History Library and Archive
he recently opened 'Here Comes Good Health!’ is a tiny exhibition that’s well worth a visit. It is essentially a quaint and darkened room a bit like an air raid shelter, with a constantly running series of 1920s and 30s films. What is most fascinating is the insight it gives into 1920s and 30s life. The crackly silent film reels are brought to life by the characters in their Great Gatbsy-style clothes, against the backdrop of an antique-looking south London. The films themselves, which were broadcast from mobile cinemotor vans in the streets of Bermondsey and powered by street lights, were watched by crowds of up to 1000 people, and reveal early attempts to spread public health messages in a time so clearly different to now. A 19-minute film uses cartoons, monkeys and elephants to drive home the message that we must all wash with soap, making it so apparent that what we see as common sense and learn as young children was once new. Mothers are taught how to care for their children, and whilst it seems good common sense to dress them in cotton layers and warm wool, advice not to use garters as it restricts the flow of blood, is accompanied by images of stockings on a small baby and an old man! How fashions have changed. Other films drive home equally impor-
tant but more melancholy messages about avoiding preventable but fatal diseases like diptheria, reminding us of a time when losing a child was not a rare occurrence in life. As Angela Saward, the curator of the exhibition says of the films’ content, ‘many of the principles of healthy living are now more or less universal, and we are fortunate to live in an age where many of the [deprivations] outlined in the films are a distant memory.’
"A 19-minute film uses cartoon monkeys and elephants to drive home the message that we must all wash with soap, making it so apparent that what we see as common sense and learn as young children was once new." These films were the brainchild of the Bermondsey Borough Council, and were just one aspect of an eccentric campaign to bring simple but vital messages to people unaware of the means of avoiding illness. Whilst films were the most popular means of communication in times which saw the birth of cinema, other methods used included billboards, posters, flashing electric signs and demonstrations of medical
practitioners at work at public holiday parades. Other initiatives to improve the health of residents included the planting of over 5000 trees and the provision of garden tuberculosis shelters to allow patients to sleep in the ‘fresh air’. Solarium treatment, at the newly-built Grange Road Health Centre, also became hugely popular as did other new treatments such as the dubious-sounding medical electricity and, curiously, mechanical vibratory massage. The work was pioneered by doctor and Bermondsey MP Alfred Salter and his wife Ada, who in 1922 became the first female Mayor of London, who were spurred into action by the tragic loss of his eight-year-old daughter to scarlet fever. The 1927 Better than Cure manifesto set out to improve Bermondsey’s health through moving visual images – as the most ground-breaking technology of the time they were considered to be the most appealing to Bermondsey’s residents. The campaign was a huge success, and also became influential in writing British public health policy, and Alfred was honoured with statues of himself and his daughter with their cat on the banks of the Thames at Bermondsey
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Here Comes Good Health is on at The Wellcome Collection until 3rd June 2012. Nearest tube - Euston.
My next recommendation is a slightly more ‘interesting’ cut that may not be everyone’s cup of tea… I am talking about the onglet. Also known as the hanger steak or the butcher’s steak, it is the diaphragm of the cow. Now before you all turn the page and vow to never read my column again, let me try and convince you that you should at the very least try this mercurial cut of meat. Though much tougher than the fillet, what it lacks in tenderness it makes up for in its flavour. Due to its anatomical proximity to the kidneys, the onglet possesses a strong and earthy flavour that separates it from the aforementioned cuts. Having praised its virtues, one would think that it is easily available but alas that is not the case and you may have to go to a decent butchers to pick it up but don’t despair, it is by far the cheapest cut of meat of the three! By nature, onglet is a very thin piece of meat that requires cooking on a high heat for a short period of time and it is best served medium to medium-rare. This will ensure that the meat, though relatively tough and fat free, will be tender enough to eat without developing jaw cramp. As a final thought, it wasn’t long ago that our predecessors would be eating cuts of meat that we now find to be ‘disgusting’. However, they did so not out of choice per sé, but rather through necessity. Whilst the bourgeoisie were stuffing their faces with fillet and foie gras, the less well-off had to learn to adapt and make do with what was left over, which was often offal and other miscellaneous cuts of meat. Now I’m not saying we should all eat offal and what not but considering the current time of austerity, I think we have a lot to learn from our humble ancestors.
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March 2012
medicalstudent
Culture
Imperial College Indian Society Presents East Meets West
Dancers perform the traditional Punjabi bhangra. Image courtesy of Imperial College Indian Society.
Savan Shah Vamsee Bhrugubanda Guest Writers As the curtains open, a lone singer serenades the audience to welcome them to 'East Meets West'. Yes, it is that time of year again, when the Imperial College Indian Society present their annual celebration of culture and diversity. Born from a seed of ideas, it has now blossomed in to one of the largest student-led charity variety shows in the country. This year the special 20th anniversary show was held at Her Majesty’s Theatre on February 19th. With over 250 students performing and 22 different acts, ranging from traditional performances of Carnatic Music to the contemporary styles of hip hop group Funkology, the anticipation and expectations of the audience were running high. The essence of the show lay in one central theme: a fusion of diversity. Desh Dhvani, one of
the opening acts, played beautifully to this theme. As they sang the soulful rhythms of South Indian Carnatic music and merged them with the pleasurable harmonies of North Indian Hindustani music, we could appreciate how music can bring a country together. These dulcet tones were offset by the ground-shaking drum playing of the Ministry of Dhol. The crowd was energized, cheering and clapping to the rhythm of the drums as the musicians poured their hearts and souls in to the beat. A number of societies played an important role in the show. The ICSM Dance society performed a beautiful fusion of Sleeping Beauty, The Nutcracker and Swan Lake. With pliés and pirouettes, the dancers' grace put the audience into a state of enchantment. This was in contrast to the up tempo performance of the Imperial College Bhangra Team. Their passion was infectious and they brought a whole new level of creativity to this already hugely popular art form.
Throughout the show the energy and vibrance of the students was clearly evident, from the spirited performance of Women of Africa by the IC Afro-Caribbean Society to the animated, body popping hip-hop act of Funkology. The Indian Society also had their own street acts, 'Attention!' and '5.4.3.2.1. Showtime!' This was all capped off by the lively acrobatic performance of the IC Wushu Society, who dazzled us with different fighting styles from the mantis to the tiger. We definitely have nothing bad to say about them, lest we become their personal practice dummies. A welcome addition to this year’s show was the IC Drama Society’s production 'Meet the Parents', a Bollywood take on an English classic. The crowd was left roaring in their seats with a stitch in their sides, as an Indian girl brings home her English fiancé only to watch him being berated by her dad for doing dentistry instead of medicine. Com-
plimenting this fine piece of acting was a musical snippet from the very successful production of 'The Producers' by the ICSM Light Opera Society. No Indian show would be complete without a dance number to the tune of Bollywood hit songs. In this respect, East Meets West certainly didn't disappoint as the boys and girls shook their hips to rhythm of the one chart topper after another. Starting from humble beginnings the show really has reached a pinnacle. Having raised several thousand pounds for the Demelza Hospice, I-India and Water-Aid UK, the show was a resounding success. The only disappointments were the poor rapport between the MC, Anil Desai and the audience, along with a few technical glitches. If the only criticism we can give is of a seasoned professional who has performed so many times in his career, then this speaks volumes of the quality of the show and the students involved
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medicalstudent
March 2012
19
Culture Complications - A Surgeon's Notes on an Imperfect Science Kiranjeet Gill Culture Editor Primum non nocere – one of the fundamental tenets of medical ethics, instructing us that above all, we must not cause harm. But, as Atul Gawande is keen to emphasise in his book, ‘Complications – A Surgeon’s Notes on an Imperfect Science’, mistakes and the harm they cause are not only an inevitable part of Medicine, but also crucial for the training of new doctors and advancement of the field as a whole. I think it’s fair to say that medical students can broadly be divided into two categories – those who cannot imagine doing anything but surgery, and those who would rather chew off their own hands than ever have to wield a scalpel. I consider myself firmly part of the latter category, and have often wondered at the tenacity of those who dedicate themselves to a career hunched under the bright lights of the operating theatre. In reading this book, I hoped to understand better what motivates someone to choose this most demanding of careers, in which the stakes are so incredibly high and room for error non-existent. With the kind of academic history that makes you wonder if he’s a real person – he holds degrees from Stanford, Harvard and Oxford - and an
equally remarkable career, it’s not clear whether Gawande was born to be a surgeon, writer or leader of the free world. He took time out of medical school to work as Bill Clinton’s healthcare adviser and began writing for the New Yorker during his surgical residency. Now, in addition to his main career as a general surgeon he is also an associate professor at Harvard Medical School. His undeniable talent as an author no doubt stems from his academic and journalistic know-how, but all of his experiences inform his writing. Gawande’s background in philosophy and ethics is particularly evident, and enables him to pose thought-provoking questions that may be particularly relevant to us as medical students – for example, how can we balance the need to train junior doctors without compromising standards of care? A lack of experience combined with the pressure and long hours of the job mean that mistakes are all too easy to make. Patients’ stories are used as springboards for Gawande’s fascinating insights into the surgical profession and admittedly, the book may not be for the faint-hearted. I dare you not to wince as you read his horrifyingly detailed description of the nightmare of placing his first (and second, third and fourth) central line. ‘In surgery, as in anything else’, he says, ‘skill and con-
fidence are learned through experience – haltingly and humiliatingly’. It’s almost enough to make even the most dedicated medical student hang up their stethoscope and call it a day. But of course, there comes a moment where it all clicks. Everything just goes right, and the relief, almost elation, that the author expresses helps to remind us why we’re in this business. As barely a month goes by without some story in the press about the incompetence of a doctor causing a tragically untimely death, it is reassuring to hear Gawande’s views on the topic. He recounts a handful of surgical mistakes an enormous magnitude. Where did they come from? Well, he simply asked a few of the best surgeons he knows. Whilst doctors who make mistakes are reviled in the press as incompetent or negligent, there is a ‘central truth in Medicine that complicates the tidy vision of misdeeds and misdoers – all doctors make terrible mistakes.’ Scary, yes, but what is important here is that Gawande accepts doctors as human, emphasising that mistakes are an unfortunately inherent part of what we do, rather than the infallible beings we are often expected to be by the media and the public. For this reason this book is important – not just for those involved in medicine in a professional context but for those we treat as well
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Why George's students should never become surgeons...
Music Review - The Cribs at University of London Union Rob Cleaver Staff Writer
Image by Autumn De Wilde.
For a venue more often frequented by a university Harry Potter Society than three siblings from the slow Yorkshire town of Wakefield, ULU was a strangely welcome bolt-hole for The Cribs' first gig since debuting brand new single 'Chi Town' on the airwaves just a few weeks ago. The crowd hissed chants like football hooligans before the brothers Jarman took to the stage. The band are known to be bold and brave performers and they stayed true to their colours with an explosive rendition of the lead single within seconds of pacing out onto the stage. Despite only having a matter of weeks to get to grips with the new material, the entire crowd heaved their way forward, panting and jumping at the slightest chance of any contact with a Jarman hand. With their fifth studio album 'In The Belly of the Brazen Bull' set for release on the 7th March, they were always going to try out some of their
new material, the first since the departure of ex-Smiths axeman Johnny Marr, with six of the new fourteen on show tonight. Each one seemed like a future anthem but these were the six lulls in the set, as no-one knew whether to cry at them, to scream for them, or to jump like a frog during mating season to them, apart from 'Chi Town'. The crowd screamed throughout for iconic single 'Another Number' during any silences whilst instruments were swapped and Ryan teased them with the first few notes of another early favourite, 'Run A Mile'. However when they played anything off their third, and breakthrough, album 'Men’s Needs, Women’s Needs', Whatever, the crowd burst into life, with punters aged 1665 jumping and tossing beer skywards, running the words they rehearsed for hours beforehand through their minds. 'Hey Scenesters!' got a phenomenal number of crowd surfers, fearlessly defying gravity and floating on a sea of limbs below them as their faces contorted in passion and song-lust. When Ryan Jarman finally played the riff the crowd wanted, 'Another
Number', it was almost drowned out by the crowd singing it back to them and indeed, at the end of the song, when normally the riff is left on its own to hang amongst the venue’s rafters, the band just sat and listened back to the crowd’s rendition. Smiles aplenty on the faces of Ryan, Gary and Ross. For me though it was the moment the backing lights dimmed to darkness, and the flickering image of Lee Ranaldo of Sonic Youth bubbled forth into life with the spoken word part of 'Be Safe' that defined the brilliance of the event. The song was rousing and at six minutes long, pretty epic, and whenever the twins up front closed in on the mics to sing the chorus, you knew that everyone in the room was on board, and that everyone in the room was having one of the greatest moments of their life. With the final trio of 'Men’s Needs', 'Our Bovine Public' and 'City of Bugs' this was a moment cemented in history as a brand new age of the biggest cult band in the UK. The only thing I left pondering was whether what I just experienced was a gig, or communal worship to a deity of DIY musical brilliance
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medicalstudent
March 2012
23
Sport
Brunel left wondering by ICSM women
Continued from back page Dinner, with nerves possibly calmed (or tautened) by alcohol. University of London’s first boat unsurprisingly won the men’s Invitational group in just under 12 minutes, with another of their boats leading the men’s Senior VIIIs. However, as UL is not a UH club, the medals for that race went to RUMSBC, who left St George’s (who won here last year) wondering what might have been a mere 3 seconds adrift, with a weakened ICSM crew a more distant third.
Elizabeth Nally Guest Writer
ICSM
39
Brunel
28
After beginning 2012 with three consecutive BUCS wins, ICSM Netball 1s knew that they would face their toughest competition yet playing away to Brunel 2s, who were top of the table having not lost a game. The previous meeting between our two teams earlier in the season had ended with Brunel coming away with a twelve goal advantage. However we knew our game had been weak and have made vast improvements since then, with freshers really beginning to flourish and experienced players stepping up their game. We arrived at the court on a snowy, Wednesday afternoon to be met by the sight of the Brunel team running through their practice perfect drills to a soundtrack of Chris Brown blasting through the speakers. The home team's multiple coaches and three deep crowd had us slightly jittery but despite the distractions, we managed to remain focused throughout our slightly less choreographed warm up. The match began with tensions running high but both teams started out strongly, each converting our first centres to goals. We remembered Brunel to be a very physical side and refused to be pushed around. We held our own and lead the game by one
"Another Invitational crew, UCL’s second VIII, won the Intermediate category too but once again RUMS were there to clean up from the other UH clubs."
Victory for ICSM goal after the first fifteen minutes. Although still the under dogs, we felt we had a fighting chance to take the game from Brunel early on. Despite Brunel’s 6am daily coaching sessions our defence were still able to pounce on many of their mistakes, with Lindsay Hennah and Emma Williamson making some fine interceptions to turn over three of their centre passes. We had pulled away by the first half to gain a five goal advantage and
showed no signs of slowing down as we entered the penultimate quarter of the game. Ffion Harry appeared to be putting shots away for fun, rewarding the continuing hard by her teammates in defence. The experienced influence of Charlotte Boughton and her support play around the attacking circle allowed us to remain calm and collected, despite shouts of 'just kick her' coming from the Brunel bench. The third quarter was by far our best, much to the frus-
tration of Brunel, and by this time we led 32 goals to 20. In the final quarter, we rounded off an extremely consistent performance, dropping only one goal to finalise the score at 39-28. The medics' team spirit shone through against a squad that were highly trained and from a specialised sporting university. With first and second place swapping regularly between the two teams in the league only time will tell who will gain promotion! Fingers crossed!
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Barts vs ICSM: A game of two halves Harold Wilson-Morkeh Guest Writer
was undone in the blink of an eye.
Barts
2
ICSM
2
Barts started the game on the ascendency testing the Imperial goalkeeper early with a shot from outside the box. They benefited from this early pressure after a contentious offside decision went their way and their striker was able to finish with ease as the Imperial defence watched on in disbelief at the linesman not raising his flag. ICSM regrouped well though and began to dominate possession and duels around the pitch. They equalised after a good move and subsequent low cross from the right was directed into the corner of the opposition net by striker Youssuf Saleh. 1-1. Unfortunately, all the good work
"Barts kicked off and managed to get behind the ICSM defence once again. As on the first goal the striker kept his composure to finish well beyond the advancing 'keeper. ICSM 1 Barts 2 at Half time." The second half was all ICSM. However, there was little end product to all the good possession and interplay. This was until Will Tomlinson, having just moved to centre midfield from right back after a substitution, made a forward run and lifted the ball delicately over the Barts' 'keeper into the far corner of the net. It was a fantastic equaliser and no less than ICSM deserved. Both sides subsequently went looking for a winner but none materialised. ICSM 2 Barts 2 at full time
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The crew were 19 seconds behind their non-medic sister club’s boat but comfortably ahead of the Royal College of Vets and St George’s by close to a half-minute margin. Just as it looked like the men’s races would be dominated utterly by RUMS, ICSM’s novice VIII (medal winners at the last regatta) beat second place King’s by over 30 seconds, showing their class by beating a couple of senior crews . UCL won again in the last male race, the IVs, and King’s were there to win the medals as top UH crew by beating Bart’s, their only competition. In the women’s categories, KCL entered a full college crew into the Senior VIIIs which counted as an Invitational boat. This meant that RUMS extended their grip on the prizes as they just edged out George’s by less than a second! Vets were rowing their first VIII in the Intermediate race under the contentious new rules and won that category with RUMS and KCL reasonably far out in second and third. ICSM ladies managed to pull off the Novice double in a large field, proving they can mix it up in both sprint and head races. They managed the same time as Vets’ winning Intermediate crew and again more than half a minute ahead of their closest rivals RUMS and George’s.
"The ICSM IV was a mere 4 seconds off repeating this victory but couldn’t quite keep up with Barts and the London."
Wait, so the ball goes between the goalposts?
So all in all a good day for older crews from University College and the younger ones from Imperial College School of Medicine but a competitive tone set for every crew in Spring head season, with a few races until the big ones - WeHoRR for the ladies, and Head of the River for men in a few weeks, where we can see how the UH club match up against each other, as well as crews from all over the world, over nearly twice the distance
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medicalstudent
Sport
Football: Barts are as Netball: ICSM teach bad as ICSM Brunel how to play Page 23
Page 23
UCL triumph at UH Head
Girls giving it all for UH Head. Image by David Sleep
Jac Cooper Guest Writer On the 18th February 2012, the competitors at United Hospitals Boat Club first head race of the year had a pleasant surprise - they were rowing and the sun was shining. A rare occurrence and one that meant the Thames actually looked appealing to row on, this set the tone for a good day’s racing. UH Head is a time-trial style
race
across
just
under
4km,
"Every rower was left with a feeling of hope, anticipation and fear as they waited for their times at the UH Dinner, with nerves possibly calmed (or tautened) by alcohol." from the Syon Park Pavilion to
Chiswick Bridge, and as a head race is very different to the sprints undergone earlier in the season where the start is all important. Here, however, consistency and commitment are the key factors to win. This year the race was split up into male and female divisions, each with Invitational crews, Senior VIIIs and IVs, Intermediate VIIIs and Novice crews. There was some controversy over the categorisation of crews into these groups this year, but all these dis
tractions become meaningless once the competition begins in earnest.
"Finally the results were announced, and as ever the margins between crews were tight and there were tears of joy and disappointment as the wait on acted to heighten emotions."
Judging performances and battles in a head race is difficult because every crew races against the whole division, setting off about 20 seconds after the previous one, so unless you overtake you are left guessing how the race went. Every rower was left with a feeling of hope, anticipation and fear as they waited for their times at the UH
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