MS_March_2011 by The Medical Student

the

medicalstudent The voice of London’s Medical Students

March 2011

Meet the tit-squad Page 4

FY1 recounts D-day Page 7

Are medical students being spoon-fed? Page 12

Day X: the NHS on trial Ken Wu The powerhouses of ICSM, GKT, RUMS, BL and SGUL were out in force this month to protest against the proposed changes - medical student style. The demonstrations climaxed in a six day protest-binge in the middle of February, with the students incentivised by the mere mention of the words ‘NHS Reform’ and united by their passion for healthcare. Change. Yes we can. Four words that won Barack Obama his Presidential election back in 2008. Real Change. Two words that allowed David Cameron to form his coalition government last year. It seems that everyone is jumping on the ‘change’ bandwagon, and the NHS is no exception. Although this time, they have found a suitable syno-

nym: NHS Reforms. Unfortunately, the bandwagon has broken down. Obama faced brutal opposition in the midterm elections and Cameron’s coalition is about as stable as a ruptured aortic aneurysm. People are getting tired of changes, they even want to change the change. It is therefore no surprise that a wave of protests have swept across the London medical schools in the short month of February regarding the recently introduced ‘Healthcare Bill’ which accompanies the 367 pages worth of changes outlined in the ‘Liberating the NHS’ white paper. It all started on the 11th of February, when an emergency protest was held outside the Royal London hospital. The outrage expressed by the demonstrators against the proposed cuts at Barts and The London NHS Trust was in full flow and the organisers reported a “militant

protest which was covered by ITN news”. If the Barts demonstration was billed as an emergency protest, then there was nothing emergency about what was about to happen at Imperial. Andrew Lansley, the secretary state for health and father of the reforms, came to Imperial on a lusty Valentine’s Day to open Imperial’s new school of public health. This prime opportunity was irresistible for the ‘Big Society NHS’ organisation, especially on a day where love (for the NHS) was in the air. James Chan, the organiser of the protest, reported that “At 4pm that day the group amassed outside the building where Lansley was due to be speaking, most people had registered to attend the event and question him personally but alas the security did not want to allow the protesters to share their love of the NHS with Mr Lansley”. How-

ever, nothing can beat the innovative genius of students, who “whilst chanting outside there was a brilliant photo stunt with one of the students dressed as Lansley accepting a Valentine’s box of money from a representative of the private health provider Care UK. The stunt drew a crowd of onlookers who were horrified to see illustrated how the dastardly Mr Lansley was accepting money from private companies in exchange for his wholesale privatisation of large segments of the NHS”. Andrew Lansley, probably anticipating the aura of furore that surrounds him, arrived at Imperial in a fashion akin to some sex-scandal ridden celebrity. James Chan further reports that “a carefully planted insider told us Lansley was still yet to speak. Quickly the protesters dashed back to the event and (cont’d on page 2)

Art in anatomy Page 19

The man killed by his coat Page 20

March 2011

News

News Editor: Ken Wu news@medical-student.co.uk

Editor-in-Chief

Hari Haran GKT Medsoc President Greetings fellow medical students. I would like to start by quashing the rumour that GKT’s absence from “Adrenaline” was due our belief that we have far greater sartorial elegance than our counterparts in other medical schools. In actual fact, we were in the midst of our RAG week so were busy putting our own bar through its paces. RAG has yet again made money for various GKT associated charities, so congratulations to all those involved. Next up, things are set to get pretty steamy as the most beautiful members of our university take to the catwalk for the Fashion show: taking place on the 8th March at the Hoxton Pony. To round

John Hardie on the second Medical Student issue

T off the month, our finest sportsmen and women will take to the field on the 30th March and do battle with King’s College in the Macadam Cup. The history books suggest that the odds are stacked well in our favour, and the bookmakers have stopped taking bets on what will follow in the bar! Till next time, Adieu

Laura Brenner BL President Welcome back! This past month has been host to our annual BLSA elections, and I can proudly announce that my successor George Ryan, is sure to do a grand job at continuing to manage the wealth of new projects that have been started this year. We had a record number of voters this year and all the candidates for both part-time and sabbatical positions campaigned their hearts out. A HUGE congratulations to all who took part and all the best for your year ahead! This month is packed to the brim with talented BL students showcasing their abilities (and their toned and honed physiques) at our RAG Fashion and BLAS Cultural shows! Both of these events are renowned for being super nights out as well as raising ridiculous amounts for charity…we’re not the best RAGgers in London for nothing and these shows demonstrate just how dedicated our students are when it comes to singing/dancing/modelling/stripping

to your tighty whities for a good cause. Tickets for our annual Association Dinner have just gone on sale and are selling out fast already! Each year, the students association host an evening in the Great Hall at St Bartholemew’s Hospital. Surrounded by historical paintings, grand architecture and under the watchful eye of King Henry the VIII, student achievement is rewarded. With prizes for best club and society, sportsman/women and the coveted “Joker of the Year” award to name but a few it really is a great event and one that sells out each year without fail. That’s all for now, enjoy the rest of the paper, see you in the Griffinn...

Luke Turner SGUL President Here at SGUL we have had quite an eventful time since the last issue of the medicalstudent. We have run a successful RAG week against the odds (clashes with TFL and threats of arrest aside) managing to raise £24,000. On the slightly more political side, we have been watching the BMA list servers with interest and the NHS white paper has been discussed with varying levels of outrage and acceptance. The SU also attended an “interesting” talk from Tony Benn on NHS reforms at SOAS of all places!? There are real concerns regarding the future provision for post-graduate education and training within the NHS and the threats of job-cuts across the country, although it remains to be seen whether this is the “scaremongering” the coalition claim it to be. We are also eagerly awaiting the decision regarding

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NHS bursaries and how the cuts will affect these. However you look at it, healthcare students do seem to be facing cuts on two fronts. This is perhaps why so many students seem keen to take part in “Day X” on the 9th March. So what is around the corner for us here in sunny Tooting? Well we have just seen a brilliant play soc production which will be closely followed by a massive band night (Emmet Scanlan and what the good thought headlining), The Footloose Musical and our Tooting dance show

his month the Medical Student comes to you from the MBBS interview waiting room. Being the free spirits we are (well, broke…ahem), we’re forced into the ever dynamic and always-fascinating world of the multi-use office. It felt somewhat inappropriate to be writing about the doomed NHS and radical shakeup of medical education whilst the quaking hopefuls sat the other side of the room awaiting the inquisition down the corridor. Should we have warned them of the quagmire they were walking into, or let them glide on in blissful ignorance? If I look back to when I was in their position, it seemed that most advised me of the former. “Don’t do it!” exclaimed a consultant I shadowed on work experience. Even the interviewer looked on bemused having seen the alternative options on my CV - “Why on earth are you doing medicine!?” BBC Three’s new series “Junior Doctors: Your Life in Their Hands” taps into the public’s fascination with the lives of medics. It follows seven recently qualified junior doctors as they

hit the wards of the Royal Victoria Infirmary and The General, Newcastle. Within minutes of the program going to air, it transpires that medicine isn’t all it’s cracked up to be. Two-parts paperwork, one-part taking bloods, a teaspoon of “I can’t remember the name of any drugs”, bake for a week of on-calls and you have yourself a freshly disillusioned F1. And these are the lucky ones. You can now add a plethora of lifetime debt and extended education to the recipe for most of us. Given all of this, are we just punishing ourselves by doing time as medics because Mummy and Daddy didn’t love us enough (or too much), as a recent “psychological profile of a medical student” lecture suggested? Well, err… no. Medical students know they are working towards something of real human worth. The current media spotlight on the medical profession shows that the public don’t doubt this - people are concerned about what happens to their health service. There’s a point when yet another anti-cuts protest sounds like old, repetitive news, but this should restore

our faith that as students we’re working towards something of importance that Britain doesn’t want to lose. All things considered, perhaps the little setbacks aren’t so bad after all. Anyway, in conclusion, give us our own office without distractions and then you won’t have to deal with such existential twaddle

Find us on Facebook and Twitter medicalstudent newspaper (cont’d from front page) successfully made it past the first line of security, and into the lecture hall planning for a silent protest revealing hidden ‘love from the Big Society NHS’ t-shirts during his talk. It turned out he was not speaking in the lecture hall but at the drinks reception instead, requiring the protesters to pass another line of security. It appeared as though the protest was foiled as the names of the protesters had been blacklisted. But one intrepid protester managed to sneak inside, as Lansley arrived the others stood outside pressing their t-shirts and banners to the window, meanwhile the one inside unbuttoned his shirt to reveal the ‘Big Society NHS’ logo. The Valentine’s day protest showed the vintage style of student protests but on the 17th February, the heavyweights stepped in: ‘The Notorious BMA’. The mention of Tavistock square will draw mixed emotions from many people, especially regarding the tragedy of 7/7. However one emotion echoed around the signature squares of Bloomsbury in the build-up to a debate hosted by the BMA between Simon Burns, Minister of Health, and Diane Abbott, his opposite number, and the BMA Coun-

cil Chairman Hamish Meldrum. Rory Barr, the GKT BMA representative reported that “The crowds outside BMA House were doing their best to make sure that all delegates attending the meeting heard their views. A whole range of people from student nurses to retired doctors were carrying banners calling for the protection of the NHS, while Trade Unionists complained that the coalition was putting profit and the concerns of big business ahead of the health of the nation. Their protest garnered a lot of support from passersby and members of the public, as well as audible support from drivers of buses, white vans, and taxis that slowly rolled by.” At the debate, the air was noticeably calmer although that soon changed when questions were opened up to the floor, with a GP lambasting the highrisk strategy to abolish PCTs and rush in a new structure. The debate itself was highly informative, with all three sides coherently outlining their respective positions. Rory Barr summarised that “First up, Dr Meldrum set the scene with a list of just some of the major concerns the BMA has with the government’s white paper. Diane Abbott then took to the podium, to give

/msnewspaper Labour’s response to the bill. Abbott spoke eloquently about the NHS. She said “the values of the NHS cannot be priced, cannot be susceptible to formal free market values – you cannot run a hospital in the way you run a biscuit factory”. She went on to say that opinion polls show satisfaction with the NHS has never been higher, and though problems remain in some areas, “a £3bn ideological experiment with the NHS is not what we need in this economic climate”. Simon Burns then got the chance to respond. He started off by clearly stating that these reforms would not lead to the breakup of the NHS. Burns went on to say that competition in the health service would not be on price, but on quality – so yes, any willing provider could offer services alongside the NHS, but patient choice would dictate where patients go.” Those six days provide just a snapshot of the incendiary device that is the NHS. The shortest month of the year produced an explosive reaction from medical students across London; a sixday skirmish in February. March will see the arrival of Day X, the ‘Exocet’ protest delivered by that unique bond shared by the London medical schools

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March 2011

News

St Georges take on Imperial in Battle of the Bands

Negin Damali Amiri RUMS Senior President

Katherine Bettany Guest writer Last week St Georges and Imperial College Medical Schools reignited old rivalries in ‘Battle of the Bands’, an event that formed part of ICSM’s annual RAG week. Tuesday night saw the most chilled out night the Reynolds has (probably) ever seen, with medics from St Georges competing against ICSM students in a night of live music that eventually saw St Georges’ alternative rock band ‘Scum’ storm to victory. The attendance was better than expected for a comparatively low key event; however, the lack of St Georges students in attendance did hinder somewhat any healthy inter-school rivalry. ICSM Jazz Band put up a good fight, impressing the audience with a diverse selection of music, from popular covers to big band classics. They looked comfortable on stage – with its members displaying a natural showmanship that visibly relaxed the audience. The band was well rehearsed, showing themselves to be of exemplary standard and exhibiting complete professionalism. ICSM’s other acts were hindered slightly by sound issues. Whilst ICSM Jazz Band and ‘Scum’ had no difficulty, the female vocalists of ICSM’s other bands had difficulty in being heard over their instruments. The vocalists were as a result not given the

The natural showmanship of ICSM Jazz Band, complete with top hat. Image by Katherine Bettany recognition they perhaps deserved as an audience member pointed out, ‘ICSM put up a fairly good show, though it was a shame that the lovely vocals were completely drowned out by the loud music in the background.’ Despite ICSM’s best efforts, ‘Scum’ (St Georges) absolutely stole the show. The band members were not only talented musicians, but also had a great song selection; covering songs by popular mainstream bands such as Oasis and the Arctic Monkeys that appeal to the majority. ICSM had attempted this tactic earlier in the night with a frankly bizarre cover of The Far East Movement’s ‘Like a G6’, without much success. What set ‘Scum’ apart though, was the added facet of audience interaction: the lead singer was charming, and spoke to audience during their set – something the other acts failed to do.

This proved a winning combination – for even Imperial medics (particularly the females – something to do with the attractiveness of the band members no doubt) abandoned their allegiances to ICSM and cheered ‘Scum’ to victory. The relaxed atmosphere was a welcome break for ICSM students, who were surely exhausted after the clandestine escapades of Monday night’s ‘RAG Games’ at the same venue. Of course, the most important thing to remember is that the night was not only designed to entertain, but also to raise money for charity. £200 in ticket sales was collected at the door which will go, along with the rest of the money raised during RAG week, towards St Mary’s Hospital Paediatric Department, a leading children’s healthcare department within the Imperial NHS Trust

The RUMS agenda for the next few months is an exciting one. With the new health and social bill being widely discussed, RUMS aims to begin raising awareness about the bill amongst the medical students through a series of events and talks to be held at the London universities in the next few days (keep your eyes open for further details). Our aim is to make students aware of the bill and its implications for the future of NHS and us as its employees. Our welfare seminars have now been booked and ready to benefit students who may have concerns or queries regarding finances, education, housing, etc (see the RUMS Bulleting for more information). A new curriculum update (timing of

final year exams, the future structure of clinical years, etc) will be given to all students at the RUMS AGM (March 21st), where a panel of medical school staff (including Professor Jane Dacre and Dr Gill) will be present to take questions and comments. At this event we will also be formally thanking Professor Bender for his long-term contributions to the medical school. On the same day we aim to embark on an evening of excitement and partying at the RUMS spring ball. Hope to see you all there

David Smith ICSM President Our biggest event since the last edition was our RAG Week and Dash to Edinburgh. Being kissed by hordes of freshers (one of the RAG invasion tasks) is a great way to start the week, although much more awkward than I could have expected. Our RAG Week was packed full of exciting events, and we have so far raised millions of pounds for our charity. This will only continue to rise with events still to come. The Circle Line Pub Crawl was, as ever, the highlight and coincided with the fourth years finishing their exams, so ICSM was out in London in full force. ICSM attended the Aldwych Group in Edinburgh with the Imperial College Union Deputy President, where medical students were the focus of discussion. The Aldwych Group is the group of Students’ Unions of the members of the Russell Group Universities. We both left feeling that we are extreme-

ly lucky at Imperial to have such a strong Medics Union and strongly believe that our students benefit greatly from having tailored representation. Speaking to reps from outside London, the theme of isolation from their central Students’ Union, coupled with a lack of representation, was a recurring theme. Fortunately we continue to have support from our Central Union as well as the Faculty of Medicine, so our position remains extremely strong. Nominations are now open for our Executive Committee elections and we encourage anyone to run, regardless of experience

Anil Chopra ULU Medgroup Chair

Teenage ‘Scum’ do something right. Image by Katherine Bettany

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Editor-in-chief: John Hardie News editor: Ken Wu Features editor: Neha Pathak Comment editor: Sarah Pape Doctors’ Mess editor: Abe Thomas Sports editor: John Jeffery Treasurer: Alexander Cowan-Sanluis Sub-editors: Martha Martin, Giada Azzopardi, Lucia Bianchi, Kiranjeet Gill, Hayley Stewart, Image editors: Chetan Khatri, Purvi Patel Copy editor: Rahul Ravindran Distributing officer: Sevgi Kozakli

Hello again London Medics. Firstly, I’m really pleased that we are able to bring out another issue of the MedicalStudent which promises to be bigger and better than the last. It’s so important that as London Medics we have a voice and this paper is pivotal. We will soon be rolling out this year’s Medgroup Campaign on mental health and welfare provision in your medical schools with a focus on bullying, harassment and “tackling the taboo”. It is clear that many students who feel as if they are being victimised or treated unfairly do not seek help or report it. Our campaign is two-fold: to encourage institutions and unions to ensure that students are aware of the support provided and also to encourage students to utilise their welfare services at their institutions should they need to. Other issues that will be oc-

cupying Medgroup’s time and brainpower over the coming weeks include the BMA Medical Students conference; educational discussions (such as the effects of changing the structure of our final years to accommodate for the new situational judgment tests due to be launched in 2013); and the Coalition’s Healthcare and Social Bill “Equity and excellence: Liberating the NHS”. I encourage you all to at least have a flick through the document to get to grips with the huge shakeup that his taking place within the NHS; it is likely to affect us more than the current doctors

March 2011

News ICSM RAG: from Edinburgh with love

GKT retro RAG on top of the world

Steve Tran and Vaitehi Nageshwaran recall a dash to The North and some Valentine Ragging

itchhiking, clubbing in new destinations, ‘Fun!’ buses and, more importantly, raising money for children, ‘RAG Dash’ has it all. With over 150 people racing to Edinburgh this year, Dash lived up to its name as the “Best ICSM weekend of the year.” On February 4th, ICSM’s finest descended on London kitted out in scrubs and red (not orange) buckets, collecting money for St Mary’s Paediatrics Department. After raising just over £1000 for charity, hitchhikers lined up along the M1 armed with a variety of colourful and witty signs, such as ‘Drag me to Leeds’. We fear to relive the questionable choice of attire that some of the hitchhikers sported. Despite this many were surprised by the journey’s ease, with many completing the journey in less than six hours. A group of final years decided at the last minute to participate in order to complete their last RAG Dash properly - they even beat most of the freshers up the M1 in record time! Those who were less committed (lazier) took the Megabus up instead; however one group of lazy freshers learned the hard way that if you want to take the easy route, you should remember to book tickets for the right day. Fortunately they were able to hitchhike up and arrive by 10pm. In Leeds, we partied at the infamous Halo, a converted church complete with a DJ altar. In the wee hours of the morning we spilled out of the club into the absolute cold before being hurried onto the coaches for a well-deserved rest. It was an utter triumph that we managed not to leave anyone behind this time. When we awoke four hours later we were greeted by the great city of Edinburgh (and I’m pretty sure I heard bagpipes but maybe that was in my head). We had the day to relax and enjoy all that Edinburgh had to offer. In true tourist fashion (Imperial is 70% Asian after all) we headed straight to the castle and hit some tartan shops! This was followed by a Pub Crawl along the Royal Mile which culminated in The Hive, one of Edinburgh’s top underground tunnel clubs. With four rooms and music to suit every taste, even those who were exhausted from the night before enjoyed the night. On Sunday, the RAG committee dragged everyone out of bed at 10am in order to get our free breakfast just before the coaches left for London. The Fun Bus made the journey back to London with no one lost or left behind (although the President almost was!). Overall, everyone had a great time – a result sweetened by the fact that we weren’t all banned from The North.

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One is a poser; the other is trying to pull. Image by Naoko McCabe On February 15th, love, and possibly hormones, was definitely in the air when ICSM students came out in flocks to attend our annual Valentine’s Ball. This year it was held at the illustrious Carbon Bar, located next to Marble Arch. The Valentine’s Ball (or ValBall), once known as the RAG to Riches Ball, is now in its 5th year, and is one of only four formal balls that ICSM hosts for the entirety of its student movement. An enormous task was given to Megan MacKenzie and myself, two mere second years, to organise a fun, yet safe, (unfortunately we gave out all the rubbers already on DASH) night for the whole medical school. If anyone ever tells you that event planning in London is stress-free, we will put them straight and testify to the contrary. Fortunately, we had a light-bulb moment; an epiphany, if you will, and stumbled upon a bar located in Marble Arch. And so we found ourselves, a month before the event, in a bar opposite the Oxford Street Primark at 3pm. Success! We were able to keep our promise to make ValBall an affordable but amazing night, even offering a glass of bubbly on the door. VIP tickets were offered to 5th and final years - little did we know that the date of the ValBall resided on the very same day that the final years got their job offers, so they were definitely in the mood to celebrate. Contrary to the belief that alcohol complicates matters, I firmly believe that the amount of bubbly we gave out was directly correlated to how smoothly the night went. And of course, one should not forget that the night made over £2500 for St Mary’s Hospital Paediatric Department, rendering the night a complete success on all fronts

Katie Allan GKT RAG Secretary Here at GKT, we bloody love RAG. Our charitable banter started early in the year with pub crawls aplenty, and our festive Jingle RAG pulling in the pounds and spreading some festive cheer. All of this was just the warm up to the launch of GKT RAG Week 2011: the year of Retro RAG. Celebrating all things neon and clashing, we decided to take a trip down memory lane to simpler, less fashionable times. Sporting ‘I <3 RAG’ tshirts in a fine array of bright colours, our courageous freshers took to the streets of London with fire in their hearts and gin in their bellies. Of course, RAG is about so much more than freezing your ‘nads off, avoiding the Metropolitan Police at all costs, and begging strangers to empty their pockets. Proving that RAG can do ‘classy’ just as well, we celebrated the first day of collections with a sophisticated party at the very top of Guy’s Tower (it’s the tallest hospital in the world, don’t you know); with the best views in London and live entertainment from our incredible a capella group, ‘All The King’s Men’. Don’t worry though, we spent the rest of the week lowering the tone considerably (lets just say the bouncers at Sports Café might not be RAG’s best friends any more). The Retro Roller Disco was another success – not a single bone was broken despite some impressive pre-lashing before strapping the skates on. Wednesday saw the biggest and best sports night of the year. With rumours of an appearance from Tit Squad themselves, the queue ran the length of the car park by about 8pm. This year the ever-seductive Tit Squad decided to appear in some particularly raunchy French Maid outfits, leaving very little to the imagination as they writhed across the floor and covered themselves and the baying crowd in whipped cream. They weren’t the only Squad to make an appearance, and throughout the week several males were left with some questionable new haircuts and a distinct lack of dignity. Hair may

Tit-squad out in force. Image by Katie Allan

grow back, but the mental scars will last forever. We even managed to venture outside of SE1 to take a trip on the Mystery Machine. Turning up to our Top Secret Destination (erm…Southampton), we grabbed our buckets and did what RAG does best: cause mischief. Whether stealing toys from children, grabbing vital supplies from the local sex shop, or contravening several public exposure laws (honourable mention to the lacrosse team for shedding the most clothes), we showed Southampton what GKT are made of before hopping back on the banter-bus for a few more Age Old Traditions en route to our spiritual home: the Dover Castle. We still managed to squeeze in one final event; the wonderful black-tie RAG Formal. In an amazing bar in Covent Garden, we enjoyed our drinks and nibbles, and gave ourselves a big, smug paton-the-back for all of our hard work. We also said a few ‘thank-you’s to those who’ve been particularly committed and gave our ‘RAGgiest Fresher’ award to the lovely Theo Willison-Parry. We also raised a lot of money for some very deserving charities. During the week we raised almost £30,000 in bucket collections and are still receiving money from ticket sales and sponsors (including the lovely GKT Medsoc Musical Theatre, and the upcoming KCL Fashion show – tickets on sale now!). By the end of the year we hope to have raised even more for our six charities: Evelina Children’s Hospital, Guy’s and St Thomas’s Neonatal Unit, Medicinema, St Christopher’s Hospice, Alzheimer’s UK and Malaika Kids. We chose each of these charities because they represent causes close to the hearts of our students. Particularly personal this year is Malaika Kids, a charity that supports orphans in Tanzania, which we’re supporting in memory of Muhammed ‘Haris’ Ahmed, a GKT medic (and particularly enthusiastic RAGger) who sadly passed away last year. Retro RAG isn’t over yet. March 5th-6th is our Jailbreak: a wild weekend where teams attempt to get as far from campus as possible without spending a single penny. There are also rumours of other events happening throughout the year, so keep your ears to the ground for more information!

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March 2011

News Research in brief

The NUGSC: just what the doctor ordered for aspiring surgeons Hasan Asif Guest writer The last weekend of February saw UCL host the inaugural National Undergraduate General Surgery Conference. World-renowned speakers, undisputed masters of their domain, imparted knowledge for the benefit of an eager audience. Surgical workshops attempted the task of furnishing students with the technical know-how in cricothyroidotomies, central venous catheterisations and surgical knot-tying in the space of just two days. The event accommodated some three hundred culturally and internationally diverse but universally ambitious delegates from countries as far as Russia and Malaysia. The NUGSC had one sole aim: to provide all delegates with a no-strings-attached, honest and detailed introduction to perhaps the most colourful and exhilarating specialty of them all - surgery. The event was launched elegantly with the legendary Prof. Harold Ellis, former Vice President of RCS and RSM and influential Prof. David Rosin, Hunterian Professor and the pioneer of English laparoscopic surgery both highlighting the history of the art and selected examples of famous operations. RCS council member Mr. Michael Parker and research fellow Dr. Yoav Mintz highlighted the progression from the “barbaric” open cavity approach, reminiscent of the days of old, to the modern minimally invasive surgical approach. Minimally invasive surgery, as a separate entity, is evolving at breakneck speeds, leaving surgeons gasping for breath. Three decades on from the invention of laparoscopic procedures, single incision laparoscopic surgery is suddenly the norm and preferable, by patients and clinicians, to multi-incision

laparoscopic surgery. And now, revolutionary natural orifice transluminal endoscopic surgery allows surgeons to transgastrically or transvaginally remove assortments of internal anatomy. Dr. Mintz further revealed new technology potentially capable of magnetically levitating surgical robots and instruments. Such technology may make it possible to remotely perform an appendicectomy by manipulating a robot using multi-axis magnetic fields and radio waves. The advent of this technology marks the beginning of the end, an end to the days in which surgeons are stereotyped as bloodthirsty scalpel jockeys. The potential advantages of such rapid and breathtaking developments are clear: reduced perioperative complications, reduced recovery times and better cosmetic results. It is, however, a ‘double-edged scalpel’, theatre times will increase, equipment costs will rocket and overhauls of the current surgical training scheme will be necessary. Currently, surgical training is in unequivocal shambles. The European Working Time Directive looms in the background with its debilitating 48 hour week limit (ironic right?). Combined with bottlenecks at every application process, one may as well question sanity of opting for surgery at all. So should surgical trainees wash their hands of the entire process? No, argues Prof. Nigel Standsfield, head of the London postgraduate school of surgery. An overhaul, in postgraduate and undergraduate teaching, is definitely required but for the talented and passionate, surgery will always remain an option. He did not, however, make any excuses for the competition, mercilessly declaring it “necessary to ensure that only the best candidates progress in the field”. There were many more distinguished

ICSM: Significantly lower levels of antibodies are found in uninfected babies born to HIV-positive mothers, when compared to babies born to HIV-negative mothers. These findings may partly explain why HIV-uninfected babies born to HIV-infected mothers are more prone to infections, and are up to four times more likely to die before their first birthday than babies born to HIV-uninfected mothers. Published in the Journal of the American Medical Association. RUMS: Looking at your body reduces the perception of pain. Subjects who looked at their own bodies whilst heat was applied to the skin had a pain threshold 3°C higher than those looking at other objects. Published in Psychological Science. BL: Men with the highest levels of cell cycle progression (CCP) genes are three times more likely to have a fatal form of the cancer than those with the lowest levels. It is hoped that after clinical trials, these findings will be used to predict the severity of prostate cancer, potentially reducing the need for surgery in those with less aggressive forms of the disease. Published in the Lancet Oncology.

Look at my big...scalpel. Image by Hasan Asif members of the discipline who gave some truly inspirational talks about their respective fields and careers. Some of whom include academic surgeon Prof. Irving Taylor, trauma surgeon Lt. Col. Nigel Tai, transplant specialist Sir Roy Calne, Prof. Michael Baum (aka Mr. Breast Cancer), Mrs. Linda de Cossart, neurosurgeon Miss Helen Fernandes, Mr. Jay Vaidya, stem cell researcher Dr Paolo de Coppi and International Journal of Surgery & wikisurgery.org founder Dr. Riaz Agha. Heart-

felt appreciation has been extended to the faculty and committee who ensured the unbridled success of this event. Surgery is around for the foreseeable future but in this modern day and age, the details are more uncertain than ever. One thing is for sure; the NUGSC has successfully exposed the trials and tribulations of this dynamic profession. It would not be an understatement to say that it will undoubtedly play it’s role in deciding the future of 300 surgical hopefuls

St Georges: IgA type monoclonal antibody, when combined with interferon, was found to give protection against TB infection. Published in the Journal of Immunology. GKT: Clinicians at GKT have developed the Elastin-Specific Magnetic Resonance Contrast Agent (ESMA), a painless, noninvasive imaging technique used to track the build up of plaque in arteries. Published in Nature Medicine.

Managing without management Eric Edison Guest writer Management is not a word that excites many people, not least medical students. In the eyes of many medics, the job we train for is too virtuous for us to be worrying about boring things like 'management' and 'finance'. But we can't keep our heads in the sand for much longer. It is vital to realise that a move towards a more clinicianled health service predates the current government. Unfortunately students generally leave medical school woefully naive and poorly equipped to lead health service provision. The role of the NHS is changing. In

the not-too-distant past, patients would put their life in the hands of doctors without question, and the NHS funded whatever treatments the doctors saw fit. When the NHS was set up it was thought that demand for health care would drop as the nation became healthier.

“Of course, when it comes to doctors and managers working together, there is a sense of incongruence” They could not have been more wrong. As NHS costs spiralled with expanding demand, there was an inevitable tension between fair resource

allocation and meeting the demands of individual patients. One consequence has been the infiltration of non-clinician managers into layers of bureaucracy between the Department of Health and the shop floor. Of course, when it comes to doctors and managers working together, there is a sense of incongruence. Managers are accountable to their bosses; their job is to make the numbers add up. Doctors see themselves as accountable to individual patients and, understandably, they want to provide the best treatment regardless of cost. We need to bridge this divide. Universities have been slow to catch up. Most students are idealistic or not aware of the issues, and some actively shun knowledge of the man-

MNG on the board...WTF!!! Image by Chetan Khatri agement and finance of the NHS. Yet the NHS Institute and the GMC both suggest that leadership and management are core competencies required of graduating students. Stepping into the breach are a new wave of societies springing up at universities, with one forming at UCL (UCL Medical Management and Leadership Society) and another recently launched at Imperial (The Medical Management Society). The current system turns many

junior doctors quickly into cynics, unwilling to change systems they know are inefficient. Doctors need to feel empowered to make changes. The NHS2040 is a new group that seeks to empower healthcare professionals who may otherwise feel helpless to make change happen. The NHS of the future will not be led by managers and politicians, but by doctors and patients. Are you ready to lead?

March 2011

News Google Body: the future of anatomy?

So you want to be a...Paediatric Surgeon The medicalstudent brings a flavour of each of the specialities to you every month. This month, Anika Kaura from ICSM interviewed Mr Simon Clarke, a Consultant Paediatric Surgeon at Chelsea and Westminster Hospital.

Ali Hosin Guest writer

AK: How did you get into it? SC: I entered the general surgical pathway, and once I got some experience of Paediatric Surgery, I decided that is what I wanted to do, and went to apply for Paediatric Surgery jobs at ST3 level. I love paediatric surgery because it represents one of the few remaining fields of surgery where the surgeon is trained and practises within many subspecialty areas such as neonatal, urology and thoracic.

Search engine giant Google recently launched an online anatomy browser, aptly named Google Body. It describes itself as “a detailed 3D model of the human body” which allows you to “peel back anatomical layers [...] search for muscles, organs, bones and more”. Best of all, it’s free. It might be just what the (student) doctor ordered. I tried the software myself (after having to download Chrome - Google’s own web browser) and was very impressed. It lets you toggle what ‘layer’ you are viewing (skin, muscle, blood vessels, bone etc.) and if you click something, not only does a bubble pop up with its name, but it almost leaps out at you as everything around it fades away. You can also type the name of any structure into the search bar and it takes you straight there - in true Google fashion. However, it raises an important question: what role do online anatomy portals such as Google’s play in our learning?

AK: What are the true stereotypes of the job? SC: Because paediatric surgery is so niche compared with other types of surgery, there really are no stereotypes! AK: Tell us about the most interesting case you have dealt with? SC: It has to be a case of conjoined twins. An absolutely epic operation to separate them that took 15 hours! AK: What are the on-calls like?

“Along came Google’s Body Browser. At first glance, it appears to be perfect. It costs nothing, it is accessible by anyone with an internet connection” It’s Thursday morning. You walk into the dissecting room, still recovering from last night. You’ve gloved up, put your safety specs and disposable apron on and are raring to go. Yet before you’ve even had the chance to identify the ileum or locate the lumbricals your time in the dissecting room has expired. This is no doubt a familiar scene in medical schools up and down the country. The reality is we are rarely given sufficient time in the dissecting labs to enable us to absorb the relevant anatomy in detail. Therefore we have no choice but to consult alternative resources such as textbooks and the internet. Wikipedia is freely accessible and, dare I say it, a good first port of call. Much of its anatomy content is derived from the original Gray’s Anatomy, having lapsed into the public domain since its writing by Henry Gray (a former student, surgeon and Anatomy Lecturer at St George’s Hospital). However, it can be difficult to navigate and, being Wikipedia, its absolute reliability is questionable. Then, in 2004, Gray’s Anatomy for Students was born. It too uses the original Gray’s as a foundation for its material, with the advantage of being less wordy, more clinically oriented and, ultimately, more student-friendly. It is thus unsurprising that this book has made its way onto reading lists and bookshelves around the world. However, it has not been welcomed ubiquitously (reviewers on Amazon.co.uk highlight various issues including excessive detail and factual errors); and, what’s more, the anatomy luxuries it offers come at a hefty price of £44.99, which some

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SC: You cannot get away from the fact that there are a lot of on-calls, but that is with all types of surgery. AK: What has been the biggest challenge of your career? SC: It was definitely getting the paediatric surgery ST3 job in the first place! AK: What puts people off this job and can you counter this? Anatomy is a pain in the neck. students cannot justify spending, especially if they only need it for their preclinical years. Then along came Google’s Body Browser. At first glance, it appears to be perfect. It costs nothing, it is accessible by anyone with an internet connection, and, being Google, they have made sure that the software is easy to use. I was interested in what the anatomy academics of London thought about Google’s new creation, and whether they feel that it and similar resources will be the way forward. Professor Christopher Dean, Professor of Anatomy at UCL, agreed that online resources do have some value. “All e-anatomy learning adjuncts have their place and are an easy source of encyclopaedic factual knowledge about human anatomy.” However, a criticism was that “almost every structure - either minor or major - in the body is labelled and represented”, which Professor Dean believes “makes it impossible for students to extract core material [...] and without careful guidance can lead to over learning of irrelevant facts and an under-learning of practical, clinical or functional concepts.” Furthermore, I was unable to persuade Professor D. Ceri Davies (President of the Anatomical Society of Great Britain and Ireland, and Professor of Anatomy at Imperial College) about the necessity of online anatomy. He stated: “Such software is an ad-

junct to learning anatomy and can be used as self-directed learning, but it cannot replace textbooks and probably not the best atlases.” Professor Jon Clarke, Head of Anatomy at King’s College London, shared Prof Davies’ sentiments: “I'm a great believer in books myself, which I do not believe can be replaced.” I wouldn’t call Google Body revolutionary by any means – even though it does rather niftily let you rotate the body through 360°. At the moment it merely provides the names of structures without any detail as to their function. What’s more, it is certainly not the first interactive anatomy portal – for example, there is also www.anatomy. tv, which many universities provide their students access to. However, the key advantage of Google’s creation is that it is free to all, and in turn contributes to the notion of democratisation of knowledge (popularised by Wikipedia et al.) which will no doubt expand even further over the coming years. With the impending elevation of tuition fees to up to £9,000 per year, and the ever-increasing emphasis medical schools are placing on ‘e-learning’ , it is possible that students in years to come will rely more on open-access learning tools such as Google’s, and less on costly textbooks and anatomy atlases that have traditionally been the mainstay for students’ learning

SC: It has to be the lifestyle. I have a very understanding partner and dog who always seem happy to see me no matter how much time I spend away (the dog that is!). AK: Final words... SC: If you want to succeed always go beyond the call of duty and show initiative If you have any questions for Mr Clarke, please send them in to news@medical-student.co.uk

medicalstudent

March 2011

News

Diary of an FY1 Junaid Fukuta recounts day one: D-Day

-day, day one, doomsday, call it what you will. The moment we knew would arrive had finally come. All those years of training came to this day and the fear and dread was palpable in the air...and that was mostly from my patients. Yes they all notice the change of the faces from the grizzled, battle-hardened house officers who have left to the baby-faced, terrified, ‘rabbit caught in headlights’ faces that we, the new house officers have. I had even tried to mask my fear by buying a whole new wardrobe of confident shirts with my pretend money, only realising too late that my first pay cheque was still a month away and that new clothes make you look more like a fraud. I had spent the previous week

shadowing my predecessor and was amazed by her efficiency, knowledge and above all her relaxed demeanour. I asked her: “how long before you felt you were not sinking”, expecting her answer to be about six weeks. “Nine months” was her reply. The thought of taking just as long to have a baby as to finally feel comfortable in my new job was not the answer I was looking for and filled me with more dread and foreboding. Now the problem with day one is not that the house officers start on the wards, it is that the holy NHS have decreed, in all their wisdom, that thee (that’s us wee house officers) shall have no senior support (that is registrars and SHOs) on the same day ye (that’s us again) are let loose onto the world (that’s the ward).

It takes just as long to have a baby as to finally feel comfortable in my job

The result is something akin to ripping off a plaster: just get the damage over and done with in one fail swoop. Many of my colleagues were left to their own disastrous devices on the wards on that first day with them staring blankly at each other for advice that would never come. Luckily my consultant, trying to avert this scenario, arrived bright and early and introduced me to the most important person in the entire hospital for the next four months: the ward sister. Now a word to the wise, the ward sister is part manager, part nurse, but, most importantly, part mother. If you do what she says she will feed you tea and cake with a smile; if you piss her off you will have a most miserable existence. Having been warned of this fact I smiled sweetly and listened attentively to all her advice fully realising that she ran the show and I was a two bit, part time player. The ward round then started. When I was at medical school I wanted to be one of those amazing doctors able to multi-task, reel off CRPs and sodium levels like the back of my hand and know all my patients inside out. However, after that ward round they all blurred into the same patient (apart from one demented racist who I took shine too) and I could barely keep up with writing in the notes let alone memorising anything I was writing inside them. Aspirations zero, reality one. After a couple of hours the ward

round was done and the consultant left me, even patting me on the back in what I hoped was a “you-can-bemy-wingman anyday” way rather than a “nice to have met you before you die” way. I had relief etched onto my face until I realised I had 18 patients who are now my responsibility and a whole stack of jobs to carry out.

“I was so nervous my arms felt heavy, I began to slur my speech and words disappeared from my mouth. I thought I was having a stroke” Most of the jobs involve filling out a form or making a phone call, the first one any monkey can do, the second one is a lot trickier than you might think. Now medical school teaches you many things like 500 causes of atrial fibrillation (thank you Dr Orchard) or the clinical features of every endocrine disease, but one thing it does not teach you is how to speak. Many of you are thinking you have done this for 20 odd years, why would you need to be taught how to speak, but when I made my first phone call for some advice from a microbiology consultant, I was so nervous my arms felt heavy, I began to slur my speech and words disappeared from my mouth. I thought I was having a stroke.

The consultant was shocked into silence by how poorly I had presented the patient until in a eureka moment he realised what day it was and then proceeded to give me the helpful advice of “I know it is your first day, but really you should have some idea as to why you are calling me.” Aspirations zero, reality two. The rest of the day seemed to pass quite innocently - all the jobs got done and I did not run into anymore difficulties. I got the blood forms ready for the next day and at 17:30 managed to leave the ward thinking that I had not killed anyone, had not died myself and managed to get some tea and cake (from the ward sister). All in all it really was not that bad. Later I met up with my fellow fledgling doctors and we all recanted our stories. One of my colleagues was the first responder to a cardiac arrest whilst on the ward round. Whilst starting compressions they started to get covered in some indeterminate bodily fluid from the multiple drains sticking out of his hole-ridden body. She watched as the patient did not come back despite all their efforts. To add insult to injury as she changed into scrubs she realised that her purse had been stolen from the locker room. That is when I realised the true nature of the beast that we had entered. There will be good days and bad days ahead, and I was lucky in having a good first day, I just hoped that my luck will hold for a bit longer

The truth behind why you were accepted into medical school Alexander Isted Guest writer Prospective medical students seem to have more and more hoops to jump through every year when applying for medical school. The grades you get at A-level, IB or Scottish Highers, as well as UKCAT and BMAT aptitude tests, are quantitative numerical values that can allow for objective discrimination between candidates’ academic abilities. However the personal statement and teacher’s reference leave far more to be subjectively interpreted, leading to differing admissions standards between medical schools and even between admissions tutors within medical schools. A research paper has been published in the ‘Medical Education’ journal this month, which looks at “Reasons selectors give for accepting and rejecting medical applicants before interview”. The study follows the selectors at a London medical school admissions centre in the 2006-2007 cycle, looking

in particular at how the UCAS form’s parts of the application, such as the personal statement and teacher’s reference, are used as discriminating factors prior to interview. The study follows the selectors and their justification for rejecting 1550 of the 2500 applicants to allow 950 to be interviewed for 277 places. The research was prompted by the questionable “validity and reliability of screening students’ personal statements”, and its results show the ways in which the different elements of the UCAS form are interpreted by the selectors, including the work experience, the personal statement and the teacher’s reference, ultimately attempting to paint a picture of the ‘ideal candidate. The study involved a review of all the components in the selection process and found that “personal statements and teacher references, a significant component of many medical schools’ current selection processes, have a low predictive value for success and contain insufficient detail to be useful selection tools”. The review raised

concerns regarding the true authors, and the truthfulness of personal statements, as it was found that 1% of UCAS forms contain directly copied material from online resources and 5% ‘borrowed’ sections from online examples. Work experience was found to be the most significant selection criteria, being the cause of 65% of the rejections. Two varied forms were generally required to demonstrate that the applicant “understand[s] the realities of a medical career”. There was little consensus regarding the length of time required but it became apparent that the most valuable experience was long term, over several months to show an applicant’s dedication. The teacher’s reference was found to be the cause of 27% of rejections, which was criticised as a differentiating method due to the ambiguity of the comments and the subtlety required to read between the lines, resulting in inconsistent interpretation by selectors. The final cause of rejection, at 8%, was “characteristics of a poor candi-

Image by Chetan Khatri date”, which was determined by the selector through analysis of the personal statement. This determination has no standardised guide, but is simply based on the single selector’s decision. The ‘ideal candidate’ profile was formed by the findings of the research, with a consensus between selectors that it is a candidate “having undertaken and reflected upon an appropriate amount and type of medically-related work experience, having a supportive teacher reference, possessing positive attributes detailed in the candidate’s personal statement, and demonstrating commitment.” There were no great surprises in the discovery what the selectors were

looking for, but what was highlighted was the subjective nature of the UCAS form, and how this leads it to be an unreliable method of finding the candidates who will become the best doctors. The conclusion of the study was that in an age of applicants all having the highest academic results, more distinguishing factors must be used to be able to positively and negatively discriminate candidates reliably. The personal statement and teachers’ reference are by no means an ideal method due to their subjectivity and poor representation of the applicant’s true quality, and “it is imperative that additional appropriate selection tools are developed”

March 2011

Features

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Features Editor: Neha Pathak features@medical-student.co.uk

“This is putting the fat person in charge of the sweetie shop” Is this the end of the NHS? Rashmi D’Souza and Sana Ajmi speak to the BMA’s Dr Kevin O’Kane

Image by Alexander Isted

r Kevin O’Kane, Chair of the BMA’s London Regional Council is sitting on a swivel-chair in the nurses’ station on a busy acute medical ward. He has agreed to talk to us between reviewing x-rays, hoping to inspire the London student population to get their placards out against Lansley’s reforms. Dr O’Kane has been lobbying MPs since the Bill’s inception to have it rejected. He adamantly states that “they [the reforms] are the most disastrous thing that could happen to the NHS”. There is a frenzy beginning to grow among the public. Outside the BMA Annual Representatives Meeting (ARM) on the 17th of February, there was a crowd of protestors, complete with loudspeakers and banners, fiercely committed to defending their most prized asset of post-WW2 Britain – the NHS. Their greatest fear is that the reforms will lead us down the American way, the darker side of the Pond. When asked about the potential privatisation of the NHS, Dr O’Kane has much to say. “It’s going to break up the NHS into little bite-sized, private chunks. All trusts in the country, all hospitals in the country have to become Foundation Trusts.” “In other words, they have to become independent private businesses. When they fail, one of the options, and the one the government would like, is that they will be taken over by the private sector. What this is about is frank privatisation. This is a way of bringing in a private, American-style healthcare system by the backdoor.” But what about the increased patient choice the reforms propose? Giving decision-making power to GPs can only improve the system. After all, it is the GP who knows the patient best. Dr O’Kane shakes his head astutely - is there an air of conspiracy? “It’s a total fallacy. So-called GP commissioning is not giving control to the GPs. Patients have a nice, fluffy idea that maybe their GP

will be able to choose which hospital to send them to, and it’ll be the GP seeing the patient in charge.” “But it will not be that way. You will have consortia looking after half a million patients. The chances that your GP is on that consortium will be absolutely minimal.” If it is not your local GP, the family doctor who knows you from cradle-to-grave, who will be pulling the purse-strings, who will it be? Dr O’Kane is convinced about the imminence of privatisation despite continual claims made by the current government that the changes are to save the public service. “The commissioning boards will have people from private health care organisations on them, they will enlist GPs on them, and there is no requirement for the GP to be in charge of the board. On an annual basis, the commissioning boards will be reviewed according to financial rather than clinical criteria. The idea that GPs are in charge is a fig-leaf for privatisation - the whole thing is a Trojan horse.” So essentially, Lansley’s gift looks like a GP, but is actually an accountant? “Thisis putting the fat person in

“This is a way of bringing in a private, American-style healthcare system by the backdoor” charge of the sweetieshop”. Interesting… In line with national campaigns to reduce obesity-related illnesses and their strains on the NHS, there are murmurs that we should try to keep this “fat person” out of the “sweetie shop”. What, we ask, is being done to stop this Bill progressing further? “Some of us have been lobbying since last summer for the BMA to come out in rejection of the bill.” “The BMA Council announced that we would now have a Special Represent-

atives Meeting (SRM) and that’s taking place next month, on the 15th of March in London. An SRM is when you call all the elected representatives around the country because there’s a crisis issue and it has to be debated. I’m hoping that at that meeting, we will be able to go from a policy of ‘critical engagement’, to outright opposition of the bill.” But why, if the reforms promise such abominable destruction of the NHS, has the BMA not rejected the Bill entirely? Apparently there is almost unanimous support from all doctors to do so. He hesitates - a pause so pregnant it seems well into its third trimester. We edge closer - he seems to be on the brink of divulging controversial information from the inside of the BMA. “Um… You would need to ask the top end of the council why they decided not to do that.” Underwhelmed by the explanation of this controversy, we asked his personal opinion. He replies, “I think that people were unduly optimistic about the White Paper. [We need to] re-assess critical engagement and we will go to opposition. The alternative is that they’ll keep steering towards the iceberg”. Presumably, the ice-berg here is a metaphor for the destruction of the NHS. There has been much discussion about Hamish Meldrum, Chair of the BMA’s alleged co-operation with MPs and the fact that he has not done enough to represent grass roots doctors’ opposition to the Bill. If the SRM were to decide on outright rejection of the Bill, apparently the only possible outcome would be for Dr Meldrum to resign. Dr O’Kane’s response to this was markedly brief - “I’m not aware that’s the only possible outcome”. He did not seem inclined to elaborate, which in itself was unlike him, but we continued to press the point until he proceeded with another rather brilliant extended metaphor saying, “It’s all about policies rather than personalities. If the Captain of the Titanic is steering towards an iceberg, would you rath-

medicalstudent

March 2011

Features

NHS reforms for dummies Rita Issa & Timesh Pillay Guest Writers

Major cuts in public services are sweeping the nation in an attempt to make efficiency gains. This is most evident in the NHS, whose budget has been ‘ringfenced’, that is protected, but will not keep up with ever-growing demand. To achieve greater cost efficiency Andrew Lansley, the Secretary of State for Health, has proposed the ‘Health and Social Care Bill’. Despite the apparently drastic reformation that will follow, the Bill is poorly understood by healthcare workers and medical students. So what does the bill propose? And why should we care? The Bill’s main stated aims are to improve the quality of healthcare provided by the NHS. There are many complexities to the bill, but there are two main restructurings that everyone must be aware of. Firstly, let us consider GP Consortia. With an estimated 60% of medical students likely to become GPs, their changing role is perhaps the most important part of the Bill for students to be aware of. Currently, Primary Care Trusts, or PCTs, control the budgets for GPs and other community services. By April 2013, however, the 152 PCTs will be replaced by GP-led commissioning consortia. These consortia will control 80% of NHS budget and supporters of the Bill claim that GP involve-

ment in financial decision-making will lead to services better suited to patients’ needs. This will cost £1.4-3bn. However, over 50% of GPs admit to not wanting the extra workload and responsibility and some believe that patients might perceive a conflict of interests between the GP’s own salary and paying for their healthcare. Because of this, some PCT staff have already started organising themselves into private groups to whom GPs can commission this management responsibility instead. This essentially negates the efficiency gains that restructuring the NHS is expected to provide, as well as increasing the role of private groups in a previously public service. The second important structural change is the apparent privatisation plans for the NHS as a whole. Health services will now be purchased from ‘any willing provider’ which results in a competitive market open to private health providers and controversially, private health providers can use EU law to argue against the protection of NHS hospital provision. On the one hand, there is ample evidence to show that competitive markets can be economically efficient but it is unclear whether this will facilitate higher quality care. There is concern that private companies may place greater importance on profits rather than patients - contracts may provide cheaper care at the cost of quality and longevity of services. Furthermore, private hospitals may

end up specialising in specific areas that are cheap and easy to provide such as hernia operations, leaving public hospitals to provide more expensive but vital services with less economic return (end of life care and emergency services).

er he steered on that way or changed course? Would you rather he stood back from the wheel and said ‘can anybody else do this for me?’ Hamish is a very accomplished medical politician”. Dr O’Kane also commented on the effects of general cuts. “860 job losses announced at Barts and the London two months ago, 500 job losses with 50 million pounds worth of cuts and three more closures announced at the Royal London last Thursday”. “Last Thursday also saw the announcement of 460 job losses, 46 million pounds worth of cuts at Kingston Hospital in the next twelve months. Those cuts apparently included 22 consultants, 240 nurses and midwives and other nursing staff, 55 technical and scientific and therapeutic staff and 145 non-clinical staff. Doctors are going to lose jobs here, and in the longer-term there will be fewer places for medical students”. Personally, I think it’s impressive he managed to get through all those figures without taking a breath. On the subject of medical students his thoughts were alarming and rather unusual in the context of his anti-privatisation attitude. “FY1s are officially

doctors for training, not service provision. How does it benefit a private business to have them employed? If I was a chief executive, I wouldn’t want to employ them. I might as well get doctors of a middle-grade who are maybe driving taxis, or working in a sweetie shop because they can’t get a proper training course”. The sweetie shop seems to be a recurring nightmare. His manic spirit almost had us convinced. So what, we asked, do you suggest we do about it? “I’d like you all to lobby your MP. If we get every medical student in London lobbying their MP and asking to see their MP, it will cause utter mayhem”. Whether the BMA should be advocating causing “utter mayhem” is highly questionable. Dr O’Kane convincingly argues that these reforms may not be the answer to both the inherent problems within the NHS and the public debt. And we certainly agree with him that medical students have got to start pricking their ears up and evaluating the future of our healthcare system. NHS. After all, it is our future too. However, there is a fine line between lobbying for a solution and lobbying for

the sake of lobbying. On that rather pensive note, we left Dr O’Kane to busy himself with Xrays and he left us with images of students lobbying sweetie shops owned by fat people who drive taxis

“The proposed reforms may cut costs at the expense of quality care” If private services do take, say, all the hernia operations, and, as the current Bill stands, have no obligation to train future consultants, it will be harder for those training to reach minimum competency for consultancy level. EU Law restrictions on working hours are already making this difficult. So are these changes the answer for the NHS? Opponents of the NHS often complain of its bureaucracy and the Bill claims to cut this. Indeed, the staff cuts are estimated to save around £5 billion. There is undoubtedly a need to tackle the public debt and address the many concerns with current health services regarding both the lack of doctor involvement in decision-making in the NHS, and the sustainability of the system with an ageing population. However, the proposed reforms may cut costs at the expense of quality care. The health system was in fact created under the worst public

debt in the UK’s history and promised to provide ‘comprehensive care at point of delivery’ – in times of economic instability perhaps increased welfare investment is preferable. The Bill is still in the committee stages of parliament, and amendments can still be made. There is growing resistance with the Royal College of GPs and Royal College of Nurses openly opposing the reforms. The BMA will vote to do the same at their national meeting on March 15th and ‘Save the NHS Now’ will be actively demonstrating against the bill on the 9th of March and the 26th of March. In the words of the BMA, “What do you call a government that embarks on the biggest upheaval of the NHS in its 63 year history, at breakneck speed, while simultaneously trying to make unprecedented financial savings? The politically correct answer has got to be: mad”

Illustration by Gemma Goodyear

March 2011

Features

medicalstudent

“I can’t do this all on my own. No, I know I’m no superman...”

Sometimes medical school is just too much. Image by Rhys Mansel

Tharini Mahesan Guest Writer

It’s Friday evening and you have just arrived home from a trying week on the geriatrics ward. Shoes off, you fall onto the sofa ready to watch whatever E4 has to offer. Your tired mind wanders and you drift off into a bizarre parallel universe, where you and your fellow students have been cast in the brand new UK series: ‘Scrubs: the prequel’. You are JD - a fourth year medical student struggling to cope with the emotional burdens of being a doctor. Your clinical partner is Turk - overly competitive future surgeon - and two others play Elliot – obsessive overachievers, intent on making you appear as stupid as possible. Then there is your consultant – Dr. Cox, whose bullying humour is unfailingly at your expense. You feel perpetually tortured and can hear them laughing at you struggling. Suddenly you jolt awake and realise

that it was just a dream. But, how easily it could be reality. Unfortunately, for many students, this reality already exists. Of 438 medical students surveyed at KCL by Medgroup, 18% experienced bullying or harassment, of which only 18% reported it to the medical school. Worse, 25% discussed it with no one at all, despite 68% saying that it occurred more than once. And hearsay suggests that these figures are not exclusive to KCL. The underlying problem? Students fear seeking help, perhaps believing it inappropriate for a future health professional. One in four medical students are thought to suffer from a form of emotional disturbance. Why is this so high? Starting medical school is a shock. Students suddenly feel decidedly average, exacerbated by the competitive spirit medics are notorious for. Of students who reported feeling bullied or harassed, 48% of the perpetrators were fellow students. With a shortage of foundation jobs, the pressure to compete is understand-

able, but where do we draw the line? Medical students are not the only problem. 54% of students reported feeling bullied by a consultant, 17% by a junior doctor and 23% by a nurse. Perhaps this is a ‘tough love’ approach to teaching but combined with an overloaded course as well as the Type A personalities that medical school attracts, this may not be a productive teaching style.

“It is about removing the stigma of seeking help” For many, clinical medicine is their first exposure to illness and death. Seeing a person dying, explaining a death to a relative or a mother being told her child has autism can be a harrowing experience. Discussing experiences with other professionals can ease the burden. But the hostile environment indicated by the survey suggests support is not always available.

Also, social problems common to all students are often exaggerated in medical schools. BMA surveys claim over 96% of medical students have significant debt and many students feel they have little time for jobs, relationships and hobbies. GMC’s Tomorrow’s Doctors states, “[competent] students will be encouraged to look after their own health… they will feel confident in seeking advice, support and treatment in a confidential and supportive environment”. Currently, students with asthma, diabetes, dyslexia, hearing impairments and epilepsy (to name but a few) receive significant support from medical schools - mental health and social welfare should be no different. According to the survey 81% admitted to being unaware of bullying and harassment policies and anecdotal evidence suggests students are equally unaware of access to student support facilities. All London medical schools have facilities for academic, financial, pastoral, housing and legal advice as well

as excellent tutor systems and counselling services- and it’s clear that these are under-used (see ‘Who to Contact’). To combat this, Medgroup have launched the welfare campaign: ‘What’s on YOUR Mind’. The team will be creating ‘Who’s here to help?’ guides which will be available as posters and downloadable PDFs as well as circulating stress busting tips issued and another mental health survey this year. The teams have already been lobbying the medical schools to respond to the recent surveys. Early successes include the medical schools reviewing policies to ensure that identities will be protected following concerns regarding anonymity of complaints. Finally, each student can play an integral role themselves. Friends are best placed to notice the changes in mood and behaviour. Obviously, the first step is to talk, but Medgroup say “don’t be afraid to seek help on their behalf”. The welfare campaign is not only about reporting bullying or harassment. It is about removing the stigma of seeking help

medicalstudent

March 2011

WHO TO CONTACT UCL

Medical Student Advisor / Personal Tutor / RUMS Welfare Reps / RUMS Senior President / RUMS Medical and Postgraduate officer / UCLU Welfare officer w.officer@ucl.ac.uk / Walk in clinics phase 1: daily at the Rockefeller building / Walk in clinics phase 2 & 3: at all three sites / Pre-book at studentwelfare@medsch.ucl.ac.uk / Rights and Advice Centre 020 7679 2507 or 2533 or uclu-rights. advice@ucl.ac.uk /

Imperial

Personal tutor / Senior Welfare Tutor Years 1 & 2: m.emerson@ imperial.ac.uk / Senior Welfare Tutor Year 4 & Graduate Entry: t.tetley@imperial.ac.uk / Senior Welfare Tutor Years 3, 5 & 6: m.schachter@imperial.ac.uk / ICSMSU: medic.welfare@imperial. ac.uk / ICSMSU: medic.president@imperial.ac.uk / counselling@imperial.ac.uk / www. help.icsmsu.com /

KCLMS

Phase 1 & 2: Personal tutor / Phase 3-5: Clinical advisor / Counselling: www.kcl.ac.uk / Counselling Advice: advice@kcl. ac.uk or 020 7848 6858 / Drop in clinics: 11.30am-1.30pm at the three main campuses (Room G.05 HR building, Guys Campus: Tues & Thurs) / thecompass@kcl.ac.uk or Tel: 020 7848 7070 / KCLSU: advice@kclsu.org /

Features

To PhD or not to PhD? That is the question Zoya Arain Guest Writer

The MB PhD course offered by a handful of universities is targeted at medical students with an interest and aptitude in research, to develop basic science skills from a BSc to a PhD. Sir John Tooke, Head of the UCL medical school recommends this as “an ideal way to prepare for a clinical academic career”. But is this really true? The programme usually involves three years of research after completion of an intercalated BSc with minimum upper second class honours degree plus successful completion of two preclinical years of the MBBS course. The student then continues clinical training and will graduate with an MBBS and PhD nine years after matriculation. Tuition fees are not required for the additional three years of study; however students must apply for funds in collab-

oration with the supervisor of their project. The prospect of investing a further three years of study, in addition to an already lengthy six years, is formidable. To understand the rationale behind the MB PhD programme, it is important to consider the wider context of ‘academic medicine’. The NHS has seen considerable structural change in the past few decades, but one reason for its longevity is the contribution made to it by academic clinicians. Important discoveries such as the link between smoking and cancer, anti-hypertensives and the aetiology of stomach ulcers can be attributed to this group of medical professionals. However, from 2001 to 2004, the number of academic clinicians dropped from 4000 to 3000 and clinical lecturers dropped by 30%. Conversely, the number of medical students rose dramatically. The Walport Report, published in 2004, addressed the many reasons for the reluctance of students to pursue a career in academic medicine. These

Barts

QM advice and counselling service: 020 78828717 or www.welfare.qmul.ac.uk / BLSA: welfareofficer@bartslondon.com / BLSA: president@bartslondon.com / Academic: annie.mitchell@qmsu. org or 020 7882 8042 / Dean for students: Prof. Mike Roberts: c.m.roberts@qmul.ac.uk /

delaying a PhD until speciality training – the subject of interest is more relevant to the clinical practice and speciality of the medical trainee, than

“Ultimately, a PhD is a prerequisite for any senior academic role” one which is pursued during medical school, where a student may be less decided upon their future field. UCL have recently announced plans to introduce an eight year runthrough course for the MB PhD programme. This means that applicants commit to a PhD upon entry to medical school. Whether a seventeen year old is able to make such a decision is controversial. Further, the nine year course, to which students do not commit until their intercalated year, is already notoriously difficult. Students often find that they are writing up their thesis during their final clinical years, arguably the most important before the challenging foundation years. On balance, there appears to be substantial merit in pursuing an MB PhD if one is almost certain of a career in academic medicine and Sir John Tooke, head of the UCL medical school recommends this as “an ideal way to prepare for a clinical academic career”. However for those who aren’t, the current system provides opportunities to tread the academic path at a later stage. The MB PhD is not the be all and end all

Chris McKinnon - MB PhD Student, UCL: Thinking about doing a PhD?

St Georges

“I caught the research bug during my intercalated BSc project and knew that it was something I wanted to integrate into my career as a doctor. Studying for a PhD at this early stage allows you to establish yourself as both a clinician and a scientist.

Personal Tutor / Year representatives / Spiritual support / Vice President (Education and Welfare): vpeducation@su.sgul. ac.uk or 0208 725 0451 / Counselling Service: counselling@ sgul.ac.uk or 0208 725 3628 / Student learning and Support: jmyers@sgul.ac.uk / Finance Support: jobrien@sgul.ac.uk or 0208 725 0962 /

After spending six months on the wards, I was apprehensive about leaving it all to start work in the lab. Having completed the first year of my PhD, I know it was the right decision for me. The research is definitely challenging but I enjoy working in the lab. My biggest concern was that I would be sacrificing a career as a clinician to become an academic. In reality, the programme prepares you to be a doctor who can influence clinical practice by identifying current limitations in disease management and carrying out research into the alternatives.

Non university affiliated

listening@nightline.org.uk or 020 7631 0101 6pm-8am / www. samaritans.org.uk or 08457 909090 /www.nationaldebtline. co.uk or 08088 084 000 / Doctors Support Network: 0870 395 3010 / BMA doctors 4 doctors: 08459 200169 /

included the lack of transparent career structure and clear route of entry, lack of flexibility and geographical motility as well as the shortage of structured posts. The UK Clinical Research Collaboration and Academic Careers Sub-committee of Modernising Medical Careers, recommended the implementation of a new and more structured career pathway which identifies numerous roots through which a student can enter academic medicine. The MB PhD is one of the earliest, and could lead on to an academic foundation post, integrating clinical teaching with research. Alternatively for those preferring not to do a PhD, the academic foundation programme offers four months dedicated to research. Another entry point is during speciality training, where it is possible to apply for an academic clinical fellowship post - 25% of the time spent in this post is spent on a research proposal for a PhD. Ultimately, a PhD is a prerequisite for any senior academic role such as a clinical lecturer. The recommendation and subsequent implementations of the Walport Report were designed to enable numerous entry points to academia for applicants who realised their interest later on during their careers. However, competition for such training posts is fierce with around 9.5 applicants per place for academic clinical fellowship jobs. This may result in a bias towards applicants who have realised their research interests early – a PhD upon application may then be an advantage. Nonetheless, there are advantages to

Image by Alexander Isted (based on the Walport Report)

Advice? To commit to three years of research, you need to have a good idea of what it’s going to be like. Scientific investigation can be exciting and high impact, but there is an almost equal amount of frustration when weeks go by without getting any experiments to work. Intercalated BSc projects and summer research placements give a great insight into life as a researcher. If you think it could be for you, go along to an MB PhD Open Day and start contacting labs to see what projects are on offer.”

March 2011

Comment

medicalstudent

Comment Editor: Sarah Pape comment@medical-student.co.uk

Are medical students spoon-fed and sheltered? Yes

Hannah Bowles

othing really prepares you for life on the wards: the responsibility, the bodily fluids, the chaos. Our time in medical school is supposed to give us the tools with which to tackle such situations, after all this is a stepping- stone into the real world where our decisions can ultimately spell life or death. However, are the schools’ aims to ensure we get relevant experience preventing students from developing into mature and independent doctors? Isn’t the desire for figures and paperwork in fact detrimental to our individual growth? It would seem that medical students are increasingly being spoon-fed; we jump through hoops and sign bits of paper just because we have to, not because we want to. Surely this will breed junior doctors with little commonsense, and no confidence in their independent decision making capabilities? From our first day there is an emphasis on “independent learning”, which would be drastically different from the structured teaching we had been exposed to at school. Yet our timetables were set out in detail so we always knew where we had to be and when. Lectures were accompanied with notes and detailed learning objectives so we could make sure we covered everything necessary for the exams. There was even guidance on which aspects of the course could be missed out.

“This will breed junior doctors with little common-sense, and no confidence” Similarly, when moving into third year we were informed of the importance of individual study now that we were away from the main campus and the safety of lecture notes. Yet placements were accompanied again by long lists of objectives, compulsory sign offs, and even attendance sheets. Aside from the fact this makes the course overtly structured, the strict guidelines can detract from the experiences you gain on a placement if they don‘t correspond with what you have been told you should be learning about. While the schools will say you must have as diverse an experience as possible during each attachment, it makes it difficult to get involved in extra activities when you are worrying about the mandatory sign-offs you still have left to complete.

Hannah and Rashmi go head-to-head There is also have a great emphasis on form filling that has to be completed for each placement, proving that you can examine someone, cannulate and turn up on time. This culture of box-ticking means the desire to practice skills to be good at them is replaced with the fear that “I’m going to get in trouble with the medical school if I haven’t done it.” Trust does seem to be an issue in medical school; there is a feeling that the university is watching your every move. Not that I’m saying medical students don’t need to be on placements, but sometimes if there are five of you competing for one clinic or surgery, it would make more sense for someone to sit out and use their time for independent study instead, whether that’s inside or outside the hospital walls. However the fear of losing a signature can force students to waste endless amounts of time waiting. Exams are also changing, the majority are now multiple choice - which can be great with a little bit of knowledge and some guess work - but real life isn’t like that. When I get on the wards and a consultant asks me how I would manage a patient they don’t give me a list of options to choose from. While I’d definitely appreciate a Who Wants to be a Millionaire style ward round, this won’t prepare me for making independent decisions when I qualify. At some point a university has to sit back and allow students to develop themselves, and take the initiative to turn up to the wards every day. It has been recently reported in the media that staff shortages are making it commonplace for the most junior of doctors to be left in charge of almost entire hospitals with little or no supervision. With huge jumps such as these it appears that medical schools need to step up their level of responsibilities for students to prepare them for entry into the real world of medicine. This doesn’t necessarily mean offering more counselling and support, but may in fact mean taking away a lot of the monitoring and guidance that is currently offered. Finals are designed to keep incompetent people out of the medical profession, this means there should be more scope for different styles of learning beforehand. A list of learning objectives and multiple choice questions only get you so far; it’s the ability to handle complex situations independently and ask for help when needed that will make a good doctor, and that’s where I think the emphasis of medical school teaching should lie

person who is spoon-fed is someone to be pitied; someone you should speak slowly to; who needs patting on the back and gentle coaxing. It is an insult to your ego to be spoon-fed. You must do everything alone, struggling through life with no help. God forbid you get lost and ask for directions. The exception is a medical student. A nine-to-five day, placements, workshops, dissection, practicals, histology, patient-simulation, SSCs… my fingers grow weary with the typing so I’ll stop, but you get the idea. It would be impossible to fit all of this into a 32week year without a strict timetable. Fine, but why do they need to register the sessions? I hear sceptics cry. Probably because, while some think they can learn the entirety of Gray’s Anatomy (for Students) sitting in a messy room with leftover Dominoes – sorry for the stereotype, that isn’t all there is to being a doctor - there are some skills you just can’t learn on your own. It is also completely understandable why medical students are given less artistic licence in their education, with clear learning objectives and notes. We cannot be given the choice about which organ system they want to study, sadly knowledge of all of them is equally necessary. There has to be a base-line standard for doctors so there has to be a set curriculum and (though it pains me to admit

it) regular testing and assessments. Aside from the issues regarding an overly structured course, the fact that students recieve constant offers to participate in counselling sessions often has people scoffing. Yet this is somewhat of a myth. Every single one of my medical school interviews involved a discussion around how I ‘deal with stress’. I of course gave the undoubtedly average answer of I play X sport and/or X instrument to let out my X negative feelings-the answer it seems vital to give if you want a place on the course.

“I doubt we would have signed up for six years of ‘sheltering’ had we not had personal drive” Why then should we feel we can induldge in those vaguely patronising offers of confidential oneon-one sessions? There is actually pressure to give the impression of being able to cope without mothering, rather than the common stereotype of mothered medical students. Yet according to the BMJ, estimated prevalence of emotional disturbance in students is around 31%, and from cynical television shows we’re all well aware that doctors are more likely to become alcoholics, depressed, divorced, or sui-

Rashmi D’souza

cidal. So perhaps a bit of guidance on how to manage your sleeping patterns would actually be a preferable alternative to more extreme methods of dealing with pressure. Doctors and medical students appear to require more support due to the nature of their job, but we are critisized for demanding or accepting it. Finally, what are we supposedly being ‘sheltered’ from? It might be the skill of whiling away stifling hours in a library? Or perhaps it is the inability to keep ourselves occupied. Or even the drive to do something because we want to and not because there will be a tutor there. However, I doubt we would have signed up for six years of ‘sheltering’ had we not had personal drive to get through the many hoops that you have to jump through. The application process to medical school is hardly simple, and yearly exams aren’t completed by virtue of adhering to your timetable alone. It is hardwork and personal motivation that helps medical students, not hugs from the chaplin. In case you haven’t gathered by now, I have strong objections to the allegation that we are being spoon-fed. While it may look over-indulging, the situation needs to be considered in context. We medics might be provided with a lot of ‘help’ or ‘information’, but it is not so much so that we do not think for ourselves. It is merely the minimum input necessary so that we can make outselves into worthwhile doctors

medicalstudent

March 2011

Comment

Juggling babies and medical school

How to mend a broken heart

Maria Anjani Knobel Guest Writer

A new Brian Cox of the medical world has entered the limelight, in the form of Dr Kevin Fong who explores the groundbreaking world of heart transplant surgery in the recent BBC Horizon episode. A show I found interesting and varied, even through the jaded eyes of a medical student. The programme revolves around the issue of how a lack of donor hearts has led to different cardiac treatment options being explored. Dr Fong investigates the life of a patient after a heart transplant, and looks into development of artificial hearts, meeting a man who quite literally wears his heart on his sleeve with a mechanical heart in a backpack. There are also observations of the remarkable technologies increasingly used to create computerised, “personalised models of your heart, capable of being tested on without harming you”, which are helping doctors to provide individual treatment plans for patients. This could pave the way for a removal of generalised medical protocols and towards individually tailored medicine. In addition the shortfalls of artificial hearts have paved the way for amazing research into stem cell therapies and ‘grow your own’ hearts, taking Dr Fong’s journey to the US where researchers are stripping pig hearts cells to leave a “ghost-heart” which is then repopulated with the patient’s stem cells to form functioning, vascularised, innervated hearts. They have al-

Alex Isted reviews the Horion programme

t’s not that I’m broody - or dying for or worse, Hull, and then all over again an episiotomy - but studying med- for F2. So if I decided I didn’t want a icine as a second degree will make baby until I was settled with a job, and me 26 when I qualify, leaving me hypothetically decide to become a GP wondering when babies are supposed to - the quickest destination - I would feature in a woman’s medical career. A be 31 years old, leaving me with a few quick hypothetical fast-forwarding ex- years before the scary graph spike. ercise of my planned career steps apOk, so maybe not within foundation pears unaccommodating of babies. Yet years, but things improve during residenthere are female doctors with babies! cy right? I came across a journal article How? And more importantly when? that made pregnancy sound like some In fact, most female physicians do sort of disease on the rise: “Pregnancy end up being mothers with two chil- during residency training is common dren on average. It turns out they tend and becoming more common.” Oh no. to defer pregnancy, and are usually 7 Its ‘Main Findings’ include that years older than the general popula- pregnant residents should expect tion at the birth of their first child. We “long hours, unpredictable work deof all people understand the biologi- mands, guilt from absences at work, cal disadvantage of having children stress from high expectations of late: decreasing fertility, increased in- themselves, difficulties finding adfant mortality, risk of congenital ab- equate child care, and less support normalities, obstetrical complications, upon return to work”. Encouraging. and so on. We have all seen the textNot that it’s a perfectly realistic porbook graph of Down’s syndrome inci- trayal, but take Grey’s Anatomy for indence shooting up somewhere in the stance. The only character with a child mother’s thirties - 37 to be precise. If is Dr. Bailey, which she complains she I were more melodramatic I’d say I’m has no time to see, whilst Meredith doomed to either do my OSCEs with a and Derek - who are both getting oldbaby on my arm, or raise a triplet with er - have been trying unsuccessfully Down’s when I’m eventually settled. for a baby throughout the latest season. A quick Google search reveals that By 2015, women will make up about there are indeed medical students who 40% of the physician work force, and I choose to start a family whilst still at have a feeling a lot of us are going to university. Some even begin medical postpone starting families until we school pregnant. Online forums are feel we are in a more stable stage of peppered with threads by pregnant our medical careers. Work-life balance students, surprisingly many in their will also most likely affect which cafirst year, exchanging advice on how reer path we choose, especially when to handle medical school. Some tell of it comes to certain specialties that are giving birth just weeks before final ex- perceived most incompatible. I started ams, or doing OSCEs at 39 weeks into medical school very keen on eventupregnancy, but overall the atmosphere ally specialising in neurology, but it’ll on these threads is glowing and encour- be interesting to see whether intellecaging, making pregnancies, exams, tual interest or lifestyle triumphs in OSCEs, breast-feeding, PBLs, and uni- my decision. Maybe I’ll just adopt versity in general sound like perfectly Let’s hope the baby compatible events. doesn’t drop its dummy Whilst I’m happy for the superwomen out there who are indeed raising babies while studying to be doctors, what about the rest of us who have no intention of getting pregnant at medical school? In the years after life is even more uncertain. For our foundation-year-ofhell we could get shipped off to the middle of nowhere,

Dr Fong warms our hearts. Image courtesty of BBC/Cat Gale

“A man who literally wears his heart on his sleeve”

ready managed to form a beating mouse heart . Overall the documentary presents a broad picture of the future for cardiac treatments. whilst still being varied and visually impressive. Kevin is a passionate, young face for medical science, discussing issues in ways that can be appreciated by the average viewer as well as medics. It introduces new exciting therapies, but also highlights a more basic problem: the growing complications of heart disease. Thus it was both highly inspiring yet suitably humble

iPhone therefore I am Rhys Davies explores the advanatages of technology I recently joined the twenty-first century and got a new phone. It has a whole array of shiny doodads and gizmos. It has a camera with the resolution to individually identify the hairs in Karl Marx’s beard from across a crowded dinner party. Its GPS is so precise it even knows when I’m standing on one leg in the middle of the Sahara desert - though sadly, not when I’m in Fulham. On top of this, it has a veritable host of apps, each more pointless than the last. I can even phone people with it. It seems that the world of medicine is also becoming aware of the usefulness of such gadgets. There are applications for the iPhone, such as MCQ revision tools and anatomy guides. Even the iPad is being incorporated into education, with whole copies of the Oxford handbook available at a click - or in this case a prod. It seems a million years from handwritten notes and photocopying journal articles, yet for doctors who trained a mere decade or so ago, that was reality. I am amazed that what would have been a supercomputer thirty years ago can now nestle down in my trousers, Admittedly, this new device throws off

enough energy to give me leg cancer, but my main reason to coyly refuse previous techno-advances was my belief that a phone should be a phone and just that. But then I began to be left behind. This fear of the future, of change, of the unfamiliar, is only so cliché because it is so ancient. Scrape away all the gadgets and pretty colours and the scene hasn’t changed much since pre-history, when a prognathic ancestor of Steve Jobs brought moveable drawing tablets back to the cave, his friends must have looked at him as if he’d been at the red berries.

“What would have been a supercomputer 30 years ago can now nestle in my trousers” However people came around to the idea of mobile communications. Words were added much more gradually, as people got worse at drawing and their scribbles looked less and less like what they were supposed to. Compare

Egyptian hieroglyphs with Greek lettering, and look at what passes for the Greek constellations – Egyptian constellations were the ancient equivalent of a Flickr album. Similarly just think about the ineligible scrawl that passes for consultant’s notes in patient files. It seems obvious in retrospect that medicine was crying out for text-based mobile technology. At the turn of the last century, or thereabouts, the inventions of the telephone, the radio and the television all rolled back the frontiers of speed, reach and media of our communication, but we simultaneously forgot that things could be small as well as cool. We’ve spent most of the past hundred years getting back to the comfortable customer experience the book offered. This brings us to now, with burnmarks on my trousers and childish delight in my eyes. Who knows where we’ll go from here? Since Steve Jobs has declared that the age of the tablet PC is here – and received the reply, what does it do? - I think the march of technology is cyclical, or at least a bell-shaped curve. Which means we’ll soon be able to watch videos, read books, take photos, preen our e-go and even make calls on the iPanel – coming to a wall near you! It also means while working in A&E we’ll have to watch out for people with laptop burns on their crotch, and repetitive strain injury in their thumbs. So much for advancement

March 2011

Comment

medicalstudent

Hello, 999? I’ve got the hiccups David Fisher Guest Writer

Our team sprung into action as the first call of the day flashed onto the ambulance monitor. We were required to rush to a shopping centre to assist a man with a broken leg. Arriving, we found a drunken man, standing stoutly, and verbally abusing staff in McDonald’s. Turning to us, he aggressively asserted, ‘I have a tib and a fib’. Delighted having found something in common with the man, we felt confident to inquire further. He informed us, with certainty, that he had two broken legs and needed to go to hospital. Attempting to placate the man, we tried to convince him that it was impossible his legs were fractured, given the ease with which he could move. This bore no fruit. Left with no choice, we transported him to the nearest hospital. Ironically, he was happy to walk through the doors into the busy emergency department, demanding to have his ‘broken’ legs examined. The intensifying demand for London ambulances is flooding hospital emergency departments. If the trend continues, the next generation of doctors will be confronted with saturated hospitals, and emergency care standards will inevitably deteriorate. The requests for London ambulances have exhibited exponential growth over the last two decades. During the 90s, the total requests more than doubled, and last year, an unprecedented 1.4 million calls were made to the London Ambulance Service (LAS). Swelling emergency departments are bulging under this increased pressure. Paradoxically, studies have shown only half of ambulance calls are medically warranted, and the other half of patients are discharged from hospital without treatment or referral. Since the introduction of operational targets in 1974, governments have been obsessed with ambulance response times. They have neglected to consider the appropriateness of calls, whether each ambulance arriving within nineteen minutes should have initially been sent. In 1996, a Department of Health group suggested categorising emergencies that would prioritise calls into three classes. The division into category A and B was

Top 10 most ridiculous ambulance call outs 1.

A woman caught throwing lollipops

Sore tongue

Pretending to be asleep

Hiccups

Feeling unwell after drinking Lucozade

Finding a blister on the their heel

Soft-toy poodle being unwell

Missing pet lizard

Checking to see if a phone was working

10. Not getting the correct sauce on a Subway sandwich

adopted immediately, but the Government hesitated before introducing category C, representing non-emergencies. Clearly, the Government was unsure how to respond to non-emergencies that should be referred to other services. Governments should have had the confidence never to include non-emergencies among the obligations of the ambulance service. Now, these patients are clogging ambulance services, for fear of litigation. Failure to adequately respond to this issue in the past has allowed the problem to surface and spill over into emergency departments. The root of the problem is inappropriate calling of ambulances. An understanding of when it is appropriate to summon an ambulance has never been a component of the National Curriculum. Children and many adults are not educated to appreciate the exhaustible nature of the NHS resource. The result is a collective flagrant disregard for the NHS and complete brazenness, calling ambulances at will. This is surely going to worsen. Studies have associated demand for ambulances with poverty and unemployment. The current economic recession is going to exacerbate this crisis. The introduction of NHS Direct in 1997, a nurse led telephone service, had no effect on the

number of ambulance calls. Plainly, the public are unaware of this alternative service. It would help if the service was free. It is wasteful and inefficient that it is free for patients to call an ambulance and be ferried to hospital in unwarranted cases, yetsaving public resources by telephoning for advice is a cost-bearing exercise for patients, one that requires them to pay phone charges, If triage forwarded non-emergency patients to this service instead of 999, fewer ambulances would be needed as patients could be re-directed to the care of nurses, pharmacists and walk-in centres. To stem the tide of ambulance calls, an effective educational advertising campaign is essential. Collective responsibility for the NHS must be infused into the public consciousness by utilising the media. Simultaneously, learning about the NHS must be included in the National Curriculum. Future generations need to learn when it is appropriate to spend a valuable national resource by calling an ambulance. There is, however, one proposal that has made a discernible improvement in hospital over-crowding. In 2000, the Ambulance Liaison Committee, providing speciality advice to ambulance services, recommended introducing a new category of

paramedic, Emergency Care Practitioners (ECP). They would be more highly qualified, able to provide diagnosis, treatment and management of minor illness, often at home. In 2003, the scheme was introduced to the LAS, gaining popularity during its two year pilot. In 2005, the chairman of the LAS expressed his expectation that ECPs would become the initial response to most calls within five years. The same year, a Department of Health National Ambulance Review, recommended expanding the number of ECPs, citing case studies, reporting high patient satisfaction. The scheme is also highly economical. The case studies assert ECPs often treat patients at home, relaxing the strain on hospitals and thus saving costly resources. Each year, until 2009, the scheme expanded in line with the chairman’s vision that ECPs would come to dominate ambulance responses. In 2009, 65 ECPs attended 18,000 incidents in London. Shockingly, the only emerging solution to emergency care overcrowding in London, has been torn away by the roots. The LAS NHS Trust has surreptitiously terminated the ECP scheme in London, with apparent disregard of the overwhelming economical and patient care benefits of the scheme. They have been careful to withhold the announcement from public scrutiny, only announcing the cut in a one-off Quality Account review published in June 2010. They have failed to mention the decommissioning in any other publication. Until 2009, the progress of the ECP scheme was a regular feature in the LAS Annual Review. In the 2010 review, the absence any mention of ECP is ominous. Meanwhile, the scheme has been successfully promoted by ambulance trusts outside of London. The cut of a championed scheme, hailed as potential saviour to emergency departments, is bizarre and misguided. ECPs must be urgently re-instated in London and nationally the scheme must be expanded. The next generation of doctors are going to be required to battle high waves in a flooded NHS. To stand a chance, we must invest by plugging the holes immediately, as well as addressing education

The real price of “high” fashion Sophie Tang brings a new meaning to killer heels After a night out, Jenny Sailey fell over in her four inch heels and was rushed to hospital with a broken ankle. She is just one of over three million women who have needed medical attention as a result of wearing high heels. What’s more is that a third have even fallen flat on their face, resulting in damaged teeth or a broken wrist. I bet neither of those statistics were part of the seductive image conjured up when buying sexy new five-inch high-heels that you can’t really walk in but still must have now because oh-my-God-they’re-just-so-unbeliveably-cute. We all know that high-heels aren’t exactly good for you, but are they actively bad for you? Yes, and the damage to your body probably lasts a whole

lot longer than the damage to your bank balance. The problems start at your feet; high-heels shift the pressure of each step onto the ball of the foot, inviting complaints such as bunions, toe deformities and trapped nerves. The problems then travel upwards, with the ankle, knee and hip joints all suffering. Dr Michael Nicholas, a foot doctor from King’s College Hospital, warns that “wearing high-heels puts women at increased risk of developing pain and stiffness in their joints due to wear and tear”. Muscles and tendons can be shortened as well, leading to an “awkward, unnatural walk”. As if that’s not off-putting enough, highheels have been linked to infertility. Posture specialist Dax Moy claims that very high

heels make your hip bones tilt forward, resulting in squashed reproductive organs. If that’s not suffering for fashion, I don’t know what is. I love heels as much as any woman. What else can make you look taller, slimmer and leggier without going under the knife? I appreciate that getting women to ditch highheels all together is pretty unlikely. However, you can minimise the damage to your body by choosing your next pair wisely. Make sure you have the right fit, avoid pointy pairs, look out for chunkier heels and try to wear them only when you have to. That way, hopefully, the only accessory you’ll need for your killer heels is a matching handbag and not a shiny new knee replacement

medicalstudent

March 2011

Comment

It’s official, Imperial are wankers

Speaker’s Corner

Chengyuan Zhang reflects on the results of Imperial’s sex survey There was a soft and intense moan of appreciation as I leaned over and gently bit the soft skin on the side of her neck. I continued my assault on her body, slowly sliding my hand up her right thigh. Then suddenly, after switching me on, she pushed me away saying she was late for lectures. I've heard of busy schedules before but this is ridiculous. Fuck my Imperial life. I was despondently left to carry out a controlled explosion. Sex is one of the most important things in our lives. To make love is one of the many motivations of the human psyche. Of course, I'm talking in a purely hypothetical sense here and I can only apologise for my poor dabbling into erotic literature above. Perhaps I'm not the most qualified or experienced person to write about this topic. I'm not a sexologist and I've never shagged anyone. There's no sexual relationship here, and I expect this to still be true when you're reading this in print. I've never been in the sack, giving someone a good rogering, or fucked the fuck out of anyone. I don't believe in cheap thrills either. So if you're expecting firsthand accounts of my sexual exploits, you can stop reading right now. Imperial students will be aware that Felix, the student newspaper, recently conducted a sex survey. An Alfred Kinsey-esque systematic and scientific study of the sexual behaviour of students. Except, unlike the prominent sexologist, there thankfully wasn't any direct observation or participation in sexual activity in the name of science. Most of the results probably didn't come as a shock to people. In fact, it helped to clear the air on a few things. I'd previously thought that the dull and subtle noises emanating from certain recesses of the Central Library were just your typical Asians unaware of the code of silence, or the excitement of nerdy overzealous World of Warcraft players. New evidence, that sites such as the Library and Union are campus sex hotspots, places these noises in a new and more disturbing context. As you can tell from the statistics, Imperial is full of wankers. It must be pretty hard to sleep at night to the midnight resonant murmurs of students staying up and banging away. I don't doubt that Imperial's average wrist strength is probably very much above the national average too. There seem to be quite a lot of wankers around Imperial, especially as we're a male dominated institution, and men evidently masturbate more than women. It's one of those age-old facts that don't require a Captain Obvious to verify. Your grandmother might shirk away when masturbation is mentioned. The reality is there's nothing wrong with wanking. It's totally safe auto-sex with zero risk of contract-

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Imperial is demographically 83.3% straight, 9.4% bisexual, 6.2% gay 57% of people have had unprotected sex, though only 3.5% of people have contracted an STI Bisexual women were twice as likely to masturbate regularly than straight women and had the highest proportion of respondents claiming to have sex daily 50% of gay men said they masturbated every day compared to 20% of straight men Men masturbate more than women: 68% of men masturbate regularly compared to 25% of women 25% of women have purportedly never masturbated before 1/2 of all respondents admitted to watching porn at least once a week 10% have engaged in a threesome 60% lost their virginity aged 16-18 57% of people admitted to using restraints or handcuffs in the bedroom. 1/3 of students have engaged in anal sex, this value rising to nearly 1/2 among Chemists, with the value being highest among the more experienced PhD students and current third years Maths (unlucky!) has the highest number of virgins at 23%

ing or transmitting STIs such as HIV. It's far safer for a person to stay at home and jerk off than going to a sweaty club with the aim of shagging left, right and centre. Masturbation is an appealing alternative to casual sex. Plus, there's a correlation between high wanking frequency and lower incidences of prostate cancer. Save lives, save the NHS money, do your part and jerk off.

“Save lives, save the NHS money, do your part and jerk off” All you philistines who snigger with disdain at masturbation, just think about those poor Imperial Maths students and people who aren't self-confident, good looking, able-bodied or 'sexually desirable' by our high cultural standards? Don't they deserve the right to some form of erotic fulfilment? We're not Dorian Grays. Our looks will all eventually fade and we'll all lose our pulling power sometime. (Admittedly I find it difficult to pull a book off a bookshelf). I'm not quite sure where I stand on pornography though. Half of Imperial students seem to be sure-footed on that front. However, I doubt they're considering the morals of it when they're watching it. I'm sure it isn't as anti-women and exploitative as extreme feminists make out. It doesn't have to be dehumanising either, although I feel that in many ways it is. I don't feel it should be banned or criminalised. It is a part of 'sexual freedom', though I do feel that many people are unwillingly exploited by pimps or driven into

porn by financial problems and debt. They're probably not doing it out of genuine choice. I also take issue with how porn can be degrading and humiliating. Linking to this, I feel very strongly that our current sex education is a deeply inadequate shambles. It's an issue that I'm very passionate about. Young people leave school completely clueless and unprepared for later life. People want the full facts but rarely ever get them in the classroom. Teaching is euphemistic, fact-based and inconsistent with reality. Homosexuality and bisexuality are completely neglected, leaving kids confused, prejudiced and isolated. The most we ever did in school was place a condom on a banana - incorrectly as well, might I add. Kids need to have sex and relationships properly explained to them. They deserve to know everything from a reliable source, not from half-baked school lunchtime banter or the latest Hollywood sensation. The government need to realise that this won't encourage premature and irresponsible sex. Look at the Dutch. Young people should be better educated to stick up for their sexual rights. It's my body and I'm in charge. We must embrace and highlight the importance of mutual consent, responsibility and respect for our actions, but also the appreciation, as the sex survey highlights, that human sexuality is gloriously diverse and unique. Some people may find some things unpleasant which others take as their sexual nirvana. What's so great is that we're all different, that we have our own erotic tastes, and get aroused by individual thoughts and experiences. It adds a bit of spice to life!

Why getting old is the new getting cool Hayley Stewart speaks out A recent study in The Lancet told us that most babies born since 2000 in Western Europe and the USA will live to be one hundred. The UK Department for Work and Pensions predicts that ten million British people alive today will reach that age, that by 2080 600,000 of us will be 100 already, and 21,000 will be 110! We’ll be supercentenerians. I told my flatmate this and she thought it was a good excuse to keep smoking. I told her off in a wise medical student way, but I understood how she felt. Do any of us actually want to live to 110? And what will our quality of life be like if we do? The government has recently changed the laws around retiring, encouraging many of us to work beyond 60 or 65, but even if we do, we’re still going to spend about a third of our later lives not at work, and it is the fortunate few who manage to save enough during their working lives to have a luxurious old age. Meanwhile, they’re also worrying about who will pay for all our meagre pensions, and if it’s an improved healthcare system that will be keeping us alive, who will pay for the increases in funding that will enable that? This is all very depressing, so I’ve decided to take a positive look at what it might be like to be old. Why would it be a good thing?

Robbie Williams sung about wanting to be old before he dies, to ‘relive the days gone by’ and ‘see the pope get high.’ There’s a famous poem by Jenny Joseph that talks about wearing crazy clothes and only eating your favourite foods, and generally not caring what anyone else thinks. That sounds a bit more realistic, and older people I have known have said this is a pretty good thing about being over the hill – being beyond peer pressure, and not expected to be a size zero, bring home a big salary or be a better athlete than your kids or your friends. Then there are the people who’ve already reached a very impressive age. What were their lives like? The oldest recorded living person was Jeanne Calment from France who died aged 122. Born in 1875, she lived through two world wars, the reigns of six monarchs, from Queen Victoria to Elizabeth II, and the invention of the telephone, the television, the aeroplane and even the electric lightbulb. It would be pretty amazing to see so much in one lifetime. You’d certainly have some wisdom to pass on to your grand children. I’m not sure how I feel. There are lots of life expectancy calculators online and apparently I’ll live to be 92. I think I’ll settle for that

Illustrations by Giada Azzopardi

March 2011

Culture

Culture Editor: Robyn Jacobs culture@medical-student.co.uk

St Patrick’s day in London Odhran Keating explores the issues of immigration (whilst drinking the necessary pint of Guinness...) What links Jimi Hendrix, Robert De Niro, Charles de Gaulle and Rihanna? Well you may or may not be surprised to find that the common denominator here is that they all have, to varying degrees, Irish heritage. All over the world the effects of the Irish diaspora can be seen in some of the most notable people of the last century and beyond. It is easy to see why St Patrick’s Day is truly an international festival. On the 17th of March people of all ages and nationalities will come together and celebrate the feast day of St Patrick, many by raising a pint of Guinness and saluting our common genealogical tradition. Can anyone doubt that this is a good thing? Despite the fact that the international nature of this celebration of all things Irish was made by untracked and deregulated migration, few will be raising this issue when it comes round this year. The issue of immigration is something that reignited recently when the consultation period for Home Secretary Theresa May’s review of student immigration ended. The UKBA paper proposed major reforms to the current system mainly focussed on raising the standard of English language requirement, reduction of the post-study visa, and a reform of the laws currently governing the status of dependents. The reason this is such an issue is set out clearly in the consultation: “In 2009, the student route (including dependants) accounted for approximately 139,000 out of the total net migration figure of 184,000, which is 76% of total net migration”. The Coalition pledge to reduce net migration by a half is therefore dependent on the reduction in the levels of student migrants. No one would be happy with the government dictating their everyday movements, but with migration control that seems to be exactly what is being regulated. As Rousseau wrote in his 1754 treatise Discourse on the Origin and Basis of Inequality Among Men –“The first man who, having fenced in a piece of land, said “This is mine,” and found people naïve enough to believe him, that man was the true founder of civil society”. What do we gain from this fencing in? Is there not more we could gain from thinking of our world from a common vantage point? It certainly seems obvious to me

medicalstudent

that if we were of an international mind-set then it would be much easier to tackle international problems such as climate change, overpopulation and poverty in the developing world. “Doesn’t this already exist” I hear you say, “what else is the eternal schmoozing of summits such as the G8 meetings if not an example of a responsible international mind-set?”. However the benefits of rich, developed countries sending monetary aid overseas is tarnished somewhat by figures published by the World Bank which show that money sent home by migrant workers is almost three times the amount ‘gifted’. Countries, as long as they exist, will always prioritise their own interests. If these clash with the interests of another smaller and less developed state, then so be it. However, what is the price of tearing down these fences? Loss of cultural identity and pride may be one outcome and you don’t need to be a financial expert to predict the tumultuous effects such a revolution would have. Many of you will dismiss the notion straight out of hand as ludicrous. In fact, I think that such a massive upheaval of our social systems would most likely change our lives so much as to be almost unimaginable. Whether you think it would be unimaginably good or unimaginably bad most likely depends on whether you’ve ever listened to John Lennon’s ‘Imagine’ and considered joining him. As the worldwide celebration of St Patrick’s Day shows, however small the link, what people really want is a chance to celebrate their identity and to relate to those that share it. If we stopped for a second in our quest to build a bigger and tighter fence and all started thinking in a more universal way then we may be able to do great things for our planet. As Rousseau went on to write about his creator of civil society – “From how many crimes, wars, and murders, from how many horrors and misfortunes might not any one have saved mankind, by pulling up the stakes, or filling up the ditch, and crying to his fellows: beware of listening to this impostor; you are undone if you once forget that the fruits of the earth belong to us all, and the earth itself to nobody”. I, for one, will be considering Rousseau as I drink my Guinness this St Patrick’s Day.

REVIEW

Never Let Me Go

John Hardie Editor-in-Chief “In 1952, a medical breakthrough permitted human life to be extended beyond 100 years.” Mark Romaneck’s ‘Never Let Me Go’, based on Kazuo Ishiguro’s 2005 novel of the same name explores the human consequences of this radical post-war breakthrough. Kathy (Carey Mulligan), Ruth (Keira Knightley) and Tommy (Andrew Garfield) become acquainted whilst attending the seemingly idyllic English country boarding school, Hailsham. Their carefree childhood antics are soon forgotten as the three become entangled in an intimate love triangle, one which is tainted by Ruth’s possessiveness of Tommy. Their days, however, are numbered by the impending organ ‘donations’ they are to make to those they were cloned from. “You have to know who you are and what you are,” says Miss Lucy (Sally Hawkins) to her schoolchildren. “It’s the only way you’ll lead decent lives.” Although the young people have been bred exclusively for

replacing the organs of the diseased, they are encouraged to behave humanely – the dichotomy of the film. Does this film tap into public fears of medical science having gone too far? Probably not. I cannot admit that I was convinced by the absurd world that Kathy, Ruth and Tommy inhabited. Any medics who have tried getting their seemingly innocent research projects past an ethics committee will know how tough it is. To try and get the morally reprehensible idea of harvesting organs from healthy individuals past an ethics committee seems almost ridiculous. What I did find unsettling was the atmosphere of passive acceptance the students of Hailsham had of their sacrificial destinies. There was little attempt to wrestle with the system that was to deprive them of their lives for the sake of saving alcoholics and junkies. Even more disturbing, was the inference that the system could never change – once people have found a solution to perfectly cure the incurable, it’s somewhat unlikely they would want to return to suffering and disease. The quiescence was broken only by Tommy’s astonishing outburst of frus-

tration at his doomed situation. Andrew Garfield’s portrayal was entirely believable, and for me was the most powerful moment in the film (Kleenex share prices went through the roof). The production perfectly captured an ambiance of calm and normality with its warm and immediate cinematography. Combined with Rachel Portman’s soundtrack for strings and piano, the atmosphere of Ishiguro’s book was effectively conveyed, helped in part by Ishiguro’s frequent presence on set. The point of Ishiguro’s dystopia is not a Huxleyan warning against medical sciences. Nor is it an Orwellian vision of children brainwashed into blindly following the path set before them. Instead, it is a call to act - to make sense of our situations and have the courage to do what is important to us. But, as Kathy points out, maybe none of us really understand what we’ve lived through, or feel we’ve had enough time

‘Never Let Me Go’ is out in cinemas now. For more information check out www. foxsearchlight.com/neverletmego

Student Artwork of the Month By Alexis Nelson “A life, ever-winding and ever turning. Just like medicine, the road is tricky, long and not without its bumps, but we always strive for clarity in the clearings. That’s when we know we have done our best. If you would like to see your artwork, photography or poetry featured, please email culture@medical-student.co.uk

medicalstudent

March 2011

Culture REVIEW

AN INTERVIEW WITH...

ICSM Drama Society

at The Old Operating Theatre

Rhys Davies talks to President Trish Reece

hen on the wards, patients may mistake you for being an actual doctor. If this situation ever happens, it can pay to know how to act. Drama societies are a perennial favourite across the London medical schools, allowing students to try something different and have some fun. I spoke with Trish Reece, president of ICSM Drama, about what they get up to at Imperial College. MS: So, Trish, you’re the president of ICSM Drama. Could you tell me what happens in the society in a typical year? TR: Well, we have two big productions in the Union Concert Hall, one in the Autumn and one in the Spring. These give people an opportunity to try out different aspects of putting on a show, so not just acting, but writing and backstage too. We also put on the Freshers’ Plays in the Reynolds Bar – these are performed exclusively by freshers and are a good introduction to the society. This year we are also reviving the annual Soiree, which is an evening of comedy, songs, sketches and general revelry. Because we’re not a sports team, we don’t meet every week for practice and matches, so we try and have fairly regular socials. Here we can get together and discuss how the society is progressing. But I think what is important is to encourage people to get more interested in theatre, not just getting involved in one of our shows but going to see productions as well. MS: So the next big show is the Main Play. What are you putting on this year? TR: The Main Play this year is ‘James and the Giant Peach’. It’s been adapted and rewritten by Robyn Jacobs, Michael James and Fiona Seabrook. It’s a really light-hearted play. Every year, we like to contrast between Autumn Play

Kiranjeet Gill Guest Writer

The repetition of lines got too much for one cast member. Photography by Francis Trapp

and Main Play. One is serious, or we like to think is serious, and the other is funny. It adds more variety for our audience and for our performers. ‘James and the Giant Peach’ is just a really fun play to be involved in and to come and watch. This year, we’re also doing a Saturday matinee, a family performance, which is the first time this has been done. ‘James and the Giant Peach’ is a much-loved story that many people know and it’s a nice way of spending an evening, coming to watch a play. MS: I’ve heard that Imperial is hosting the UH Revue this year. Now what’s that about? TR: The United Hospitals Revue is a fiercely fought competition between the five London med-schools. It’s an annual event, each year being hosted by a different med-school. This year is the first time in the history of the UH that we’re hosting it. Essentially, it’s an evening of comedy. Each of the five med-schools is given twenty minutes to perform for the audience and make them laugh, basically. Whoever the audience deem to be the funniest at the end of the night goes away with

‘Whose Blood?’

the Moira Stewart Cup – not officially endorsed (but hopefully soon will be). It’s a really nice evening to get to know some of the people from the other medschools, to play up to that rivalry that there inevitably is between us, laugh at each other and laugh at ourselves. MS: Obviously, you’re President for this year. Where do you see ICSM Drama going after your tenure? TR: I’m actually really excited because there are some really great people in the society, people who are really passionate about getting involved and pushing the society forward. I really hope that they want to step up so they can put their ideas forward and make them happen. I hope things continue to improve and that people come up with their own material and still want to direct and be creative within the society. MS: Any final words? TR: Go see Main Play. Go see Soiree. Go see UH Revue

‘James and the Giant Peach’ 9th-12th March, Union Concert Hall, South Kensington. For more info, email icsmds@gmail.com

London, 1832. The Industrial Revolution is in full swing whilst a cholera epidemic looms. The world of medicine is experimental and dangerous; standard treatments include blood letting and amputations. In a time with no anaesthetic and only Gin for pain relief, few who enter the operating theatre leave it alive. With medical schools facing a shortage of bodies for dissection, ‘ressurrectionists’ resort to digging up graves to provide a fresh supply... This is where the audience enters in ‘Whose Blood?’, a new play by Alex Burger currently showing at The Old Operating Theatre, London Bridge. As the play begins, we meet Efua (Candice Onyeama) and Abakah Kuntu (Charlie Folorunsho), Ghanaian immigrants who came to England in search of a better life. However, four years on and Abakah is growing tired. His work in a tannery is demanding, and a pain in his side keeps getting worse. He dreams about returning home, but Efua, a gin maker, is happy with her new life. After Abakah is turned away twice from St. Thomas’ Hospital, Efua decides to take matters into her own hands. Familiar with the doctors who frequent the shop in which she sells her wares, she meets Hugo Forester (Mark Hawkins), a surgeon at St Thomas’, who drinks to forget the screams he hears in the operating theatre. After supplying him with a liberal amount of gin, Efua tells Forester of her sick husband. Lured in by the fame that would follow a successful operation, he proposes a novel solution: treatment, in return for bodies that the medical school so desperately needs. What follows is a fascinating story of a woman torn between traditional

values and her desperation to save her husband’s life. She becomes close to Forester, the guilt surrounding this merely adding to her existing torment. We see tender moments between Efua and her husband starkly contrasted against her passionate encounters with Forester. These romantic undertakings are interspersed with the young surgeon’s conflicts in the operating theatre with his superior, Samuel Carter (John Gorick). As Abakah’s condition worsens, the characters’ lives become intertwined against a backdrop of a growing racist sentiment and reports of violence against Africans in the city. ‘Whose Blood?’ is, as a concept, brilliant. It draws on themes of race, class, culture, medicine and ethics, yet these don’t detract from the characters’ personal crises. The result is a thoughtprovoking and original play. Burger’s well-researched script is brought to life by an excellent cast; in particular, Candice Onyeama’s portrayal of Efua which is convincing and utterly compelling. The intimate setting of ‘Whose Blood?’ is also key to its success. A maximum of fifty audience members, who sit on tiered wooden benches surrounding the operating table, become part of the story. Indeed, in dialogue between Forester and Carter, the audience are addressed as trainee surgeons, which brings the play to life. It also emphasised to the miracle of modern medicine, and the incredible progress that has been made since the days in which Hugo Forester and his colleagues operated. Overall, this is a moving and captivating play, that leaves the audience with plenty to think about. This play is most definitely worth a trip

Until 12th March at The Old Operating Theatre, Saint Thomas Street, SE1 9RY. For more info, visit www.bankcider.com

Calendar of Events BL

GKT

ICSM

SGUL

RUMS

BL Fashion show 15th March

KCL Fashion Show 8th March Macadam Cup GKT v KCL Varsity 30th March

‘James and the Giant Peach’ 9-12th March IICSM Orchestra Concert 19th March RAG Fashion Show 15th March IC v ICSM Varsity 16th March Soiree in the Reynolds 22nd March 24 Hour Opera 27th March

Footloose 9-11th March

RUMS Halfway Dinner 15th March Spring Ball at Opal 22nd March Alumni Sports Night 30th March

March 2011

Culture FOOD

Swedish cuisine on Brick Lane

A glowing Stag’s head to light your dinner? Photography by Jianan Bao

Jianan Bao Guest Writer Studying medicine in London can get really stressful. So it’s good to know that at the end of the day, you can sit down for a nice meal at a restaurant, with good company, and on top it of being a relaxing affair, also be transported to another part of the world. Sort of like a mini-holiday for around a tenner. There’s a little wood-paneled restaurant just at the top of Brick Lane (the Bethnal Green Road end) where you can sit next to an Astroturf reindeer and sample a slice of Sweden. The coffee break is an intrinsic part of Swedish culture. It’s even earned its own word in the language: Fika. Fika (the restaurant) serves coffee and cake during the day. Currently, its the season for the ‘semla’, a cardamom bun filled with cream and marzipan. Tasting as rich and fatty as it sounds, it’s only consumed once a year as a preLent treat. Indulge whilst you can. I had a little chat with the Swedish chef. She comes from Stockholm and she’s very enthusiastic about Swedish cuisine. JB: What’s a typically Swedish dish that you can make on a student budget? Fika: Chokladbollar (chocolate balls). You just take porridge, butter, cocoa and mix it all together. It’s party food. If you want something savory, you can make pytt i panna. You take leftovers in the fridge, dice it up and fry it together. Usually you use potatoes, carrots and bacon. You serve it with a fried egg and some sliced beetroot. If you want something fancier, you can add

some sliced beef steak and a raw egg. That’s called a Biff Rydberg and it’s the version they serve in restaurants. JB: What’s an essential part of Swedish cooking? Fika: Metaphorically or literally? (She chuckles.) Purity is important in Swedish cooking. It’s about bringing out the natural flavors. We wouldn’t mask our food with an infusion of rosemary. Like when we eat salmon, we just add a bit of salt. An ingredient we use a lot in Swedish cooking is dill. You can usually buy fresh dill in Turkish shops. They also sell it in Tesco in little plastic packs. Meatballs are most traditional, but I went for their signature dish: grilled salmon served on a plank with mashed potatoes. I could smell the rich hollandaise sauce before I could see the food, which is always a good sign. The fish was fresh and the peppercorns in the mash were quite exciting. However, it did set me back £13.50. As with most places on Brick Lane, you’re paying more for the atmosphere than for the content. Luckily, it was filling, so I would just skip the starters if your wallet isn’t feeling up for it. If you feel like splashing out, Fika serves cocktails as well. They recommend Valter’s Dillicious Dillight. With dill vodka, elderflower snaps, and lemonade, it sounds like a refreshingly Swedish way to end your evening.

Visit Fika at: 161a Brick Lane, Shoreditch, E1 6SB. Alternatively, visit http:// fikalondon.com

medicalstudent

Art in Anatomy... Anand Ramesh Guest Writer Human anatomy has always held profound fascination for mankind, knowing how we are put together is natural curiosity. The mysteries of the hidden are always a more tantalising prospect than those which outwardly present themselves. The Artist’s deep-rooted interest in anatomy has remained steadfast through the ages; from Da Vinci’s sketches to present day treatises, such as Gray’s Anatomy. The disciplines certainly complement each other. Incredibly complex components of the body and structural intricacies of each organ system, along with requirements to work within the constraints of extreme accuracy, all offer an excellent challenge to the artist, as well as making images as organic as possible. Anatomy is in essence a practical subject. It is very difficult to gain information from a textbook without having appreciated the content in situ, hence why dissections are a central part of its teaching. However, aside from this, textbooks remain the mainstay of anatomy learning, as seen in Gray’s, which uses artistic drawings, or atlases, such as McMinn’s, showing real dissected material. At the outset, it seems logical that real dissected material is the ‘gold standard’ for anatomy teaching, being undisputedly accurate. However, I believe that artistic portrayals in anatomy have unique merits. From experience, it can be difficult to appreciate the arrangement of structures within dissected material. Even when certain nerves or arteries are pointed out in a specimen, it can still look rather homogeneous to the untrained eye. Therein lies the beauty of art; it provides a platform to make sense of the amorphous tissues you may have seen in the laboratory. The ability to use contrast and colour in artistic images helps reinforce structural relationships which may not be clear in real life material and which are central to sound anatomical knowledge. I find this particularly pertinent when considering blood vessels and nerves. A drawn colour image is key to understanding where each branch goes, often not clear in the monochromatic setting of a dissection. Anatomy is essentially the static study of systems that are in constant flux. While dissection is invaluable for appreciating interior architecture, it remains detached from the functionality of the different parts, the ‘living anatomy’ so to speak. On the other hand, artistic portrayals, through use of mediums such as texture and colour, impart a sense of dynamism to images. This can help strengthen the link between structure and function and consolidate learning. Colour

schemata can often make sense to our faculties. For example, red for arteries to signify blood flow and yellow for nerves to signify electrical current. So should art have a more prominent role in anatomy teaching? Traditional methods of teaching should certainly remain the mainstay, through a combination of dissection, lectures and textbook learning. These methods are tried and tested and ultimately work. The key question is whether art can be extended from textbooks to the classroom. In Durham University, body painting has been employed as an innovative teaching method, mapping out structures onto students’ bodies with different coloured paints. Teaching has focused on anatomical areas such as dermatomal distributions, lung fields, and blood vessel distributions. Nottingham University have researched into the possibility of integrating different art forms such as life drawing, collage and wire modelling into anat-

Image source Grays Anatomy

omy teaching. They found, from feedback of participants, that this approach helps relate structure to function. Interestingly, participants also received slightly better results in their anatomy exams. If such approaches were employed as adjuncts to conventional anatomy teaching then I think it could help contextualise otherwise lifeless structures seen in a dissecting room. Importantly, studies such as those conducted at universities highlight the effect art has in personal development, something I feel is neglected. Too often, in the context of dissection, human beings are considered a mere set of body parts. The study at Nottingham found that participants could connect with the ‘emotional’ aspect of dissection. I believe that if the mixture of science and humanities can renew our awareness of the human being behind the physical body, then this can only be a good thing, both in anatomy teaching, and in future clinical practice

medicalstudent

March 2011

Culture A Students Secret Guide to London

...Anatomy in Art Benjamin Goodman Guest Writer Vanessa Ruiz is the founder of StreetAnatomy.com, a website dedicated to exploring the uses of human anatomy in medicine, art, and design. She is also a medical illustrator herself and a regular blogger about art and anatomy. Here she gives us her perspective. BG: So, Vanessa, what do you think are the main ways in which the science of anatomy has inspired artists? VR: Anatomy has always been part of the training curricula of most artists. Just like doctors begin the study of medicine with a foundation in anatomy, artists also begin their training with an intimate knowledge of the skeleton and musculature of the body. This is usually learned during rigorous figure drawing classes where anatomical landmarks on the body help an artist accurately visualise their subjects. I

find that artists who tend to be a bit left brained can’t help but become transfixed by what’s beneath the surface during this learning process. And so, anatomy tends to appear in their actual works. It’s not so much that anatomy inspires them, it’s a part of them and they want to figure it out. They do that by figuring it out in their art. BG: Street Anatomy describes itself as an exploration of how anatomy is portrayed in everything from fine art to advertising. Are there many famous examples of fine art which have been particularly inspired by anatomy? What were the intentions of the artist(s)? VR: The most famous artist who was inspired by anatomy was, of course, Leonardo Da Vinci. I always think of him as the first medical illustrator in the sense that he dissected his own cadavers in order to learn anatomy in depth and to sketch his findings. He even had intentions of creating an anatomy text from all of his drawings, but

Illustration by Ryan Gerdes. Source www.streetanatomy.com

nothing much ever came of that. A contemporary artist whom we’ve all heard about at one point or another is Damien Hirst. Many of his works are inspired by anatomy and the impermanence and manipulation of life. He’s done everything from create a giant anatomical human torso model, to suspend a skeleton in the crucifixion pose. And he did that thing with the diamonds and skull that reportedly sold for £50 million. BG: In what ways do you think that Anatomy be used in advertising? VR: In the 4 years that I’ve been blogging about anatomy in pop culture, I’ve seen more and more uses of anatomy in advertising. It’s a direct way to say, “this product is a part of you” or “this product will make you become physically better”. In the past, anatomy has been used mostly in medical and pharmaceutical advertising, but commercial advertising has been using it in more unique ways, which is cool to see. Most people can relate to anatomical drawings from their days in school studying textbooks, so I think it’s refreshing to advertisers pull those into unexpected places. BG: Given that anatomy so used in advertising, have you ever felt that anatomy has received negative publicity in the media? VR: Only with the recent Gunther von Hagens ‘Bodyworld’ exhibits and controversial knock-off shows around the world. People really had strong opinions, both good and bad, about those shows. It became unfortunate when information started surfacing about the backgrounds of many of the bodies used in those shows. There were many stories of the cadavers of Chinese prisoners being donated without consent that sparked investigations and controversy. I enjoyed seeing ‘Bodyworlds’ and I do believe it was very educational for people that normally wouldn’t bother to study about their own bodies, but I chose to stay away from blogging about it because I didn’t want the focus on anatomy to turn into a focus on the controversy. BG: Have you ever been surprised at an unexpected representation of anatomy in a piece of art? VR: It’s hard to surprise me at this point since I look at representations of anatomy in art every single day. I do find, however, that the most creative uses of anatomy in art come in the form of music gig posters. Creating art for music posters seems to be the most free form of creativity. They don’t necessarily need to make sense or even relate to the music. They’re oftentimes the most beautiful and well done anatomy in art pieces that I see. StreetAnatomy.com contains art inspired by human anatomy,. Vanessa has also created ThinkAnatomy.com, which provides links to useful study aids and online resources for learning anatomy

A starry night outside the pub. Photo courtesy of The Flask website

Flask Walk, Hampstead Robyn Jacobs tells us about her favourite place to buy books, eat ice cream and pretend to be a fairy...

ampstead, a part of London famed for homeowners such as Emma Thompson and Jonathan Ross, for scandals involving George Michael and The Spaniards Inn; a pub made famous by mentions in classics such as ‘The Pickwick Papers’ and Bram Stoker’s ‘Dracula’. Despite the fame of the area, there are still some secret corners to be found. One of my favourite places in the world lies in the heart of Hampstead, Flask Walk. Take a left turn at the top of Haverstock Hill and suddenly you find yourself down an old cobbled street, little shops on either side of you and a feeling that somehow you have stepped back in time. On your left is an unassuming glass fronted shop with dark, dusty windows that look like nobody has cleaned them in months. Actually, scrap that, they haven’t been cleaned in years. Through the doors and down the rickety wooden stairs, you realise that you are actually in a bookshop. Keith Fawkes, to be exact, specialises in antique and rare books (with Dan Brown also surfacing occasionally, disgustingly enough). With sections ranging from the military to philosophy and literary classics to a music section, the shop really does do anything. My favourite book I bought from here was a suede-bound 1902 copy of Shirley, with an inscription that read “To our darling Daughter, Merry Christmas, Love Mother and Father”. After the mammoth book buying session, you obviously need a little refreshment. This is where the great ‘Slice of Ice’ comes in, an independent ice cream store, specialising in tasty ice creams which are both additive and preservative free. With a range of fla-

vours, plus chocolates and specialist teas available thanks to Tea Pigs, and all at a reasonable price, this makes it a nice quick stop. Three scoops of ice cream will set you back a measly £4. However, my favourite has to be their tiramisu semifreddi, a frozen dessert of ice cream on a sponge base, combined with fruit compotes or chocolate. So books and ice cream not really your thing? Really? Well, what else has this quaint little road got to offer? A few more strides up the road and you will come across ‘Mystical Fairies’ (Anyone pretending to be male may want to skip this paragraph). Full of wings, glitter and pink (yes, I used the word as a noun, not as an adjective) this shop truly is a haven for those who wish to relive their childhood experiences of pretending to be a fairy and having all their wishes come true. With children’s party hire available and ‘Fairy School’ being run during school holidays, this shop really is a young girls dream. The shop also supports the ‘make-a-wish’ campaign and GOSH. So, after all that airy-fairy (no pun intended) action, how do you round up your afternoon perusing one of the smallest streets in London? Why, with a pint at ‘The Flask’, one of Hampstead’s best pubs. With a range of cask ales and beer battered Fish and Chips coming in at a lowly £10.20, a nice evening can really be had by all

Flask Walk, NW3 1HE, can be found at the top of Haverstock Hill, next to Hampstead Station (Northern Line). For more info, check out www.slice-of-ice.co.uk, www.mysticalfairies.co.uk, and www.theflaskhampstead.co.uk

DOCTORS’ MESS

Strange Ways to Die Oliver Woolf Guest Writer

3. Empedocles: Jumped into a volcano

We’re all going to die anyway, so why not go out in the weirdest way possible? Meet the nine strangest ways to die...

Diogenes Laërtius records the legend that pre-Socratic philosopher Empedocles died by throwing himself into an active volcano (Mount Etna in Sicily), so that people would believe his body had vanished and he had turned into an immortal god! However, the volcano threw back one of his bronze sandals, revealing his ignorance. Another version has it that he threw himself in the volcano to prove to his disciples that he was immortal; he believed he would come back as a god among man after being devoured by the fire. Okay, it didn’t work, but here we are talking about him, which makes him immortal in a way.

1. J. G. Parry-Thomas: Decapitated himself breaking a speed record In 1927, the Welsh racing driver J. G. Parry-Thomas was trying to regain his own world land speed record that had been broken just weeks earlier by Malcolm Campbell on the same beach of Pendine Sands. His car, ‘Babs’ used exposed chains to connect the engine to the drive wheels whilst the high engine cover required him to drive with his head tilted to one side – the right. On his final run, he managed to set a new world record at 171mph but unfortunately, the right-hand drive chain broke, decapitating him in the process.

2. Steve Irwin: Impaled by a stingray Is it even possible to start a weird list about anything without the Crocodile Hunter? Steve died as manly as possible on 2006, while filming a documentary entitled ‘Ocean’s Deadliest’ in Queensland’s Great Barrier Reef. His heart was impaled by nothing less than a short-tail stingray barb. Of all the different ways to die, we can’t think of a weirder more ironic way. His legacy will impale us forever.

5. Eleazar Maccabeus:

8. Kenji Urada:

Crushed to death by a war elephant

Killed by a Robot

Here’s a guy with real balls of steel. During the Maccabean revolt, where Jewish people revolted against Seleucidic and Syrian rulers, Eleazar identified a war elephant that he believed to carry the Seleucid King Antiochus V - due to the special armour the elephant wore. So he decided heroically to attack the elephant single-handedly and thrust a spear into its belly. Yes, the dead elephant then collapsed upon Eleazar, killing him as well, but he remains a true hero for eternity. Good general advice? Don’t let life get on top of you.

After working on a broken robot at a Japanese Kawasaki plant, 37-year old Kenji Urada forgot to turn it off. Big mistake! The Robot woke up, said “hasta la vista”, and accidently pushed him into a grinding machine with its hydraulic arm. Okay, he died, that’s awful, but we’ll always remember him as the second man ever to be killed by a robot. The first, Robert Williams, got struck by a robotic arm; not weird enough for our list.

Killed by his coat Reichelt (alias the flying tailor) ingeniously decided to design an overcoat to fly or float its wearer gently to the ground like a parachute. So confident was he in his own tailoring skills that he premiered his invention by making a jump of 60 meters from the first deck of the Eiffel Tower, at that time the tallest man-made structure in the world. The parachute pathetically failed and he plunged to his ignorant death. Oh how the mighty have fallen.

4. George Richmann: Killed by a ball of lightning Yeah, that’s right. Richmann was a German physicist living in Russia. In 1753, he created a kite flying apparatus similar to the one built by Benjamin Franklin a year earlier. He was attending a meeting of the Academy of Sciences when he heard thunder, and ran home with his engraver to capture the event for posterity. While the experiment was underway, ball lightning appeared and collided with Richmann’s forehead. He died, but we’ll always remember him as the man who stood weirdly in the way of electricity.

9. Franz Reichelt:

6. Félix Faure: Killed by Sex In 1899, French president Félix Faure died of a stroke while in his office. Well, that’s the official story anyway, but it is popularly believed that he died in the arms of his 30-year-old mistress Marguerite Steinheil, whilst receiving oral sex. Au revoir!

7. Les Harvey: Killed by Rock and Roll Okay, so rock and roll has claimed thousands of lives, usually through overdoses or intoxicated accidents. But this is no way for a rocker to go. On 1972, Scottish guitarist of Stone the Crows, Les Harvey, was rocking his guitar on stage with his band at the Top Rank Bingo club in Swansea, and was electrocuted by touching an unearthed microphone with wet hands. Probably the saddest way for a rocker to go, besides growing old, of course.

Mutilated Medical Myths Abe Thomas Section Editor We’ve all heard the old wives’ tales and ‘common’ sense from a very young age. I wanted to see how many common beliefs are actually misconceptions. Here are some things you might know, and some that might surprise you…

We only use 10% of our brain...

This myth’s been propagated so much in movies like lawnmover man and the new movie limitless. In fact, studies in patients with brain damage have shown that damage to any part of the brain has specific and lasting effects on mental, behavioural and vegetative capabilities. And detailed microscopic and electrical analysis has shown there are no stop gaps between synapses and no area of the brain is completely inactive. Guess, we should probably stop trying to push our brain power into overdrive.

Crossword: Eponymous Syndromes

Hangover ‘cures’ Long before we all qualify and the inevitable cocaine addiction, medical students must first overcome the life affirming period of time known as ‘drinking nineteen pints of snakebite, texting someone to tell them you love them, and then defecating upon themselves’. Ideally, you’d disguise your behaviour by calling it ‘a bender’ or ‘a regretful love affair’ or ‘a normal medical education’. Of course call it what you will, but it will always end up with the same effects. You’re more grey than one of medusa’s victims and your throat feels like it’s been attacked by Edward Scissorhands on LSD. Of course those of the ‘lad’ denomination would tell you this is all good ‘banter’ and that you should merely eat a slab of raw sheep penis and drink half a litre of gin infused for three weeks with the blood of the club captain’s late great grandfather. These things however are probably less successful in curing the dreaded morning after than an American war between 1955 and 1975. When looking for hangover help, the worlds of fact and fiction get more blended than an ipod on youtube when it comes to how to deal with the affliction. Here’s some ‘cures’ I’ve come across.

Step 1. Water It seems the best place to start because, as far as I can tell, it’s the best way to defeat the enemy. Water before bed, water as soon as you wake up looking like Gollum on a bad hair day. All to negate the dehydration, which contributes hugely to your hangover. This is essentially the only sane advice I will suggest.

You shouldn’t mix alcohol and antibiotics You’ve all heard this from GP’s or mates who have had to grumpily stay sober. In fact, any interaction of alcohol with virtually all antibiotics is nonexistent, or so small as to be irrelevant. Metronidazole is the exception, with only small amounts of alcohol causing vomiting.

Wait 30 minutes after eating before swimming Admit it, we’ve all been scared to take the plunge and then get a cramp and drown. In fact, the

Robert Cleaver Guest Writer

Step 2. Thames Despite all of your immediate associations towards the great cholera spreader of ‘ye olden times m’lord’ this is not what it says on the tin. Combine a half pint of orange juice and a half pint of coke. Named, apparently because of the colour, after the bit of water that has got gradually brighter on the Eastenders credits since the 1990s, this apparently does the trick through supplying vitamins and caffeine. Of course caffeine actually causes dehydration and the OJ will only make the stomach acidity worse, so it was never really going to work.

Step 3. Paracetamol Everyone’s tried this one, and I guess to some extent it works. The fact it just makes your liver more tired than a child in a Bangladeshi slum is something you’ll overcome. Or eventually your liver will be as scarred as a 10 car pileup crash victim rolling around in bramble.

Step 4. Bacon Bacon makes everything better. Sex. A new lap record on Mario kart. Life, in general. It’s probably got no scientific basis whatsoever, but we all pretend that bacon helps your hangover. It’s a pleasure food thing, I guess. It’ll make you feel better because you’ll probably have something like water or orange juice to drink with it. Hence referring back to Step 1, which I kindly gave you first because if you’re hungover reading this, you probably already hate my stylistic musings upon body does divert blood to the GI system, but not enough to diminish muscle function and so we find that this isn’t dangerous for the vast majority of people. Obviously, if you were pregnant with muscle weakness, I wouldn’t recommend a Christmas roast and then swimming in rough seas.

Gum takes seven years to digest Well, the gum base in chewing gum is indigestible. But this doesn’t mean that it stays in your gut for 7 years. Gum comes out in pretty much the same shape it went down your throat. Chew on that bit of truth.

this topic.

Step 5. Mushed up Fish and Pickle Juice Sounds about as delicious as a rotting pig slow cooked in tomcat urine with umbilical cord pasta but people swear by it. Especially in Poland. They’re more about the pickle juice than the mushed up fish though. Both supply the body with all the minerals it will need to prevent the night before becoming the worst night of your life. Of course the ensuing vomiting the morning after will probably cause the following day to be the worst day of your life, so it’s pretty much swings and nausea inducing roundabouts. My personal method is a pint of water before bed, and two in the morning. It’s not definitive, as even I have experimented with it. Doing the same all the time can cause boredom and trialling such things as doritos, frijj, and masturbation can all help to beat the dreaded morning after. It seems to do the trick. It doesn’t reverse the problem; it’s just a stopgap between me, you and a long hard eventual fight for a liver transplant. So next time you’re drinking tobasco sambuca shots with a quad vod giving in to peer pressure, think about dirty river water and Polish pickle juice you could be consuming just to get to your final lecture of the day.

Feed a cold, starve a fever, cold weather can give you a cold This probably came about since you can lose your appetite fighting a fever based illness. But that’s perfectly fine as long as your fluid intake is adequate. And colds are more prevalent in cold weather when people tend to stay indoors, making it more likely to spread viruses via airbourne droplets when they cough or sneeze. You won’t see this in Kumar and Clark.

Across

Down

1. Commonly only one eye is seen, because of Trisomy 13 (5) 6. Anyone with this frenchman’s syndrome is likely to swoon at your feet (11) 7. From Noon an ‘til night this will cause dwarfism (6) 8. Due to mid-life neurodegeneration, hunting is not an option (11) 9. Short girls with webbed necks, because they lack one little X (6) 11. Hitler invaded and stole one of your pectoralis major (6) 12. A rare dissociative disorder is why you’re getting wrong answers (6) 14. An immortal, irish misfit that causes hypopituitarism as a result of necrosis (8) 15. An american entertainer most famous for saying ‘yeah’ but sadly those affected cannot see or hear him (5) 16. Commonly placed on the autism spectrum, a result of which results in no empathic reflection (9)

1. Misspelled British captain of the Enterprise leads to hypothyroidism (8) 2. Not costochondritis, as you can tell, when some of the costal cartilage swells (6) 3. Expensive clothing and male genitalia, not just a diet will cure you (11) 4. You may decline, but 1 in 1000 males has felt the effect of this extra chromosome (12) 5. The direction of this word gives a well-known syndrome (4) 10. Three lots of eighteen make fifty-four, and the chromosomal disorder that John saw (7) 13. Childhood abuse of aspirin will deliver, this syndrome and a large fatty liver (5)

S U D O K U

Look for the answers in next month’s paper!

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March 2011

Sport UH blast British Army Benjamin Faber Guest Writer

UH hockey Club.......3 The British Army......0 Each year the finest medical students the London Hospitals have to offer board the train at Waterloo and head to Aldershot to play in the annual UH vs Army Hockey match. This year was no exception. This was the club’s first match of the season; with plenty of new faces we knew it was going to be a tough game. Hew Torrance (GKT), this year’s captain, took a squad of sixteen men down with him on the 22nd February knowing full well his team were up against people who exercise for a living. The mind games began early, as we were being driven to the ground we were warned by the burly army driver “don’t mess with the Paras, we’ve got quite a few playing today.” The army were clearly very confident, though were “being screwed by Afghan” where their keeper was currently being stationed. Even so they were being coached by two time Olympian Guy Fordham who is now a doctor in the army, something which the United Hospitals could merely dream of. Straight after pushback, the army started to dominate possession and territory. For the first 15 minutes UH struggled to get any consistent possession, this being easily explained by the team having never played together before. The medics who had just spent an hour on the train after a hard day on the wards tired early but luckily the number of subs meant everyone kept working hard. The army had the first chances of the game but were mainly reduced to hitting speculative balls into the D. UH were working hard in defense, tracking their men, which meant that even though the army had most of the ball they were not threatening with it. The army won the first short

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Sports Editor: Jonny Jeffery sport@medical-student.co.uk

corners of the day, a sign of the pressure they were building, but they were kept at bay by confident saves from the medic keeper Dan Cromb (GKT). The umpire announced two minutes left of the first half and the medics at this point looked unlikely to be victorious. Those on the sidelines encouraged their team mates to hold firm until the break, when suddenly a break of brilliance occurred. Over the space of 20 seconds, quick passes and good movement had lead to the medics moving the ball from their own D into the oppositions goal. Fergus Catmur (GKT) finished the move well, taking the applause as the umpire blew for half time. The army looked stunned, in every department they had dominated yet some how they were going into half time down by one. After the break the medics seemed to gain in confidence, as the army seemed unable to break through. Once more a break-away goal came against the run of play, but it was fully deserved. Shifting the ball quickly between men, Tim Weeks (St Georges) finished the move off well. 50 minutes into the match and the medical students found themselves 2-0 up. Moments later it was 3-0, this time Ryoki Arimoto (GKT) was the executioner finishing off a move, which was a far scrappier affair than the last two. The Army continued to pressure for the rest of the game but never looked like they were going to score. The umpire signaled the end of play to the delight of the students who had pulled off a surprising, but well deserved victory. After the game, The Army were fantastic hosts, feeding us and making sure plenty of subsidised pints were available. As is traditional, those playing their first game for the club were initiated after the match, to the great amusement of the army. Matt Burden (RUMS) was voted man of the match after a fantastic performance at centre back and Hew Torrance (GKT) was given DoD for bringing two keepers. The only thing left to do was to get the train back to London, and the team managed to get the last tube home. The side now has their annual old boys game, University of London game and tour to look forward to

Image by Hew Torrance

UH Tennis

A season’s preview Jonathan Simon Guest Writer It may be cold and wet in London at the moment, but for those in the United Hospital’s tennis squad the preparation for the summer’s tennis season is already well under way. The United Hospital’s Tennis Organisation has been in existence for over 120 years and has been facilitating inter-medical school tennis

competition ever since its inception. The league matches they organise generally take place throughout the summer with each medical school competing in a men’s, mixed and ladies division. The current trophy for the men’s league, taken home last summer by Barts and the London, is similar to that awarded at Wimbledon and it is in fact older – being first awarded in 1912. The league isn’t the only form of competition though. Each year there are numerous invitational matches against the likes of Oxford and Cambridge as well as a one day mixed doubles tournament, which this year was held indoors at the Westway Tennis centre. This was a hugely successful

event both on and off the courts with nearly 40 medical students from the 5 medical schools getting involved. In the end it was the pair of Robin Vasan and Katie Groom from RUMS who triumphed over Adam Gunasekara and Siree Wongrukmit from ICSM. The event was followed with a sumptuous barbeque buffet helped along of course with copious amounts of good wine. Despite the fierce rivalries which exist between the constituent medical schools of the UH group, the fundamental aims of the tennis conglomerate is to get as many students playing tennis as possible. To these ends the club can look forward to what promises to be a great summer

Continued from back page rain intensified – far from ideal weather conditions when all you are wearing is a Lycra all-in-one. Spectators and members from the men’s crews trudged up to Kew Bridge ready to cheer the women on for the last third of the course. The race started on time (to everyone’s surprise) and the women’s boats set off one after another, snaking down the Thames towards central London. By the time the crews reached the spectators at Kew Bridge, the majority of the course was complete - although the last stretch is where the exhaustion really kicks in. ICSM 1st VIII looked very strong leading the pack down the river. This crew has remained almost unchanged for the last 2 years, during which time they have been unbeaten at the UH head. By the time the crews came under Kew Bridge the Royal Vet’s junior crew had already powered past Bart’s senior women and were neck and neck with the ICSM juniors. They went on to pass ICSM’s crew (last year’s winners) and finish with an impressive time just over 13 minutes which would give many male crews a run for their money. GKT novice girls were also having a good race, having passed two of the other novice crews with over a kilometer left until the finish. They finished the course 22 seconds ahead of the Vet’s novice girls, which have came top in both of the UH novice races held so far this year. However the UH Head marks the start of the Head season, where the races become longer and endurance and technique take over from brute power in being the deciding factors of success. As the last of the novice boats rowed off towards the finish, the men’s crews headed back to boat house to get ready for the men’s heats. Once the women had finished their races and rowed back to the boat house, they had the rest of the afternoon to sit through, before their times and the medal winners were announced at the UH dinner that evening. An annual black tie event for all the boat clubs held in central London. The men’s teams finished their last minute team talks and warm ups and set off up the river to the start line. The Great Britain under-23s boat was the first down the river looking very impressive

Totally oarsome: ICSM senior women

as they darted through the water effortlessly. After the invitational crews from the University of London boat club and UCL had passed, the UH senior crews began to pass under Kew Bridge. GKT have had a very strong season so far placing first in both the men’s and women’s senior divisions at the UH Winter Regatta and winning the senior men’s category at The Allom Cup. Their senior men were looking very strong today and sailed past one of the UCL invitational crews with ease. RUMS novice boys rowed an exceptional race, not only coming top of the novice category but clocking up a faster time than the men’s senior crews from Bart’s and the Royal Vets and all of the boats in the junior category (which was also won by the RUMS boat). This continues an excellent year for the RUMS novices who have remained unbeaten in every UH event they have entered so far this season.

“The vets were serenaded to the tune of ‘Old MacDonald had a farm’ as they collected their medals” ICSM also had a 4 man boat rowing in the 4’s category of the men’s division, in which they were the only entrant. These individuals, known only as ‘the banter four’, rowed the race seminaked (even more so than your average rower) and sporting a dashing array of headwear. They had the arduous task of finishing the race without capsizing or falling out of the boat in or-

Image by Chris Graham

der to win medals and, although it was touch-and-go and times, they just about managed to complete the course in one piece and place 1st in their category. Once the last of the men’s crews was over the finish line and back at the boat house there was time for a bit of postrace speculation about the results, as well as the customary team photos before everyone dashed off to catch the end of the England rugby match and prepare for the evening’s festivities. Later that evening once people had washed the Thames water out of their hair and made their way to Cape Bar in Bank, they were treated to what can only be described as the best food and drink that £25 can buy in central London. After the food, tensions were rising, as were the volume of the drinking games and inter-med school joshing, and so the Universities were gathered for the announcement of the winners from the UH captains. Teams collected their medals to the sound of rapturous applause, except of course the vets who were serenaded to the tune of ‘old MacDonald had a farm’ as they collected their medals for the winning the women’s junior category. After the medal ceremony the usual array of boat club debauchery continued late into the night and the crews eventually trickled home to enjoy a rowing-free Sunday to recover from their hangovers

For more pictures of all the crews that raced in the UH head check out The Medical Student Facebook page

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March 2011

Sport

Hockey: Med Students Vs the Military Page 23

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Tennis: Holding out for the summer Page 23

GKT senior men take gold at UH head RUMS boys dominate the novice and junior categories and ICSM women win again

Oargasmic: The GKT senior men stroke it long and hard

Jonny Jeffery Sports Editor GKT’s senior men rowed through wind and rain to emerge victorious in the men’s division at this year’s United Hospitals Head race, whilst ICSM’s women came top of the women’s division for the 3rd year in a row. RUMS novice boys

Image by Markus Sagmeister

rowed one of the most impressive races of the year, beating all the other novice and junior crews, as well as the senior crews from The Royal Vets and Bart’s. On Saturday the 26th February, The University of London Boat Club in Chiswick played host to the biggest inter-medical school boat race of the season so far; The United Hospitals Head. The UH Head is an annual boat race

that takes place between all 6 London medical and vetinary schools plus invitational crews. This year George’s, ICSM, GKT, RUMS, Bart’s and the Royal Vets were joined by invitational crews from LSE, Peninsula medical school, UCL and University of London. The GB under-23 team also entered the event and were there with their coach Sir Matthew Pinsent himself.

Each boat takes it in turns to race down the 4km course, which stretches from Richmond downstream under the bridges of Kew road and Kew rail, past the boat house to the finish line just before Chiswick Bridge. On the morning of the 26th, rain drizzled over the University of London Boat House as the teams began to arrive. Although there was quite a strong

side-wind to put crews off balance, the water itself was mercifully calm. The women’s divisions were the first to race and after they had checked and rechecked their boats, the commanding barks of head umpire ‘Jerry’ herded them towards the water. As the women’s crews rowed up to the start line, the

Continued on page 23

Google body explored

Varsity sex survey

Secret London

General surgery

Ali Hosin tries out revolutionary anatomy software Page 6

ICSM takes on Imperial in a battle of the bedroom Page 15

Robin Jacobs reveals London’s hidden gems Page 19

UCL holds national undergraduate conference Page 5