MS_October_2011 by The Medical Student

the

medicalstudent The voice of London’s Medical Students

October 2011

London for medical students Centerfold 8-page pullout

Westminster blocked NHS protests on bridge Page 4

Crisis Hits Medical Schools Katie Allan

Barts and the London Medical School are facing a dramatic loss of representation within the Queen Mary’s Students’ Union as a result of structural changes to their shared student council. These proposals mark just one episode in an ongoing trend to squeeze representation and recognition of the London medical schools out of their associated universities. The proposed ‘structural changes’ at Barts to the student council threaten to drastically reduce BL students’ representation. With the aim of cutting redundant roles and minimising the divide between students, representa- tives will be divided not by their campus, but into three ‘zones’ - academic, welfare and union. While there will be some campus-specific representa- tives, all other positions will be open to those from either site. Whilst theo- retically any of these places could be

held by BL students, resulting in them holding more than 50% of seats, An- drew Smith, a final year BL medic and student council member, questions the likelihood of this occurring. ‘It can be questioned what the chances of a BL student being voted in to a cross-campus position are, as they will undoubt- edly require votes from Mile End (QM) students too. W hile BL have a relatively high voter turnout, it is a fact that QM has an higher absolute turnout, based purely on student numbers. There is also the issue of differences in campaign time available;; this may be varied for a clinical medical student with hospital commitments, compared to a student reading another subject with only a few hours scheduled a week’. Historically, the two institutions of Barts and the London Medical School and Queen Mary University merged in 1994, as did their respective students’ unions - the active and well-established BLSA (Barts and the London Students’ Association)

and QMSU (Queen Mary’s Students’ Union) which, at the time, was struggling financially and had a poor infra- structure. It was recognised that the well-organised BLSA had a lot to offer, so the student council was formed with 18 students from each campus. Though BL students are dissatis- fied with the proposals and their im- plications for the autonomy of BLSA, it seems that they were made with good intentions – even BLSA President, George Ryan, concedes that they are ‘a step in the right direction’. However, they have failed to take into account that medical students have a different set of experiences than those studying other subjects. ‘A medical degree places bur- dens on students that no other course does’ says Gareth Chan, senior president of the RUMS executive committee. ‘What other course exposes its students to the realities of life and death? How many courses have timetables that start prior to 9 and finish after 5? The answer is none, and as a result medical

students have unique demands and re- quirements, and a medics’ union is best placed to deliver the services required’. However, at GKT there is a bleaker picture. Other medical schools in Lon- don have their own union acting as a largely independent branch of their ‘parent’ union. Unfortunately, there is no such body at GKT and all students are represented solely by King’s Col- lege London Student Union (KCLSU). There are only three clinical health rep- resentatives on a student council of 50, and specific representation for the medical school. To fill this void, MedSoc was formed to replace the GKT Stu- dents’ Union which was absorbed into KCLSU. Though MedSoc is very active, it is administratively just a society like any other within KCLSU. It is af- forded no greater importance or influ- ence than, for instance, the wine-tasting society, despite being the voice of over 2000 students. By extension, GKT remains the only London medical school (cont’d on page 2)

Health and safety - the danger of doctors Page 8

Trial by tube - TFL woes for medical students Page 12

Human Art - interior design on a body Page 14

October 2011

News

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

Mark A Shimmings GKT Medsoc President A warm welcome to all those starting medicine this year, especially those who managed to get into the finest hospitals of Guy’s, K ing’s, and St Thomas’! Freshers’ Fortnight has been a great success, with every event sold out and everyone having a good time. Com- ing up we have medics’ tour, 999 and the Halloween Party. If they keep up their enthusiasm for debauchery from the last couple of weeks then we can look forward to a successful RAG. If not, we can always rest assured we’ll raise more money than RUMS. Speaking of RUMS, they have been rather quiet on the MedGroup front.... too quiet. Word on the street in is that once again they plan on boycotting 999 in favour of a good night’s study and sleep. RUMS just doesn’t quite cut the mustard when it comes to extracurricu-

Editor-in-Chief John Hardie on a new term for the Medical Student

lar gusto. In fact, I have seen so little of RUMS in the last four years of medical school that it is quite hard to find much to mock. Perhaps the rumours are true- they are just as boring as everyone else at UCL. That being said, we have to be nice to those studying at the ‘God- less institution on Gower St’, otherwise we would start sounding like King’s students, which would be abhorrent

George Ryan BL President Why is the Barts Student Association the finest in the land? For those of you not privileged enough to be a part of our institution, we have own Student Association under which are our clubs, societies and charities stand. People who play sport for our clubs are f iercely proud to be representing Barts, societies put in hours of work to provide events, talks, debates and shows for our students and RAG raise more money than all of your medical schools put together. To the freshers who have just ar- rived, welcome to the next 5, 6 or 7 (if you’re hard) years of your life. To the oldies who have survived thus far, keep it up. At the moment it all sounds like fun and games but as they say - work hard and play harder. Barts recently scored 94% on student satisfaction in last year’s National Student Survey and

it wouldn’t be appropriate, so we won’t mention it here in any form whatsoever. This month, the issue of student representation has been pushed to the fore- front with the reduced numbers of medical students being allowed to sit on student union committees at GKT and Barts ( page 1). This follows the attempt- ed ban on medical school sports teams at the British University and Colleges Sports annual conference (page 12). We’ve produced the essential guide to the best places to eat, drink, dance, and visit in our ‘London for Medi- cal Students’ guide. Our writers have scoured tirelessly to locate the top spots for medics to whittle away their student loans between lectures and clinics.

Oh, and there’s also a quality arti- cle about Japanese toilets as the future of patient-centred care. It could be vital to your medical career. Seriously

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came second in the country in the Foun- dation Programme Application System scores. It’s no coincidence that last year’s graduates were also such an active part of our student body. Barts will be bringing along the strongest contin- gent of students to 999 for the second year in a row - I look forward to seeing you there, except RUMS students, for one of the biggest nights of the year

Nana Adu SGUL President Hey all. Georges like most other Uni- versities has just undergone Freshers, it was completely epic. We undertook one freshers for postgraduates and another one for undergraduates. Some how, we made it through. Currently I have got “Freshers Flu” despite my attempts to dress warm and generally avoid anyone who coughs. Our next tasks include 1st year rep elections and selling more 999 tickets than anyone else *cough* unlike some *cough*. This year our team is hoping to build upon the work of last year’s union, who did a fantastic job. The idea is to main- tain our great relationship with the university, be more inclusive to all, solve many of the past issues, refurbish the school shop, and leave an insurmount- able legacy. Our blueprints are secretly stored on a password encrypted USB,

Why do medical students make such excellent journalists? The reason is simple – the prerequisites for journal- ism bear a high level of resemblance to those for medicine. Namely, the utmost standards in moral and ethical reasoning. In clinical situations, medics face tough decisions, which could profound- ly affect the lives of their patients. Here in the Medical Student office we’ve been deliberating over the moral and ethical appropriateness of the pub- lication of a certain story. This includes intimate accounts of the conduct of a female Imperial medical fresher, namely the pleasuring of a male Imperial medical fresher on the dance floor at an of- ficial welcome event. Twice. Obviously

within a safe that’s within a safe, ap- proximately 15 minutes away from our local chicken shop (in other words it’s still to iron out). Hopefully this year we will also achieve well for our students and continue to work with other universities in events similar to 999. So in summary: we are alive, freshers have the flu, 999 will/has been awesome, and the future looks bright

(cont’d from front page) that does not have a sabbatical position for the medics’ union president. The current MedSoc president, Mark Alexander Shimmings, feels strongly that this is detrimental to GKT students - ‘Cur- rently, MedSoc presidents must balance the pressure of clinical years with their duties and responsibilities to the medical school, which inevitably means that our MedSoc cannot perform to the level expected at most schools’. It should not be forgotten that medical students tend to contribute more to university life than their peers in the humanities and arts. At KCLSU, for instance, 70% of students involved in sports and societies are from GKT. The huge fundraising efforts of RAG, almost exclusively by medical students, are also significant. There is clearly something within medical students that makes us want to get involved and contribute to our community - it’s not unreasonable to suggest that it is the long tradition of such activity within

the

our medical schools that motivates us to do so. Therefore, the current move towards a shared university brand and identity runs the risk of medical students losing this community spirit, with profound effects on student activity. National organisations, higher education institutions, and students’ unions have been working to quietly dismantle medical students’ community identity. Regardless of whether decisions have been made with ‘good’ or ‘bad’ intentions, they have been made without our consultation. So what should we do to prevent further threats to our community and traditions? Medical students across the country have already started taking action this summer and have put aside their differences to fight a common enemy - BUCS. British Universi- ties and Colleges Sports surreptitiously proposed a motion that would seriously jeopardise the future of medical school sports. Hidden in a footnote of an appendix, lay a short but serious proposal - to

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@msnewspaper do away with the ‘anomaly’ that allows ‘former’ medical schools to compete independently of their associated universities. Thanks to a passionate campaign driven by students, the motion was re- tracted, allowing medics to retain their own teams for at least another year. According to Andrew Smith - ‘when one thinks of the changes that have happened to the London hospitals over the last hundred years, it’s safe to say that history and tradition needs to be protected. We all have a responsibility to rally our respective universities’. This sentiment is echoed by Gareth Chan - ‘In the face on ongoing attempts to erode our identity, medical students need to stand together and cross traditional battle lines between rival schools to ensure that our individual representation is maintained for the next century - if we don’t we would be turning our backs on centu- ries of history that forms not only the basis of our medical schools, but what it means to be a medical student’

Editor-in-chief: John Hardie Assisstant editor: Amrutha Sridhar News editor: Ken Wu Features editor: Bibek Das Comment editor: Rhys Davies Culture editor: Robyn Jacobs Doctors’ Mess editor: Rob Cleaver Treasurer: Alexander Cowan-Sanluis Sub-editors: Martha Martin, Giada Azzopardi, Kiranjeet Gill, Hayley Stewart Image editors: Chetan Khatri, Purvi Patel Distributing officer: Sevgi Kozakli Consultant editors: Sarah Pape, Neha Pathak

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October 2011

News Gareth Chan RUMS Senior President

St George’s Freshers Go Disco Crazy Maria Butt Guest Writer It’s hard to know where to begin really, but I guess the meet and greet is a good place to start. It’s a nice way to ease you into the next t wo weeks of no sleep, constant parties, and the occasional cadaver. After this rather relaxed start, everything kicks off with St George’s infamous ‘Back-2-School’ Disco. One last chance to don your school colours but in a much more ostentatious manner. School ties, geek glasses, short skirts. What’s not to love? This long- standing tradition transcends several generations of George’s students;; there were probably more second and third years than actual freshers this year! George’s discos bring out the crea- tive side in most people e.g. the boy dressed as a dinner lady at ‘Back-2- School’ and the girls dressed as Te- quila at ‘Toga and Tequila’. Now toga and Tequila are two words which are

not often seen together, but George’s proves time and time again that it is a winning combination. This year our most original disco was ‘Jungle-Bub- ble-UV’ disco, an amalgamation of ideas that ticks all the boxes. Trippy and wild at the same time. There was even the added bonus of free burgers at the end of each disco for freshers. Hopefully this will be a new tradition! As well as discos, George’s offers a variety of other experiences for freshers. Band night gives everyone a chance to show off their skills and trust me, George’s has talent. Multicultural night allows people to share a piece of their heritage through that common love that u nifies all cultures: food. Eve- ryone volunteers to make (or order) their own authentic cuisine, sharing a taste of their background and basically providing the freshers with a free meal. Despite all the crazy events, the real appeal of George’s is the family aspect with its Mums and Dads scheme. Now, Mums and Dads is commonplace

amongst universities with medical students but at George’s it’s a proper family network. Wandsworth 8 is a pub crawl which epitomizes this sense of family unity as one is literally tied to parents, uncles, aunts, grandparents, great-grandparents etc. and made to walk around Wandsworth. It’s all fun and games until someone needs the toilet, which for many, many rea- sons I will leave to your imagination. The Freshers’ Ball took place at C- Bar in central London this year, giv- ing students a chance to end Freshers Fortnight in style. The only event that is solely for f reshers, the ball provides a chance to get your glad-rags on and see your fellow f reshers d ressed to impress. Admittedly, it is often a bit strange seeing those same rugby lads that get naked at every one of those George’s unique discos in tuxedos. Coming to university is a massive deal for everyone but here at George’s it’s not like you’re leaving home but more like you’re gaining a whole other family

Thus begins another year! These are exciting times here at UCL where change is the theme;; UCLU has just become incorporated and RUMS have moved into our new £5million home. With the increase in tuition fees rapidly approaching, we must now start to work closely with the universities to ensure appropriate safety nets are in place for the most vulnerable. Hopefully, this year will prove to be another exciting year at all medical schools in London. There are life’s certainties;; UCL beating King’s again in the league tables. However, we must stick together to fight schemes that would destroy our heritages, such as the attempt by BUCS during the sum-

mer to prevent the fielding of separate medical sports teams. We are also seeing our sports teams competing against each other at ever increasing standards and frequencies raising the pro- file of medical schools across London. May we hope that 2011/12 proves to be another excellent vintage

Suzie Rayner ICSM President I am writing this at 3.34am. I am walking home (for those of you unfortunate enough to live in Lambeth/Camden I know the risk of stabbings makes this an alien concept) from the ICSMSU Freshers’ ball at K ing’s club. All the kebab shops are shut. Whilst this is clearly devastating for me, I take this belated wander as a sign of an excellent night. Each year ICSM spend 2 weeks trying to show our freshers that we don’t just love science and textbooks and that the medics break the Imperial mould in both the male:female ratio and in student satisfaction. I am quite content to say that so far this year we have suc- ceeded. This is not only down to our fantastic Ents team of Mitul, Lauren and Odhran, but also to the hugely enthusiastic fresher intake this year. Over the summer ICSM has been revamped from all sides, with a new

exec. team, a refurbishment of our student common rooms across 3 sites and a redesign of our website (icsmsu.com), which is now looking fantastic thanks to the hardwork of Pete, Steve and Neeraj. My year in the job started by working with Medgroup to stop the BUCS proposal to merge medical teams into the main university team in July. We will continue to watch out and work with IC Union to protect our clubs and prevent this from happening in the future

Jeeves Wijesuriya UH President

!*#!%* Yeah! Image by Yuanchao Xue

Have a Freshers’ story? Write to us at news@medical-student.co.uk

Hello! My name is Jeeves and I am the new UH president. I am a medical student at Barts and was the SU president two years ago (try not to hold that against me!). For the last two years I have also been a dedicated member of the UH Medgroup committee, a team of presidents and senior exec. committee members f rom each of the f ive Lon- don medical schools. We work on the representation of all London medical students which includes r unning events such as 999, running campaigns and representing our students collectively with the BMA, BUCS and other large bodies. We have always been an active voice and t ried to help improve the lives of all medical students by helping their presidents in their new roles and trying to change services available to students across London and the country. This year we have relaunched UH, returning to our historic name and

logo. More than that, the new presidents, committee and I are passionate about increasing not only our activity at each medical school, but to be a more vocal force for the good of our students. As chair, I will fight for the needs of our medical students, their student unions, respective identities and history and build on the good work of my predecessors, who were bril- liant despite some of their unlikely Imperial and RUMS origins!

October 2011

News

Research in brief

Bridge over troubled NHS

ICSM: Removing cholesterol from the membrane of HIV stops the virus from triggering the innate immune system, allowing a stronger reaction from the adaptive immune response. Researchers used betacyclodextrin to remove cholesterol, leaving large holes in the virus envelope. This permeabilised virus could no longer activate pDCs but was still recognised by T-cells, which were able to combat the virus more effectively.

John Hardie Editor-in-Chief Westminster Bridge was blocked last Sunday by thousands of protest- ers demonstrating against government changes to the NHS. Medical students, doctors and nurses were amongst those taking part in the demonstration, which was organised by the anti-austerity group, UK Uncut. The bridge links St Thomas’s hospital, part of the King’s College London university hospitals of Guys, King’s and St. Thomas’s, with Parliament. As Big Ben struck one, nearly 3,000 activists prevented traffic from passing over the bridge.

RUMS: Promoting the production of nitric oxide may help critically ill patients to adapt to hypoxia. The study analysed blood samples collected from the participants of an expedition to Mount Everest, and discovered that NO production and activity rises with altitude, increasing the body’s ability to tolerate low oxygen environments by increasing blood flow in capillaries.

“By blocking Westminster Bridge we symbolically block the bill from getting from Parliament to our hospitals” Clock-block. Image by Nicholas Middleton Demonstrators covered in fake blood played dead, performed mock operations in scrubs and played broadcasts of hospital radio through the political centre of the UK. The roads were not reopened until as late as 4.30pm that afternoon. The protest proceeded peacefully, with the party atmosphere continuing throughout the afternoon. 64 individuals were held on the bridge by the Met- ropolitan Police in order to request that their disguises were removed, but no other police intervention was reported. UK Uncut urged supporters to ‘Block the Bill, Block the Bridge’ ahead of the coalition’s Health and Social Care Bill moving to the House of Lords - ‘By

blocking Westminster Bridge we symbolically block the bill from getting from Parliament to our hospitals. Yes, it will be disruptive. Yes, it will stop the traffic. But this is an emergency and we have to shout as loud as we can’. The protests were ahead of the vote on Wednesday, in which the House of Lords accepted the controversial bill. The peers debated the bill containing the hundreds of amendments made since the ‘listening exercise’ over the summer months. An amendment to block the bill entirely was rejected by 354 votes to 220. Labour peer and former GP Lord Rea proposed the amendment, arguing that the bill was never a mani- festo commitment by either the Con-

servatives or the Liberal Democrats. Peers voted 262 to 330 against another amendment, which would have referred parts of the bill, dealing with competition within the NHS, to a special select committee. Lord Owen and Lord Hennessy proposed the amendment, which would have allowed a greater number of witnesses to put forward their views, but may have delayed the acceptance of the bill until April 2012. Health Minister, Earl Howe, said that any vote to delay ‘could well prove fatal to the Health and Social Care Bill’. Demonstrators on Sunday were particularly concerned about the steps to privatisation that they perceived the third part of the bill might allow. They

cited the United States health system as putting commercial interests above the interests of the patient. One trade union member said that ‘you only have to speak to those across the pond to see the detrimental effect that money-focussed corporations have on the health and wellbeing of the people’. Future doctors were equally out- spoken - ‘I think it is important for medical students to make their voice heard’, said Stephanie Green, a third year medical student from GKT. ‘Stu- dents from King’s are often on place- ment at Tommy’s (St Thomas’s) Hospi- tal with Parliament just over the road - I think we should show that we do care about what happens to the NHS”

United Hospitals reboots, rebrands and relaunches Ken Wu News Editor United Hospitals Medgroup (UH Medgroup), an umbrella organisation representing the five Lon- don medical school of ICSM, GKT, RUMS, Barts and St George’s, has relaunched itself for the new academic year. It has shed its old image and logo of ULU Medgroup and has re- branded itself with a new logo, which pays homage to the traditional union shared by the London medical schools, and a new mission statement. As mentioned in the February issue of the Medical Student, the current medical schools in London actually started out as 13 separate medical schools, which were all united under

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the United Hospitals organisation. A series of mergers in the late 20th Cen- tury has resulted in the ‘Big Five’ Lon- don medical schools that we have today.

“This year we have relaunched UH, returning to our historic name and Logo” The mergers were initiated to streamline teaching and hospital services, resulting in a more efficient and economic system. More problematic was the enforced absorption of each school into a larger university, leaving medical students in a state of identity crisis. UH Medgroup are now attempting to recreate that special bond shared by

the medical schools and prevent any further loss of tradition or identity. Not only will they do this on a student representation and political level but they will also promote more social harmony and integration between the students. This includes the successful running of big inter-medical school social events such as ‘999’ in October and ‘Adrenaline’ in February. The organisation also works to protect the welfare of the medical students and their student unions, especially through London-wide campaigns such as the summer campaign against the BUCS proposal to prevent medical school sports teams from competing in the league. More attention will also be drawn to other inter-medical school events such as the UH Cup, the UH Revue and

the traditional competition of RAG. The committee of UH Medgroup consists of the current and ex-Presi- dents of each student union, the Co- Chairs of the BMA, the Editor-in-Chief of the Medical Student newspaper and other student union officers from each of the medical schools. The current chair is Jeeves Wijisuriya, an ex-Pres- ident of Barts and the London Medi- cal School. Jeeves has stressed the importance of Medgoup in the medical school community, saying that ‘This year we have relaunched UH, returning to our historic name and logo. More than that, the new London medical school presidents, Medgroup committee and I are passionate about increasing not only our activity at each medical school, but to be a more vocal force for the good of our students’

BL: Researchers have successfully used microparticles containing the chemotherapy drug paclitaxel to reduce ovarian tumours in an animal model. The microparticles contain a protein called CD95 which attaches to the CD95 ligand, commonly found on cancer cells. The microparticles are ingested, delivering a powerful drug dose that reduced tumours by 65 times more than the standard method and has the added benefit of being targeted specifically towards the cancerous cells. SGUL: Early results suggest that the tuberculosis vaccine, BCG, could be used to enhance the activity of cancer therapies. In vivo, cancerous cells are often able to masquerade as healthy cells and thereby evade the immune response, but these new in vitro studies showed that BCG can increase the production of cytokines, which help the immune system to detect tumour cells as ‘foreign’ so they can be killed. GKT: Vitamin D deficiency may cause structural changes in smooth muscle that exacerbate symptoms of children with severe therapy-resistant asthma (STRA). This group comprises 5-10% of asthmatic children, who do not respond to the standard treatment of low dose corticosteroids. Children with STRA were found to have poorer lung function and increased muscle tissue mass when compared with moderate and non-asthmatic controls. It is hoped that treating this deficiency may reduce symptoms and improve overall lung function in children with STRA.

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October 2011

News

Diary of an FY1 Junaid Fukuta gets dizzy on the surgical rotation

our months in and I am on my last ward round of my first attachment. It goes as usual with the end of the ward round ‘time to see the outliers’ coffee break when my consultant says: ‘you run a tight ship’. Then there was a pause…I was waiting for the inevitable take down, but it never came. Four months have flown by and I have started to feel like I know a little bit of what I am doing, and there is a sense of nostalgia that day;; I will miss the mothering nurses who ask about my antics at payday, the younger nurses who are involved in my antics at payday, the patients who have lost their memory so I introduce myself everyday and boy will I miss that really cute physio who I know is already engaged. There is nostalgia in the air because tomorrow, as in every hospital in the UK, the station master of the great steam train NHS will call ‘all change

please’, and all the FY1s will switch to their second rotation, and my next station stop is surgery.

“Being the FY1 is often akin to being everyones bitch: all we need is to convert our stethoscopes into a gimp collar and that would help distinguish our role from every other doctor in the hospital” I was warned that the surgical ward rounds are a lot quicker than the medical ones, the main theory being that the surgeons need to get to theatre to play with all their power tools by 9:00. So

I turn up at 7:45 in the dead of winter with my feet numb and icicles on my eyebrows and am confronted by a list of 8 TTAs to do, and this is before I have even met the patients or my team. Then at 8:00 the surgical team arrives and then takes us on a flurry to see all 24 patients on the ward in what seems like a blur. The first patient is seen in a whopping 31 seconds. I don’t even have time to open the notes let alone write them in when we are moving onto the next patient. Tests, bloods, CT scans are all being thrown in my direction and I have completely lost the plot as to who they are for or why we are doing them. I am holding four sets of notes when a nurse taps me on the shoulder and points out helpfully that one of the patients has collapsed on the floor. I stare at her with an obvious ‘I have no hands free currently and could you not ask the 3 doc-

tors in front of me to take a look’, but she does not flinch and just points again. I dump the notes on the floor and go to assess the collapsed patient;; she is fine but it did take a while for her to get up. I tag onto the end of the ward round and then I am confronted by a scene akin to a speedy Gon- zales cartoon where paper is flying in the air as the team make a hasty exit to go to theatre. The key to a surgical ward is high turnover: more patients in and out of the ward means more operations, which means more money. Therefore the nurses are discharge-crazy. TTAs become the number one priority and by midday I have already been asked 27 times whether I have completed someone’s goddamn TTA. Now for those who do not know what these are, you will soon learn to hate and loathe these. Basically it is a prescrip- tion of the patient’s drugs plus a summary of the patient’s stay in hotel NHS. So ideally you com- plete this when you know your patient. However I often find myself only knowing why a patient has come into hospital while I am writing their paperwork to discharge them. Everyone is focussed on getting people out of the hospital so we can fill it up again with more people, so I end up writing the briefest of summaries on each patient. Being the FY1 is often akin to being everyones bitch: all we need is to convert our stethoscopes into a gimp collar and that would help distinguish our role from every other doctor in the hospital. With the SHOs, registrars and consultants in theatre, you are the only doctor on the ward and therefore you are constantly being dragged in every direction as everyone wants a piece of you. At one point on that first day I had a queue of a physio, pharmacist, nutrition- ist, speech and language therapist and two nurses waiting to speak to me. It looked like some grand book signing but all I was signing up to do was more jobs. I miss lunch to plough through TTAs and at 18:30 I have miracously finished everything, but realise with a sudden pang of frustration that I have not actually spoken to a patient all day. I have been so busy discharging them and discussing them with other specialities that I have not actually spent anytime with the people I was supposed to be looking after. Change is always hard, but it is usually for the better no matter how hard it is for me to see, especially on that day

Signing my life away. Image by Chetan Khatri

Calendar of Events

BL Medgroup 999

GKT Medgroup 999

ICSM Medgroup 999

17th October

19th October

22-23rd October

19th October

2nd November

31st October

21st October

William Harvey Day Student Staff Conference BL Music Freshers Concert

3rd November

Auditions for BLSA Show

7th Novermber

Medic’s Tour

Halloween Party

Christmas Comedy Revue

30th November - 2nd December

17th October

Graduation Day OXJAM Festival

RAG Halloween Collect

25th October

Freshers’ Plays

11th November

RUMS Medgroup 999

17th October

SGUL Medgroup 999

17th October

October 2011

Features

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

Not being Dr Kelso - why the good doctors should be in charge

Not the ideal leader.

Eric Edison & Sam Oxley Guest Writers There is a perceived cultural divide between those on the f ront-line doing their best to treat patients, and those in the back office undermining their clinical autonomy by making resource-based decisions that limit their practice. This is an outdated and even irresponsible point of view. The Mid-Staffordshire disaster, where attempts to cut costs led to failures in care, neglect and humili- ation of patients, was an almost inevitable consequence of this dichotomy. Lessons must be learnt and the fu-

ture of the NHS lies in co-operation between doctors and managers, with doctors in charge and leading the way. To do this they will need to acquire leadership and management skills and experience as well as medical knowledge. In fact, these are now assessed at application to core and speciality training posts. But what is medical leadership, why is it important and how can students stay ahead of the game? Medical leadership is not just about the personal qualities of a select few in charge. It is about the medical profession driving forward improvements to healthcare services, rather than have these forced upon them. All doctors, whether junior or consult-

ant, with their superior experience on the front line, should be able to identify situations where things could be

“Leadership is the capacity and the will to rally men and women to a common purpose, and the character which inspires confidence” - Field Marshal Bernard Montgomery done differently, and have the initiative and the skills to improve them.

This is less about individuals and their character traits, and more a dissemi- nated professional attitude, much like the duty to make the care of your patients your first concern. No doctor should ‘leave it for others to sort out’, when they see an area affecting their patients that could be improved upon. Management on the other hand, involves simplifying and organising processes to maximise the potential of an organisation. It is well accepted that doctors are expected to manage their time and the team around them. It is also becoming increasingly important that they manage resources. Consider yourself in a couple of years as a junior doctor in A&E facing a

patient with a head injury on a Saturday night. Can they be discharged? Do they need to be kept overnight? Do they need an urgent CT or surgical consultation? The decision will be based upon evidence of clinical benefit and outcomes but also on cost-analysis and resource- based considerations. For example, is it possible to get a CT scan now? Are there beds free? The point is this management of resources is not beyond the realm of medicine;; it is central to what we do as doctors, and vital to patients. There are often situations where management decisions are impeding clinical practice – often the result of management and clinicians not communicating effectively. These issues

medicalstudent

October 2011

are reported in the news time and again. The most famous case was the Mid Staffordshire Inquiry where hundred of patients may have died because of management that was focussed on cost-cutting and hitting government targets. It is easy to blame the efficien- cy drive itself for these failures but in a struggling economy with rapidly rising healthcare costs we need to provide good services more effectively in order for the NHS to survive. The key problem was that managers and clinicians were not communicating effectively. Front line workers need to have a say in how the services they run are provided. It should not be left to others with no medical background to determine clinical practice. Of course there is a role for dedicated managers, but medical engagement is necessary. There should be no ‘us-and-them’ mentality, only a common desire to maximise and improve our services for patients.

“In a struggling economy with rapidly rising healthcare costs we need to provide good services more effectively in order for the NHS to survive” Indeed, the recognition that more must be done by the medical profession is having a significant impact on the training and assessment of doctors and medical students. The Medical Leadership Competency was devised to be a national-tool for training and self-assessment, in which all doctors should demonstrate proficiency. To be certified an effective and safe doctor in the UK, it will be necessary to at- tain competencies in management and leadership as well as clinical skills. As well as generic skills all doctors need, there are skills specific to different specialities. For example, surgeons need to understand the pathways of patients through pre-op, theatre and post-op recovery and how these can be optimised. Hospital medics need to take responsibility for the safety and quality of care in the wards where they work. GPs need more specific management skills in the day-to-day running of practices and proposed reforms suggest they could be in charge of local budgets, controversial though this is. Given the importance placed on leadership and management skills, it is surprising how few medical students are aware of the concept at all. Some are even hostile to the idea, holding an- archic preconceptions of ‘going over to the dark side’ by thinking about management. Not only should students be considering how to bolster their port- folios in this domain, but students can take on leadership roles even during their training. Medical students are in a unique position to capitalise on their ‘outsider’ role, and spot what others may miss. These can lead to opportunities for quality improvement

Features projects which aim to improve patient care as well as offering opportunities for those much-coveted publications.

“Given the importance placed on leadership and management skills, it is surprising how few medical students are aware of the concept at all” For example, students at UCL are as- signed projects to follow a patient with a chronic illness over the course of their first clinical year. One such student noticed that there were certain recurrent problems encountered by patients on their journey. A project is now under- way to improve certain aspects of the patient pathway. Students notice these things every day and should be brave enough to be an advocate for patients. Support for this project is being provided by a society recently set up at UCL. Several medical schools now have their own ‘Medical Leadership and Management’, or similarly named society. Young Civitas for Medics is an independent group supported by the think-tank Civitas that provide debates and talks around clinical governance.

“Students...should be brave enough to be an advocate for patients” These groups are working together to send the message to students that Medical Leadership is a fundamental aspect of our training and careers and is important for patient care. As well as portfolio accreditation, there are opportunities to get involved and get published for projects that will have a real impact on patients. The Medical Leadership Network is a new initiative launched this year which will bring together students with senior doctors, managers, researchers, and others. The aim is to pair those who have projects with those willing to give their time to participate in one, and to provide help and support for those with ideas to realise their plan. It will also help those looking to organise SSCs, or work experience with professional firms. The medical profession in the UK is at a turning point, where more is required to constantly improve services to patients. Patients demand it, and the medical profession has a duty to deliver. Doctors must accept the leadership responsibility which goes with clinical freedom, or risk their autonomy and status as providers of quality healthcare. As medical students, we can start thinking about this now, in order to not be left playing constant catch-up with patient’s expectations. Doctors should lead improvements for the healthcare of their patients, and not let themselves be led by others

William ‘Slasher’ Harvey Dave Vedage delves into the genius of this Barts physician

Demonstration of the venous circulation from Harvey’s ‘De Motu Cordis’.

odern medicine has its roots in the scientific method, and its defined technique of method of enquiry has revolutionized the conditions under which we live in modern times. This revolution began on a small site in West Smithfield at the Royal Hospital of St Bartholomew, pioneered by the work of William Harvey in 1628 in his magnum opus, De Motu Cordis, from which emanated one of the most significant advances ever made in medical and biological sciences, the discovery of the circulatory system of the heart. This was the dawn of the modern scientific era, when the humanism of the renaissance began to evolve into the rational and empirical approach of the age of enlightenment and during the en- suing 17th century Harvey led a grad- ual transformation in medical thought away from the classical principles. William Harvey, described as a humorous but extremely precise man studied medicine at the famed Uni- versity of Padua in Italy. It was here that the foundation of his knowledge of the anatomy of the veins was laid and where he gained an interest in the movement of the blood in the body, and most probably an ap- preciation of scientific investigation. On his return to England, Harvey worked at St Bartholomew’s Hospital as an assistant physician, later becoming physician there in 1609 until 1643. During this time, there were no ‘labo- ratories’ for experimentation attached to a hospital but Harvey certainly had something of the kind, probably in his own house. This was a couple of centu- ries before his time and was where he accordingly set about the dissection of the human cadaver and of every kind of living organism which he thought might help him to gain knowledge, beginning with mammals so that the rapid heart

movements could be seen in slow motion. From this pioneering work in the employment of comparative anatomy to elucidate human anatomy, Harvey proceeded to deal in a logical manner with the various difficulties in following the course taken by the blood. Harvey also measured the capacity of the chambers of the heart and calculated their output, this being the first instance of ‘quantification’ in physiology. Harvey’s discovery was perhaps all the more remarkable because he had no means of demonstrating the minute details. This skilled and ingenious investigation led Harvey to discover the se- quence of this mechanism of the heart.

“Harvey’s discovery was perhaps all the more remarkable because he had no means of demonstrating the minute details.” His acute mind appreciated spon- taneously the value of direct experi- ment and inductive reasoning for the resolution of fundamental problems in physiology such as the properties and movement of the blood in the animal body. All this would be called ‘research’ today, but such a concept did not exist until Harvey laid the foundations for systemic scientific investigation, foundations on which all research since then has been based. Harvey un- derstood the practical means to har- ness natural science to the service of mankind and carried it on into the field later to be known as ‘physiology’, and this was to lead to the full and trium- phant elucidation of the basic problem of the circulation of the blood. De Motu Cordis quickly became

known for its rejection of traditional methods. It was viewed as challenging the traditional system of deduc- tive reasoning, advocating experimentation and sensory experience. It set forth clearly and concisely a new concept of the anatomy and physiology of the animal kingdom based logically on ocular demonstration of the truth of each detail of the vascular system, and set for all time the pattern of scientific investigation. The physician to St Bartholomew’s had provided not only the basis for a new concept of human physiology, but had also shown how scientific research should be done. Harvey’s other accomplishments also include being the first to suggest that humans and other mammals re- produced via the fertilisation of an egg by sperm and in addition to his hospital duties and his extensive private practice which climaxed with his appointment as ‘Physician Extraordi- nary’ to King James I and later King Charles, Harvey became deeply involved in the affairs of the College of Physicians, to which he was in- tensely loyal until his death in 1657. Today, Harvey’s legacy lives on through his accomplishments and his name being given to the Barts and The London annual research showcase day and laboratory centre at Charter- house square as well as a hospital in Ashford bearing his name. Harvey’s brilliance in his search for scientific truth made him the leading medical scientist of the 17th Century and the founder of modern physiology. Indeed, the way in which Har- vey tested his ideas and accumulated quantitative data to support his find- ings was arguably just as important to the development of medicine and science as the discovery itself and thus must rank amongst the most influen- tial men in London hospitals history

October 2011

Features

medicalstudent

Whatever happened A License to Kill to bedside teaching? Zoya Arain investigates the impact of the EWTD on clinical teaching

he practice of bedside teaching has evolved from the dawn of clinical medicine and is considered crucial in the development of a clinician who can integrate theory, practical skill and empathy. Under the close scru- tiny of a formidable consultant, small groups of junior doctors learn how to correctly perform the physical exam, become proficient in applying clinical ethics, and take a patient history. However, with the European Work- ing Time Directive (EWTD) and the potential consequences of the health bill proposed by Andrew Lansley this year, can this age-old practice survive the ever-changing face of the modern NHS? For surgical trainees and junior doctors, who routinely worked between 60-75 hours weekly, the EWTD had a significant impact on available training hours. Since its arrival, the EWTD has invited a barrage of criti- cism from surgical trainees and junior doctors themselves, to the senior most members of the Royal Colleges. In response to the complaints, the government commissioned an independent review assessing the impact of the EWTD on training, headed by Sir John Temple published on ninth of June 2010, entitled ‘Time for Training’. It concluded that it is possible to deliver high-quality training in a 48-hour week on the condition that trainees do not have a major role in out-of-hours services, are well supervised and have full access to learning opportunities. In an out-of-hours care system, most shifts occur in the evening or at night, and there are often gaps in the rota, filled by junior doctors. How- ever, with the 48 hour weekly cap, the doctors find themselves sacrific- ing planned daytime training ses- sions for poorly-supervised night time shifts, with consequent repercussions on the quality of training they receive. As a solution to this problem, Sir Temple states that ‘it is imperative that the NHS moves towards a consultant delivered service’ with the foundation of a ‘24 hour presence or ready availability for direct patient care responsibility’. Despite a 60% expansion in consultant numbers over the past ten years, it has been observed that junior doctors are still being heavily relied upon to fill rota gaps in out-of-hours services. Sir Temple argues that ‘there are over 15,000 hours available to trainees on a 48hr contract in a seven year training programme but these are not being used effectively’. Furthermore, planned reductions in trainees by the year 2015

Image by Chetan Khatri will only serve to amplify this problem. Although the proposal of further expansion in consultant numbers is an attractive one, there are t wo real limita- tions to its viability. Firstly, the ability of the NHS to finance this endeavour is questionable, with 53,150 posts due to be lost across 155 hospitals in a bid to cut down on expenditure. Secondly, with the progressively managerial responsibilities of consultants who are the principle force behind ‘target-driven healthcare’;; training junior doctors may no longer be considered a priority.

“Surgery is an acute specialty with a need for “24 hour cover”, which is completely incompatible with the seemingly arbitrary 48 hour cap” Despite the admonitions of the EWTD by Sir John Temple, the report was conclusively supportive for its future in the NHS, though this sentiment has not been echoed by much of the medical profession. John Black, Presi- dent of the Royal College of Surgeons, stated that ‘even in the most modest of aims, the EWTD have not delivered for

surgery’. Surgery is an acute specialty with a need for ‘24-hour cover’, which is completely incompatible with the seemingly arbitrary 48-hour cap. We ask whether we wish to be operated on in ten years’ time by a consultant which the BMJ themselves acknowl- edge would have some 3,000 hours less experience than their predecessors. This year, the liberating N HS W hite Paper proposed by the Health Secre- tary, Andrew Lansley, has been the new focus of media attention. The bill recommends the involvement of the private sector in the provision of health care. However, one of the major concerns being expressed in response to this idea is the subsequent effect this will have on medical training. The Professor of General Medicine at Manchester University, David Met- calfe, explains that the NHS has made allowances for the training of junior doctors with higher staffing levels to allow consultants and registrars to teach at the bedside;; ‘will the NHS… be able to compete on price and support education this way?’. Another point he raises is that a ‘hands-on’ approach is essential in clinical learning. The patient’s case needs to be wide enough to ensure that it is representative and will enable doctors to make ‘informed career choices’. Should private companies ‘cream off’ the most profitable illness, students in orthopaedics, for example, may see a greater share of trauma cases and far fewer hip replacements.

“Will the NHS…be able to compete on price and support education this way?” With the availability of simulators and computer software enabling students to develop practical skills in their own time, supervised training may not be the sole means of gaining compe- tence in particular skills. An example of this is the laparoscopic surgical stim- ulator, which is becoming more fre- quently sighted in teaching hospitals. However, without the presence of a patient, there is little clinical context upon which technical detail can be hung. It is difficult to fully anticipate the extent of the repercussions that a reduction in training time will have on the doctors of tomorrow. However, the dissatisfaction and anger being expressed so soon after the reforms have taken place, offer a bleak window into the future if nothing is changed

Mandy Smith Guest Writer In 2001, Josie King, an 18-month-old girl, died in one of the best hospitals in the world. Treated at John Hopkins in the USA, after falling into a scald- ing hot bath, she was admitted with partial thickness burns to 60% of her body. Josie required a number of sur- geries, skin-grafts, constant pain relief and a period in the ICU. She con- tracted an infection from her central line, which caused fever and vomiting and delayed all plans for discharge. De- nied fluids despite constant pleading from her mother, who was beside her bed every hour of the day, her condition declined and she became lethargic and unresponsive. After her mother begged doctors to look at her again, they sug- gested that her lethargic state was due to the methadone she was on for pain relief, so ordered it to be stopped. Josie began to improve, but the un- derlying causes of her previous dete- rioration were never examined. Later a pharmacist, charged with reviewing the prescriptions, prescribed a small amount of methadone to be given to stave off withdrawal symptoms. Ad- ministered by the nurse despite her mother’s pleading, Josie arrested within minutes of the injection. De- spite resuscitation attempts, she was brain-dead and her parents switched off her life-support machine a few days later. Josie King was admitted for burns, but died from severe dehy- dration and a communication error.

“The volume and complexity of knowledge today has exceeded our ability as individuals to properly deliver on it; consistently, correctly and safely. We train longer and specialise more but we still fail.” – Atul Gawande There is a commonly held belief that all doctors will kill a patient at some point in their careers. Max Pember- ton writes in his book ‘Trust Me I’m a Junior Doctor’ that ‘every doctor is allowed one mistake, one monumental cock-up’. We work in a profession in which the sole purpose is to help people, so how can we be so casual about causing them harm? In the U K alone we produce 7,000 new doctors a year – so that’s 7,000 ‘inevitable’ ‘monumental cock-ups’. Sounds like a lot, but it’s not

even close. In fact, the BMA and N PSA have calculated that we cause 30,000 deaths a year, with one in ten hospital patients suffering harm at our hands. Six years at medical school, 40 weeks of teaching a year, 25 hours a week equates to over six thousand hours of training to be a doctor. Give me a line up of children and I can pick up the strawberry tongue of Kawasaki Disease – incidence of one in 25,000. I once picked up Lyme Disease in a GP clinic in Camden – 1500 cases a year in the UK. However show me a drug chart with a subtle but dangerous error on it and I wouldn’t put money on me spotting the mistake. Tell me that we are going to kill ten patients tomorrow through our mistakes as healthcare professionals and I would have no idea how to save them. We’re in- tensely taught the pathophysiology of disease but not of our own actions, a ‘disease’ that the WHO puts in the top ten causes of death worldwide. In his book Max Pemberton describes the night he failed to diagnose a pulmonary embolism in a patient, one he was called to see while running from ward to ward on a night shift, between taking care of a heart attack patient and a patient that was fitting. It was only after a panicked phone call to his registrar that he realised what he had missed and the registrar shot in to the ward from his bed to deal with the situation himself, eventually admitting the patient to ITU. Max recalled his discussion with the registrar afterwards:

“He looked at me with utter contempt and disgust, as though my incompetence had repelled him. I had no one to blame except myself.” If a pilot crashed a plane he may well get a dressing down, but every detail leading up to that crash would be independently scrutinised to ensure the aviation industry as a whole learnt f rom one pilot’s mistake. The same can’t be said for medicine, as Max Pemberton describes, where a doctor’s mistake is seen to be his and his alone. Imagine how many more errors we could prevent if, for every mistake that a junior doctor made, rather than going home g uilty with his head in his hands he was supported by his registrar in going through what led him to make the mistake and how to improve his working practice to avoid ending up in the same situation.

medicalstudent

October 2011

Features

Hearts and crafts for medical students. Image by Chetan Khatri Experts in patient safety have long been trying to educate us about the failures of the current reporting systems that put emphasis on blame over reflection. They know a shift from the culture that punishes an individual to one that encourages accu- rate reporting and learning form errors is absolutely necessary if it is to have any impact on our patients. And they know it needs to start in medical schools, to ensure safe practice and the desired skills and attitudes become a core part of our professional life.

“Every system is perfectly designed to achieve the results it gets” - Paul Batalden A recent survey asked medical students about their thoughts on medical error and the results demonstrate the ineffectiveness of current patient safety

education and just how far we have to come. Only 46% of medical students disagreed with the statement ‘compe- tent physicians do not make mistakes that lead to harm’ and more alarmingly, only 66% disagreed with the statement ‘If I saw a medical error I would keep it to myself’. Exaggerated fears of litiga- tion and the effect of admitting an error on our future careers are preventing us genuinely learning from our mistakes, let alone ensuring our hospitals can identify their weaknesses and take steps to prevent mistakes happening again. In the mid-nineteenth century, an Austrian physician called Ignaz Sem- melweis grew tired of reflecting on the maternal deaths he witnessed on his wards. In his early years as a doctor, maternal mortality rates in hospitals were significantly higher than they were for home-births. He believed he had identified the cause – doctors and medical students transmitting ‘cadav- erous particles’ from the dead bodies they were dissecting straight to women

in labour without washing their hands in between. He tested his theory by introducing a policy of hand washing with chlorinated lime-water before examining the labouring women and his results were conclusive - within 3 months he saw a reduction in maternal mortality rates by around 90%. The hand-washing revolution was born. Except it wasn’t – his theory clashed with the idea that disease was due to an imbalance of the ‘four humours of the body’ and his colleagues, who saw themselves as gentlemen, as were of- fended at the suggestion that they could be unclean. Despite his data Semmel- weiss was ridiculed by the medical es- tablishment and was forced out of Vien- na entirely. Even today, our compliance with hand washing protocols is appall- ingly low – we have the evidence, we alcohol dispensers on every corridor, yet we still haven’t learnt - and it kills. Over the summer the national media reported the story of a 14-year-old girl left paralysed from the waist down

after an epidural was left in too long and the drugs damaged her spinal cord.

“It is a Human Truism that if we applied the knowledge we now possess, even without any new innovations we would save millions” – Dr Peter Lachman She had been in hospital for a rou- tine cholecystectomy, of which thousands are performed in the UK every year, and yet a normal part of a patient’s pain management protocol incorrectly applied has left a teenager in a wheel- chair for the rest of her life. In a BBC interview, she recalls coming home from the hospital and ‘wishing they had killed me, because I had to live with the reality and the consequences of someone else’s mistake’. Ten years

on from the death of Josie King, from the NHS’s ‘Organisation with a Mem- ory’ and Peter Pronovost’s checklists, not only are we not getting better but our continual advances are providing more opportunities to harm patients and we are failing to see it. The principle of ‘Primum Non Nocere’ dates back to Hippocrates and while some of his standards have been justifiably updat- ed to fit with modern medical practice, this one still holds as true today as it did 2,500 years ago. If we are going to be able to look back in another 10 years time and know we have got anywhere, every single one of us needs to champi- on patient safety, continually improve our medical practices and when we do make an error, be open and honest to ensure that everyone learns from it. Every one of us needs to open our eyes and realise our potential to cause harm, and pledge that as we continue with our training we challenge the culture in which we work to reinforce why we chose medicine - to help, not to harm

October 2011

Comment

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

Empowered patients or bad science? Is NHS funded alternative therapy actually good for our patients? Alex Warren Guest Writer

The new decade’s mottos are clear - the NHS is under massive strain, eternally being asked to do more with less. Buz- zwords such as r ingfencing and patient- centred care are being bandied about in Parliament like a frisbee, and hospital trusts across London and the country are working out where to draw the cut-here lines to ensure quality care is delivered to an evermore challenging population. But amid these gloomy, paranoid times a meeting last autumn by the BMA’s junior doctors association revealed something interesting - last year, the NHS spent £4 million on homeopathy, treating 55,000 patients at four regional hospitals, including the Royal London Hospital for Integrated Medicine on Great Ormond Street. The BMA themselves gave this a frosty reception, Dr. Tom Dolphin retracting his comparison of homeopathy to witch- craft as it was ‘offensive to witches.’ As medical students, we’re all in various stages of understanding the term ‘evidence-based medicine’. It’s the cornerstone of our chosen profession, we’re told. One study defines it as ‘applying the best available evidence gained f rom the scientific method to clinical decision-making.’ In English, EBM means that when we give our future patients a treatment, we do it only with stringent evidence that tells us it should confer some benefit. And that evidence must pass rigor- ous standards;; trials must be reli- able, verifiable and free from bias. Reading that, it’s a wonder how anything gets approved at all. But looking deeper, a conflict does arise;; we’re told that our treat- ments must be backed up with evidence, and yet the system is spending money on alternative practice its own doctors are denouncing as pseudoscience. Another word that gets thrown at us is “autonomy” - the right of patients to self-govern their lives, their medical treatment being a large part of that. At the very best, it can be said that there is debate over the efficacy of infinitely diluting poison ivy until no trace remains as a cure for eczema. Proponents of the scientific method ar- gue that, given that as yet no solid evidence exists for it, homeopathy should not be considered as a viable treatment. However, the 55,000 patients who received homeopathy on the N HS, and the many thousands more who did so privately, evidently beg to differ.

Contrary to popular belief, you can overdose on homeopathic medicine. It’s called drowning. care following an adverse reaction to reiki therapy. Compare a bottle of lem- on grass to the horrendous side-effects some modern medicines produce and it’s no wonder patients want it over chemo. Al- ternative medicine respects the It is here that patient’s right to the conflict rears The BMA themselves autonomy, and is its ugly head;; gave this a frosty recep- in keeping with what, as doc- tion, Dr. Tom Dolphin the Hippocratic tors, are we to retracting his comparison principle of do- do when our two of homeopathy to witch- ing no harm. guiding beacons craft as it was “offensive The placebo ef- of autonomy and to witches” fect is powerful evidence-based enough and if practice shine in it doesn’t work different direc- tions? A patient comes to you and asks for a treatment that, as a scientist working on the principle of evidence-based medicine, you know to be unproven. Does the patient have a right to choose the wrong treatment? in most cases the patient can re- Whilst there may not be any con- ceive conventional therapy later on. crete evidence that alternative thera- The basic decision is which of our pies do any good, we can be pretty sure two pillars of medicine we prioritise;; they’ve never done anyone any bad. does good, evidence-based practice There are no chronic homeopathy ad- pull rank over autonomy? Even if it dicts out there, nor anyone in intensive should, in practice it never can. We

can’t force our patients to do anything. If we refuse to prescribe our hypotheti- cal patient his desired alternative, he’ll likely flush our conventional medicine down the toilet and turn straight to Google for the nearest private clinic. The ideal is discussion;; we sit down and explain to our patients the wonders of the scientific method and evidence- based medicine, leaf through the BMJ and show them why amoxicillin will get rid of their hideous skin lesions quicker than Holland & Barrett. They stroll smiling to the pharmacy, thanking us for bringing them out of the darkness of scientific ignorance. Can we fight the power of the mass media culture and change our patients’ views in ten-minute consultations? Not a hope in hell. So what do we do to redress the imbalance? It could be argued that the system in its current state works - there’s an occasional conflict of values, but these are abundant in medicine. When one considers that the NHS’s annual budget is in excess of £100 billion, a £4 million spending on homeopathy is miniscule, even irrelevant, and as we concluded earlier, homeopathy does no harm. Except that’s not entirely true. The dichotomy of NHS funding of alternative medicine makes every GP in the country a total hypocrite, and cloaks homeopathy and its complementary brethren with the veneer of scientific

integrity. The money’s irrelevant;; it’s the principle. As the doctors of the future, we cannot be expected to practice on the basis of evidence-based medicine if our referral sheets contain hospitals and practitioners whose methods are totally at odds with that paradigm. A public-health campaign discred- iting alternative therapy is unlikely and unreasonable, but as is so often the case with public health, education really is the solution here. That said, the BMA’s suggestions would start the ball rolling;; pull government funding of the UK’s four homeopathic hospitals, and legislate to prevent alternative medicine companies mar- keting their products as medicines. It’s possible to do harm by inaction. And every time we allow a patient to make a choice that is detrimental to their health, we are failing in our duties. Patients have the right to choose alternative therapies just as they have a right to choose to smoke tobacco or shoot heroin. The medical profession’s role is not just to present the patient with options, it’s to educate the public on the choices that make them healthier and happier, whatever that may be. The key to solving the dilemma is getting our patients to independently make the choices we want them to make, and that happens through education

medicalstudent

October 2011

Comment

Rubbing salt in the wound David Fisher Staff Writer

The last two years have been painful for National Health Service workers. Committed to saving £20 billion from the health budget, more than 50,000 jobs will need to be axed by 2015. A combination of forced redundancies and abolition of vacated positions during natural turnover will leave great numbers of unemployed personnel. Despite these cuts, hospitals still need to appoint new staff. A recent investigation by The Sunday Telegraph exposed a scandalous situation where- by hospitals are employing managers to recruit f rom other countries notwith- standing that, in this country, numer- ous unemployed health workers are in need of jobs. Eleven trusts have sent teams abroad to fill positions. Bark- ing, Havering and Redbridge Univer- sity Hospitals Trust, unbelievably sent managers to Dublin to recruit nurses when two months later it would make 100 redundancies. It is ludicrous that hospitals would increase competition for jobs in the NHS by unnecessarily deepening the pool of applicants. Seeking staff from foreign countries increased in popularity throughout the 1990s. In 2000 Alan Milburn

MP, the Health Secretary, created a plan to invest and reform the NHS. One factor that restricted the improvement of health services was a shortage of nurses. To remedy this, he sought to employ an additional 20,000 nurses by 2004. It was impossible for nursing schools to d rastically increase the number of graduating nurses in such a short time frame. Instead, to satisfy the drive for more nurses, recruiters were des- patched to foreign countries such as the Philippines and India. In 1999, 10,736 work permits were issued to foreign health workers. In 2002, the number increased to 44,443. Most of the workers filled nursing shortages but some bol- stered numbers in other posts including consultants.

“It is ludicrous that hospitals would increase competition for jobs in the NHS by unnecessarily deepening the pool of applicants.” The diversification of the United Kingdom’s health workforce has prop- agated many problems. The Depart- ment of Health stipulated that recruited migrant workers must speak English

proficiently. They did not anticipate foreign staff being able to speak but unable to understand English, a problem articulated in a report commissioned by the Royal College of Nursing in 2003. Accents and colloquialisms presented themselves as formidable bar- riers to seamless communication between colleagues and patients. Another obstacle encountered was that recruited workers had varied clinical and technical skills reflecting differences in training. This led to confu- sion and frustration. The final factor preventing foreign workers integrating was the fault of the indigenous population. Racism in the workplace and f rom patients made workers feel uncomfort- able and was detrimental to the cohe- sion of multidisciplinary teams. Aside from these problems, it is also ethically dubious to be encouraging doctors and nurses to leave their countries, particularly if their own health systems are lacking personnel. The unfortunate number of redundant health workers combined with the difficulties associated with buffering the health service with foreign workers, begs the question of why the Gov- ernment continues to purse this clearly disadvantageous policy of foreign recruitment. One possible answer may lie in the report by the Royal College of Nursing, where managers are quot-

ed as expressing concern that some of the foreign nurses were underval- ued. Under the old pay system, newly qualified nurses were apportioned a D- grade salary whilst more experienced nurses received more lucrative E-grade salaries. Managers noted that some foreign nurses with experience and skills deserving of high grade salaries were paid D-grade salaries. In a time when the Government is demanding £20 billion f rom the N HS, it may not be overly speculative to suggest foreign health workers are being exploited for their services.

“Managers noted that some foreign nurses with experience and skills deserving of high grade salaries were paid D-grade salaries.” Traditionally, the problem in this country has been a shortage of nurses rather than the unique surplus we now observe. In 2003, bystanders’ wor- ried that trusts were becoming too dependent on foreign workers. We are now presented with the opportunity to break this dependence. Simon Burns, the health minister, clarified that NHS

hospitals are only permitted to employ foreign doctors and nurses when none are available in the United Kingdom or European Economic Area. This guide- line is seemingly not being followed and a penalty system should be created. Managers report that it is easy and cost-effective to recruit from abroad, even with the expense of flying a re- cruiter abroad. It is imperative that the Government takes immediate steps to protect the prospects of NHS employ- ees. Workers unlucky enough to be made redundant should have the maxi- mum opportunity to apply for vacan- cies. First, the Government must ensure there is no disparity between the salaries of UK and foreign nurses. This alone might cause foreign recruitment to become an uneconomical option. Second, the Government must rigidly enforce the rule that hospital trusts ad- equately search for health personnel before they fill positions with foreign workers. One option to be explored would be to fine trusts that overlook this country’s own neglected health workers. We have been caught unaware by a problem of which we have no experience. Too many people are redundant for the Government to be laissez-faire. It is painful enough for redundant health workers without allowing trusts to rub salt into their wounds

In fairness, if it were a choice between recruiting staff here and the jobs centre, I know which one I’d pick.

October 2011

Comment

medicalstudent

BUCS attempt to score, tackled by medical students Hayley Smith looks back at BUCS’ recent attempt to erase medical school sports

UCS, the British Universities and Colleges Sport association, recently tried to merge medical school sports teams with the teams of their allied universities. What was presented quite quietly in the recent July BUCS AGM as an appendix, was that some colleges were allowing medical schools to enter independent teams, and that this ‘anomaly’ would be removed - not just an anomaly as far as the medical schools and Medgroup were concerned, and as BUCS found out. Our identity as independent institutions proved more important than BUCS had expected, and after some swift protest from not only medical schools but other university colleges and sporting associations, the intention was removed from the AGM and the details of changes that will be made are under review. The strength of the opposition might

“people felt that merging their teams with those of their allied universities would change the face of medical school sport for the worse.” have taken BUCS by surprise and why was there such outrage? Mostly because a lot of people felt that merging their teams with those of their allied universities would change the face of medical school sport for the worse. Many of the medical schools are, and have long been, independent - quite separate from their allied universities in their origins, their management, their location, and most of all their identity. Not to mention, ‘in many instances, the sports teams of the medical school actually compete at a

higher standard than the larger university (proven by league standings and results in varsity fixtures) and thus the dissolution of the medical school based teams will lower the quality of BUCS competitions,’ to quote an independent petition organised to protest the proposed changes. BUCS had not taken into consideration that medical and dental students are pretty different f rom the regular species of student, mostly because we work much longer, more intensive hours, and asking us to share timetables, facilities and team fixtures with non-medics sounds crazy, because we know how hard it is to schedule everything we currently do anyway. Still, the issue is not resolved. An- drew Smith, the voice behind a lot of the protest and the independent online petition which gathered 2608 votes since the furore began in July, tells us:

‘For hundreds and hundreds of years all of our hospitals have stood proud;; healing the sick, training future staff and perhaps most importantly, fielding incredibly competitive sports teams. It was thus not overly surprising that when potential plans to force medical school teams to either disband or play under the name of their partner university, the proverbial excrement hit the fan.’

tion period with universities to find out their opinions on the matter. The big question are medical faculties unique enough to warrant their own teams in BUCS? I think the future of ‘United Hospitals’ sports teams and the sur- vival of autonomy for our institutes de- pends on the answer being yes

“For hundreds and hundreds of years... our hospitals have stood proud; healing the sick...and most importantly, fielding incredibly competitive sports teams.” The battle was won, nonetheless, BUCS will soon be entering a consulta-

BUCS thought it was all over...

places and I’m suddenly a small town girl in a city that will eat me alive. And it’s not just the reading that’s bizarre. Have you noticed how the people who don’t have reading material read over someone’s shoulders? Or how people walk down an escalator? Or how

people do their make-up on the train? London t ruly is f illed with the weird and wonderful, and I guess the day I get into such a tight squeeze, reach into my bag and pull out my book - that is the day I too am weird and wonderful, being a true Londoner

A ‘real’ Londoner takes the Tube Zara Zeb Guest Writer

Trying to get to my 0900 lecture on time from south Norwood takes a bit more than timing. My 0814 train arrives two minutes late, overloaded with people. Walking along the platform past crammed carriage after crammed carriage, peering through the win- dows in dire need of a wash, trying to find an aisle with space for me, I realise that today I will find out if I suffer from claustrophobia. Joining a group of fifteen people huddled around the last door, I begin to shuffle forward where everyone somehow manages to get on – but with no space for me. Head to armpits people stand, and I listen as the doors begin to beep - with me still on the platform. Uh-oh. Surpris- ing myself, I do something that proves I am truly becoming a Londoner. I jump into a gap that could narrowly fit my two size 5 feet and let the shut- ting door propel me into a male stran- ger’s side, where I spend twelve minutes sharing body heat, unable to move. Quietly patting myself on the back, figuratively as I can’t so much as breathe without brushing someone tenderly with my, shall we say, toned physique, I witness yet another phenomena – people reading. Now let me explain something. On the odd occasions I used to come into London, I thought the sight of nearly everyone reading in the carriage was bizarre. Young or old, sit-

ting or standing, people would pull out their books/newspapers/essays from their bags/pockets/armpits and begin staring intently at them. How could a journey of a few minutes, punctuated with stops, possibly be an ideal envi- ronment to read in? Surely you would want to be sitting comfortably so you could lose yourself in the magic of the words? I swore that I’d never tar- nish the wonder of reading by indulg- ing myself in such horrible conditions. Yet having only been here two weeks, I’ve begun carrying reading material in my bag and am prone to pulling it out when sitting on a train. Why the sudden change? I’ve begun to realise that no matter how often trains come, thirty seconds of doing nothing but watching time tick by on the platform monitors is pure torture. Noth- ing could be worse than waiting for my train that is due in 120 seconds. What am I supposed to do for those 120 seconds? Read. So out comes the book/ newspaper/paper from my bag/pocket/ armpit and I begin staring intently at it. Back to the crowded carriage, where I am getting to know a father of two - I saw the pictures of his kids on his Blackberry - in ways some would consider adultery, when the lady in front of me r ustles her Metro. She’s not actually going to attempt to read a newspaper, right now, right here, is she? Yes, she is. I watch as she begins navigating the turning of an A3 page – which takes up a larger area that my feet and body do in this carriage – squished as she is between seven people. Is she mad? Then I hear another rustle. The guy who owns

the armpit next to my right ear is holding his newspaper to the roof of the carriage and turning the page. Speechless. Here was I thinking I was adapt- ing to the life of a metropolitan city, yet put me in a carriage where people do the simplest thing in the weirdest of

Room for one more? I’ll let you read my Kindle.

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October 2011

Comment

Coffee, consultants and a student in crisis Rhys Davies Comment Editor

“Ah, studentes!” My consultant turns to us, “Can I get you anything?” And then I freeze. During life at medical school, you can be caught out on many occasions. Listening to a patient’s chest with your stethoscope in the wrong way, for example. Or the realisation that the dream of t urning up to lectures in your pants wasn’t a dream. However, the one that paralyzes me the most is the moment the consultant offers to buy you coffee. My first impulse is to say, polite- ly of course, “No thank you.” I don’t want to be a burden on such a paragon of medical virtue. However I then see the rest of the team, from registrar to newly-qualified F1, state their prefer- ence. Incidentally, there is a correla- tion between seniority and caffeine content. When the list is finished, the consultant nods sagely and pulls out his wallet, from which he retrieves a crisp £20 note. My fears of driving the Audi- driving, suit-wearing flash bastard to financial ruin quickly evaporate. Al- right, I grit my teeth with new-found resolve and clear my throat to vocal- ise my change of heart. I pause. While sharing a coffee might help ingratiate myself with the team (they may even

remember my name!), it might seem like blatant brown-nosing sycophancy to my more cynical peers. My reverie is broken by a loud slurp behind me. I turn to see my firm partners with skin- ny mochachinos already in their hands. Spying the end of the ward round in sight, they had slipped ahead to get their orders in early. In that case…

“My fears of driving the Audi-driving, suitwearing flash bastard to financial ruin quickly evaporate.” “Actually, I think I’ll have…” I’ll have what? The range of choices is tre- mendous! There is no such thing as just a coffee anymore and, I suspect, there hasn’t been for a while now. Espresso, latte, cappuccino, Americano, mac- chiato, mocha, double mocha, extra double mocha, and don’t get me started on the selection of teas on offer. Since money is apparently no ob- ject - to me or my consultant - I can’t let price be my guide. I’m not a natural coffee drinker so I don’t know what will appeal to my palette. Should I play it safe with a hot chocolate or try something new and Italian-sounding? I feel my consultant gaze on me, expectantly waiting for an answer – how familiar a scene. “I’ll have what she’s having.” I

Coffee or not to coffee? That is the short answer question. shrug, in an attempt at nonchalance. “A cappuccino?” “Yes?” Passing the moment as the quirk

of yet another overly-neurotic medical student, the consultant goes ahead with the order. I sigh with relief, an awkward moment clumsily navigated. Then the

consultant turns and asks, “I’m getting a croissant. Does anyone want anything to eat?” You’ve got to be kidding me

What did you think of these articles? World-winning literature or total rubbish? Got a thought, opinion or argument you need to get off your chest? Moved by medicine, students or London?

Write for Comment! In November Comment goes head to head: “In the 21st century, white coats belong in the history books.” Articles should be between 500-1000 words and sent to comment@medical-student.co.uk

DOCTORS’ MESS Inferior Decorating By Rob Cleaver There are certain perks to studying medicine. You get to attend crazily themed pub crawls in surgical gowns because it’s just ‘so down right rebellious.’ You ‘chunder’ and ‘vom’ like it’s 2011’s version of 1995’s tamagotchi. You also achieve a sense of superiority over the entire human race that for some reason necessitates wearing tweed, growing a beard and telling little old ladies to ‘man the hell up’. However, when it gets down to the nitty gritty of a medical situation, like a rabbit with myxomatosis on the M25, I stall. The inside of a human being is not all it’s cracked up to be. It’s not so much that the artist lost all sense of style or taste UISPVHIPVU UIF NBLJOH PGÞ UIF human body, it’s more a fact of ‘here is some mush. It’s themed,

moderately, so that you can all but figure out what each flap or leaflet is, but not enough to give you a definitive answer of its need to exist’. It’s a debate worth pursuing. Of course, I wouldn’t want a chest cavity to be decked entirely in Picasso’s most vulgar creations, or indeed the floppy clocks of Dali draped over each rib’s costal cartilage, and far from Georgia O’Keeffe’s more psychedelic musings. But. What I do want is something a bit… jazzier. Perhaps a rug across the plateau that is the liver, a warm electric fireplace installed between the pancreas and the spleen, new energy saving lightbulbs behind the eyes, and a Van Gogh print stereotypically hanging in the oesophagus’ hallway. Something that screams sophistication at bargain prices, Muji, not Ikea: Sainsburys Taste the Difference, not Waitrose own brand.

Whatever the bullies spat at you during adolescence, whatever your partner spat during intercourse, it doesn’t matter, because inside we’re all as abjectly bland as one another. Each with a similar design, each with the same taste for cream walls, brown leather sofas and kitchen utensils we will only ever use once, proudly collecting dust on the worktop; unplugged, unused, unloved. I guess that lack of plug sockets may impede the stately progress of 21st century technology in the games room; located at the second left after the pyloric sphincter. Maybe the cacti collection spilling forth from the windowsill may cause acute inflammation of the appendix. Bourgeois parties do not mix well with bile, co-lipase and cholecystekinin. Maybe the human body is beautiful as it is; rose-tinted, blood-flecked, poetry-in-motion.

The Liberal Lunch By Rob Cleaver

include crisps in my lunch.

There is one all encompassing problem with attending university. It’s more important than whether or not you bother to attend your seminars, or to add an attractive girl you’ve never spoken to on your course on facebook. It’s even more important than student 2-4-1 cocktails on a Thursday.

Note: I do not make crisps. How do they make crisps? How do they ridgecut stuff? Why do they ridge-cut stuff? Who invented the Hula Hoop and why? What’s a Hula Hoop for? Why did the gimmick never wear off? Can you still buy Monster Munch? Are there any crisps where you still get supplied with a myocardial infarction in a blue sachet? Who actually eats Quavers?

Yes, I am talking about the gutbuster, the fuel for your woodburner, the daily grind’s midday ceasefire.

Being a cheapskate, I prepare my own sandwiches the night before. I do this using bread, a filling, then an assortment of delicious fridgedwelling potpourri such as salad, mayonnaise, vodka…

However, there have been occasions where I have purchased a pre-made sandwich. I did this using money, a self service check-out machine and a sandwich made out of the food equivalent of faeces by a bloke round the back of a Sainsburys. This, although stretching my budget, was a good decision because I took the slightly more liberal and whimsical decision to purchase a chicken triple. For those not in the know, this entails three sandwiches, all with some sort of chicken-ey thing in it and then god knows what else. They vary. The good part about this decision was that I eliminated the problem of choice. I saved time. A chicken triple is a uniquely edible time-saving device.

Just to spice things up a bit. I also

It was during one of these bonkers

Lunch. The options are endless. Well, of course they do tend to drop off a bit once you reach the bottom of the barrel; farmfoods. However, everything between that and booking a banquet hall for one is a definite possibility.

escapades to find someone to make me a sandwich, that I stumbled upon the rumour that some people went to restaurants for lunch. My parents don’t even do that. Why spread an already meagre budget so lavishly on a half chicken from Nandos? Maybe as an occasional treat, once every five years or so, but not every week. It might be different for those Jack Wills clad autobots from rah-shire, maybe they can afford a Nandos. Maybe daddy gives them a Nandos allowance. Maybe they tugged on his leg screaming for peri peri chicken in a pitta and it was the single most convincing bit of acting seen in this country since people stopped going to theatres and just sat watching the ‘acting’ on eastenders instead. Lunch is the divider. Lunch tells you everything you need to know about someone. If they only eat cheese sandwiches, they’re probably boring. If they go for a houmous and vegetable pitta, they’re probably a psychopath (good kind). If they eat a slow cooked angus salt beef sandwich in a paper bag, they’re also a psychopath (bad kind). And if they’re eating a Nandos they’re definitely an arse.

TOTO Eclipse of the Arse

Sudoku

By Oliver Woolfe The humble toilet, so necessary yet so ignored. Not so in Japan, as I discovered to my surprise a few weeks ago. It soon will be possible for the machine to measure blood pressure, pulse, detect sugar levels and record them without hesititation. Let me introduce you to the TOTO toilet; a device that could become extremely useful in the medical world. To the unsuspecting user it’s just your average bog but on closer inspection it becomes very clear that we are dealing with a completely different kettle of fish. In a smart showroom in Clerkenwell one can experience the marvels of TOTO without the hassle of travelling to Japan. On a warm September evening I was greeted by two beautiful saleswomen at the front desk and a glass of cheap bubbly was offered - I could hardly refuse. Intrigued, I asked if it was possible to try a toilet. Sure enough they had them in the customer facilities. Bubbly rapidly necked, I proceeded. I approached tentatively, and was taken aback as the lid lifted automatically. I wasn’t sure what to expect next, so cautiously sat down. My bottom was greeted with a warm

and comfortable seat. It reminded me of my days at public school when a ‘fag’ or lower year would warm the seat for you. To my left was a futuristic control panel with a plethora of confusing buttons. The first one I pressed started a warm jet of water. It swiftly became apparent that you could change the intensity of this jet and could even get it to vibrate. What else was on offer? Another button offered the relaxing sounds of panpipes, something that I have often thought was lacking

from my daily visit. The TOTO experience was most definitely a weird one. Returning to the showroom, I discussed the future with a developer, being particularly interested in medical applications of TOTO. Perhaps one day it will be able to detect fecal occult blood - ‘Oh my! My toilet just saved my life!’

Look for the answers in the next issue!

Just a thought.

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

A N S W E R S

A N S W E R S May 2011 Answers!

Required: Editor-in-Chief 2012

Editor@medical-student.co.uk Apply by 6th November

Page 4-5 A great map of London, showing you all the best places around each of the med schools!

medicalstudent

LONDON FOR MEDICAL STUDENTS

Page 2-8 Hot tips on the best food, drink and culture at each of the five London Med Schools

October 2011

medicalstudent

Barts and The London Bars

Restaurants and Cafes

Vibe Bar

Tayyabs

Open all day, with loads of g reat benches outside for when it’s warm. Nice food and a barbecue outside on the weekends. You can go there all day then there’s live music and DJs at night.

One of the most popular curry houses around this area, it has queues down the street, but with good reason. It’s lively and f un, unlike a lot of the curry houses in the Brick Lane district, and its Pakistani grill menu is cheap and delicious.

Old Truman Brewery, Brick Lane, E1 £: £3 a pint

Indo A great, if tiny, pub with quirky décor which is open late. Also sells great cheap pizza.

133 Whitechapel Road, E1 1DT £: Pizzas at £6

The Sun Inn A great and friendly pub, where low lighting and melting candles on every table, create a warm cosy atmosphere. Staff are really friendly, and even take orders and bring your drinks to you.

Barts and the London is part of the only campus-based university situated in London. Attached to Queen Marys, Barts and the London dominates the East End. There are four main sites that the medical school utilises Whitechapel campus, Mile End, Charterhouse Square and West Smithfield. The Student Union is based at the Whitechapel campus

Money Saving Tip Number 1 Austerity measures to stop the bank going bust

Travel An Oyster card is a must to save on bus, train and tube journeys, and if you’re a more regular user then apply for a Student Oyster card and save 30% on Travelcards as well.

441 Bethnal Green Road London E2 0AN £: £3 a pint

Clubs Fabric A massive club for real clubbers, meaning some people think it’s awesome, others really hate it. Good if you like dubstep drum and bass. However, there are always long queues so go early.

77a Charterhouse Street, London, EC1M 3HN £: £3 on Friday, Saturday and Sunday nights

93 Feet East A slightly alternative music venue, depending on when you go, you can hear everything from rock to electro. Has a great cobbled yard out the back, with a barbecue from Thursday over the weekend.

150 Brick Lane, E1 6QL £: Entrance varies depending on the event, but often free on Mondays and Fridays.

83-89, Fieldgate St. London E1 1JU £: £11 per person, without drinks

Orange Room Café A kitsch diner with shiny orange tables;; serves really delicious and really cheap Lebanese food. They also do delivery.

63 Burdett Road, E3 4TN £: £3.50 for a wrap The Old Shoreditch Station A bit further away, but a chance to explore this part of town. Situated at the K ingsland Road/ Old Street junction, this area has many great cafes and bars. It’s pricier than a student bar but worth it for the atmosphere. It’s a traditional coffee house set inside an old train station, with free internet in the day, turning into a sultry bar by night.

1 Kingsland Road, Shoreditch, London, E2 8AA £: £2.25 a coffee

Markets Colombia Road Flower Market The market sells plants, flowers and herbs on a Sunday. However, it’s a great street on any day, with lots of quirky shops and brunch cafes.

Spitalfields Market Used to be a real market, selling all the kind of vintage trendy stuff you now find in Brick Lane. It’s a bit more commercial now, but still has the kind of interesting clothes you find in Camden. There are lots of vintage clothing boutiques, and some more upmarket chain cafes such as Leon and Carluccios.

Culture Richmix Cinema A great arthouse cinema with a cheap café and an atmosphere that is definitely trendy Shoreditch. It shows all the usual f ilms plus some interesting retro stuff, alongside other events such as art and photography exhibitions. www. richmix.org.uk

35 - 47 Bethnal Green Road, London, E1 6LA £: Films £6.50 for students

Whitechapel Gallery A beautiful building with very modern and unusual art. Great if you’re interested in the strange and the weird. Not good if you’re a traditionalist and think a pile of bricks is just a pile of bricks.

77-82 Whitechapel High Street, London E1 7QX £: Free Columbia Road Flower Market

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October 2011

St George’s Bars and Clubs

Restaurants

The Trafalgar Arms

Lahore Karahi

Traditional pub-grub and decently priced drinks.

A popular hang out for students, possibly serving the best curries in Tooting. Reasonable prices, hence always busy with customers!

148-158 Tooting High Street, Tooting, SW17 0RT £: For average bottle of beer £3.50

Tooting Tram and Social Hiding in an alleyway, this beautiful pub boasts a large floor space, interesting décor, enthusiastic bar staff, and reasonable prices.

46-48 Mitcham Road, London SW17 9NA £: For average bottle of beer £2.60

The Antelope

1 Tooting High Street, Wandsworth SW17 0SN £: Two course meal for two is approx. £20

Radha Krishna Bhavan Nice for a quiet meal, cosy atmosphere, specialises in dishes from south India.

86 Tooting High Street, London SW17 0RN £: Two course meal for two is approx. £25

Masaledar

Trendy high street pub, nice for pre/after meal drinks. Very good for special occasions, although a little pricey!

76 Mitcham Road, London SW17 9NG £: For average bottle of beer £3.50

The Manor Bar and Grill Prides itself in an extensive wine and cocktail list at reasonable prices, also has a bar and grill restaurant serving weekend specials.

196 Tooting High Street, Tooting, SW17 0SF £: For average bottle of beer £3.40

Ministry of Sound Host to 999 and many other events across the year, one of the biggest and busiest student clubs in London.

103 Gaunt Street, Greater London SE1 6DP £: Entry £10

Oceana Themed rooms from cheesy disco to Japanese stock ex- change. There’s something to suit everyone!

154 Clarence Street, KT1 1QP £: Entry Free before 11, £5 after

121 Upper Tooting Road, Richmond, SW17 7TJ £: price of a two course meal for two people is approx. £30+

Yip Wong The only Chinese restaurant in Tooting. Tasty food and highly recommended!

106-108 Mitcham Road, London SW17 9NG £: price of a two course meal for two people is approx. £30+

Coffee Max Italian restaurant, less pricey if you grab their special lunch time deals.

242 Upper Tooting Road, London SW17 7EX £: Two course meal for two is approx. £30

based south of the river. St Georges is attached to (not surprisingly) St George’s hospital

The usual eatery for students past midnight, open until 2am, Pizzas made freshly in front of you, to eat in or go.

teaching and student activities

72 Tooting High Street Tooting, SW17 £: <£10 per person

are situated here, along with the

Cineworld cinema

A brand new colourful dessert bar, offering delights from sundaes to milkshakes, in every flavour imaginable!

31-37 The Broadway, Merton, London SW19 1QB

it is also the only med school

which is situated in Tooting. All

Afters dessert bar

Odeon cinema

medical school left in London,

Peperoncino Pizzeria

Cinemas Southside Wandsworth, London SW18 4TE

Not only the only independant

41 Upper Tooting Road, London SW17 7TR £: <£10 per person

all important student union.

Money Saving Tip Number 2 Austerity measures to stop the bank going bust

Theatre Don’t want to spend a fortune on theatre, opera or ballet tickets? Check out theatrefix. co.uk or roh.org.uk/studentstandby. Both send you info about ticket offers for upcoming performances. The Royal Opera House run a £10 student standby scheme and also runs dedicated student performances. Ministry of Sound

October 2011

ICSM 1. Blue Elephant (Thai) 2. Hummingbird Café 3. Wafflemeister 4. Bosphorous (Turkish) 5. Beirut Express (Lebanese) 6. Pepe’s Piri Piri Chicken 7. Wahaca (Mexican) 8. Saigon Saigon (Vietnamese) 9. The Natural History Museum 10. The Science Museum 11. The Victoria & Albert Museum 12. Hyde Park 13. Royal Albert Hall 14. Harrods 15. Westfield Shopping Centre 16. Westway Sports Centre

GKT 17. Frank’s Café and Campari Bar 18. Café 1001 19. Scootercaffe 20. EV bar 21. Roebuck 22. Cargo 23. Porterhouse 24. Ain’t nothing but 25. Del Aziz 26. Chumleigh Gardens Cafe-Burgess Park 27. Borough Market 28. Brixton Market 29. German Market 30. Brick Lane Market 31. Old Vic 32. New Vic 33. Menier Chocolate factory 34. Somerset Ice Rink 35. Gabriel’s Wharf 36. Peckham Rye Barts and the London 37. Vibe Bar 38. Indo 39. The Sun Inn 40. Tayyabs

medicalstudent

London Lis

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October 2011

stings Map

Barts Cont. 41. Orange Room CafĂŠ 42. The Old Shoreditch Station 43. Fabric 44. 93 Feet East 45. Richmix Cinema 46. Whitechapel Gallery 47. Colombia Road Flower Market 48. Spitalfields Market St Georgeâ&#x20AC;&#x2122;s 49. Lahore Karahi 50. Mirch Masala 51. Radha Krishna Bhavan 52. Masaledar 53. Yip Wong 54. Coffee Max 55. Peperoncino Pizzeria 56. Afters dessert bar 57. A Bar 2 far 58. The Trafalgar Arms 59. Tooting Tram and Social 60. The Antelope 61. The Manor Bar and Grill 62. Ministry of Sound 63. Oceana 64. Tooting bec Lido 65. Clapham Common 66. Southside Wandsworth 67. Cineworld cinema 68. Odeon cinema 69. Centre Court Shopping Mall RUMS 70. Iccos 71. Guanabana 72. Bar 55 73. Jerusalem 74. The Roxy 75. Hunterian Museum 76. The National Portrait Gallery 77. The Everyman cinema 78. Camden Market

October 2011

medicalstudent

GKT Eating and Drinking

Del Aziz

Frank’s Café and Campari Bar

Built on the remains of Bermondsey Abbey, this Middle Eastern restaurant, bar and bakery is a stylish yet affordable place to brunch, lunch or dine (and maybe even belly dancing on Fridays!).

Watch the stunning London sunset from benches under a tarpaulin in Frank’s Café - a pop up venue on top of a 10 storey car park in Peckham.

132 Southwark Street, City of London SE1 0SW £: Beer - £3 or mug of tea £1

Café 1001 Follow aromas of barbeque and home cooked food to Café 1001, a unique hang out nestled on a cobbled side street just off Brick Lane. Constantly filled with good music, this place is hard to miss and provides a g reat backdrop for both Friday nights and Sunday afternoons.

E1 6QL Brick Lane, City of London E1 £: Beer £3.50

Scootercaffe

A campus in central London, GKT is situated at three sites (making the acronym); Guy’s Hospital in London Bridge, St Thomas’ Hospital near Waterloo and King’s College Hospital in South Denmark Hill. Pre-clinical teaching

This cosy little spot with its quirky origins as a scooter re- pair shop serves a great coffee or cocktail with live music during the week. This is one of the many surprises Lower Marsh has to offer.

132 Lower Marsh, London SE1 7AE

EV bar Nestled under the arches by Southwark station, this is sister to nearby ‘tas pide’. This foodie oasis serves great Turkish mezze with great falafel and borek.

97-99 Isabella Street, City of London SE1 8LF £: £10pp with a beer from £2.95

Roebuck

takes place at the Guy’s campus,

This gastropub, located conveniently opposite GDS halls, hosts an excellent pub quiz on Tuesday evenings at 7pm. £2 to enter, this goes towards a jackpot for the winning team.

along with the Guy’s bar which is

50 Great Dover Street, City of London, SE1 4YG £: Beer £3.15

at the centre of the GKT medical student union.

Cargo Renowned to be on the cutting edge of electronic and in- die scene, this old street staple closes at 6am and rarely disappoints.

11 Bermondsey Square, City of London SE1 3UN £: Mezze platter at £14 to share

Chumleigh Gardens Cafe-Burgess Park A hidden gem tucked in Burgess Park, this unpretentious café provides quality, cheap filling breakfasts, snacks and drinks. With its beautiful mosaic garden, Chumleigh café is wonderful place to chill out in an idyllic setting.

Chumleigh gardens Camberwell, SE15

Culture & Places to wander If you want to embrace London’s culture scene, south of the river can offer as much as its northern counterpart… The Old Vic at Waterloo offers £12 tickets to under 25 year olds, call to book. Equally, great deals on popular plays can be found at The New Vic 200metres in which also boasts a more student friendly bar upstairs. In the heart of London Bridge the Menier Chocolate factory often offers affordable dinner and show deals. For a Christmas treat look no further than Somerset House’s annual ice skating rink, whereas Gabriel’s Wharf is an enclave of bars, boutiques and cheap fish and chips on Southbank all with a view of St Paul’s cathedral. Peckham Rye park is one of south-east London’s most beautiful parks. The restored Victorian gardens with woodland and flowing streams are a perfect free place to seek refuge from London’s bustle. Its quaint café opens from 9am to dusk serves great homemade food.

Markets SE London boasts fantastic markets. Though too pricey to fill your average student fridge, a wander around Bor- ough market can offer any food lover a tasty lunchtime treat. A more affordable alternative can be found at Brixton market which hosts a mixture of organic ‘honest’ burgers and hai street food stalls. Mulled wine at the German Christmas market on Southbank is should not be missed. Whereas all-year round Brick lane offers quirky street music, funky clothes stalls and a vibrant crowd.

83 Rivington Street, City of London EC2A 3AY £: Entry £10, £3.50 beer

Money Saving Tip Number 3 Austerity measures to stop the bank going bust

Student Beans

Porterhouse Just another Irish pub you might think? Sprawled over 3 floors this pub hosts a lively Friday/Saturday night with live music and has an illustrious beer, ale, stout and lager menu to accompany. Great place to head for live rugby and football.

This is the most up to date website for

21-22 Maiden Ln, London WC2E 7NA

discount offers. Before you do anything, check

Ain’t nothing but

studentbeans.com as it’s likely they’ll have a way to make it cheaper; whether you’re going out for dinner, buying internet or getting an eye test!

A bit of a tricky one to find, this tiny jazz club/pub is worth the search for the intimate atmosphere with a ca- rafe of wine. Popular folk and jazz musicians f requent this spot.

20 Kingly Street, London W1B 5PZ £: Free entry before midnight Somerset House ice skating rink

medicalstudent

October 2011

ICSM Restaurants

Museums & Attractions

Blue Elephant (Thai)

The Natural History Museum

One of the best Thai restaurants in town. But you do pay for it. Set amongst the backdrop of plants, flowing streams and swimming carp, this restaurant transports you from the bustle of Fulham broadway to a land far away. The food is exceptional, especially the Sunday brunch offering (£30p/p), which is a large and equally delicious selection of Thai specialties in a buffet setting. Well worth every penny, and an impressive venue for any guest.

Dinosaurs, fossils, and even open-bar ‘Night Safari’ events. Summer late openings and Winter ice-rink.

3-6 Fulham Broadway, Hammersmith, SW6 1AA £: Avg. price p/p based on 2 courses: £25

The Science Museum As a medic;; if you have not been here yet, go. If you have, it’s always fun to go again.

The Victoria & Albert Museum One of the world’s greatest museums of art and design. Well worth a visit or three.

Hummingbird Café

Hyde Park

The most famous cupcake factory in London. Renowned for their heavenly red-velvet cupcake, this cute coffee-stop is a stone’s throw away from South Kensington station - a perfect treat for the long, cold winter evenings!

Big, beautiful, and right next to the campus. Swim the Ser- pentine in Summer. Play tennis. Or just lie down and rest.

47 Old Brompton Road, South Ken., SW7 3JP £: Avg. price p/p based on hot drink/cupcake: £5

One of the premier (and most expensive) concert and per- formance arenas in the city, and right next to the South Kensington Campus. See www.royalalberthall.co.uk

Wafflemeister The name says it all. Hot, fresh, buttery and sugary waf- fles topped with any number of delights. There is very little space to sit here, however, so a waffle-on-the-move is the order of the day. Be sure to collect the loyalty stamps!

26 Cromwell Place, South Kensington, SW7 2LD £: Avg. price for a waffle: £3.50

Bosphorous (Turkish) Small and narrow, this outwardly ‘risky’ grill churns out some of the most succulent and well-marinated meat this side of Brick Lane. Don’t be put off by the décor, and follow the large queues for a perfect example of how everything you need at lunchtime or drunktime is good meat, bread and salad. Delicious.

Royal Albert Hall

Westfield Shopping Centre Somewhere you where you could easily spend all day (and student loan). The cinema with ‘Vue Xtreme’ screens here is definitely worth a visit.

Bars and Clubs Boujis Very high quality, but pricey drinks. A fantastic, friendly, and unpretentious atmosphere! Well worth a visit.

43 Thurloe Street, London, SW7 2LQ £: Pint Price: £4.50 Cocktail: £10

Imperial College is based in West London. Pre-clinical is based at the South Kensington

The Distillers

campus (along with all other

Beirut Express (Lebanese)

An Imperial College favourite. Right next to Charing Cross, this is the f irst stop on any medic bar crawl, or post- exams celebration.

degrees) but clinical work is

Part of the successful ‘Maroush’ chain of Lebanese restaurants, Beirut Express is a cosy, homely restaurant that always represents good value for money. Their ‘wraps’ menu is particularly worth sampling, priced at £4.50 each.

64 Fulham Palace Road, London , W6 9PH £: Pint Price: £3.50

59 Old Brompton Road, South Ken., SW7 3JS £: Avg. price for a kebab with pitta & salad: £6.50

65 Old Brompton Road, SW7 3JS £: Avg. price p/p based on 2 courses: £20

Wahaca (Mexican) A short bus-ride from the Charing Cross Campus, Wahaca @ Westfield is one of the few great Mexican restaurants in London. Flavoursome and diverse, with a cool décor and friendly staff. Spicy chicken burritos, chilli nachos and an ice-cold Corona. Perfect.

Westfield Shopping Centre, Ariel Way, W12 7GF £: Avg. price p/p based on 2 courses: £18

Saigon Saigon (Vietnamese) This is a gem of a place for anyone with a taste for something a little more unusual. Fabulous food, wonderful de- cor, great staff and most importantly, incredible value for money. Jump on it.

313-317 King Street,Hammersmith, W6 9NH £: Avg. price p/p based on 2 courses: £18

GraceBar A neat and tidy, stylish bar/restaurant/club. Rarely huge queues, always a good crowd, always a good DJ. Even the food is good!

42 Great Windmill Street, London, W1D 7NB £: Pint Price: £4.00

Tuatara Chique, stylish and exceptionally good-looking. Not the cheapest of bar/clubs, but a gem of a night, guaranteed.

107 King's Road, Chelsea, SW3 4PA £: Pint Price: £4.50 Cocktail: £10

The Cadogan Arms A pub with a warm, bustling atmosphere;; upstairs f ull-size pool-tables for cheap hire, and really good quality food and drink. A perfect evening out.

298 King’s Road, London, SW3 5UG £: Pint Price: £3.00 Pool Hire: £10/hour

mainly at Charing Cross Hospital in Hammersmith.

Money Saving Tip Number 4 Austerity measures to stop the bank going bust

Groceries Diversify where you shop - London has an abundance of fresh fruit and vegetable markets at your disposal, so use them. Recently ‘pound stores’ have been sprouting up across the capital, they stock big name brands and you can guess the price.

medicalstudent

October 2011

RUMS Restaurants

Museums

Iccos

Hunterarian Museum

Small but fantastically busy pizza place on Goodge Street. Avoid between 1 and 2 because of its extreme business.

On Lincoln’s Inn Fields this is a small but full museum of medical curiosities, assembled over a few hundred years. Including various human skeletons, showing the effects of various forms of dwarfism and gigantism, and thousands of specimens it is fascinating, informative, free and sadly not well known.

46 Goodge Street, London W1T 4LU £: £4 for an enormous freshly made pizza that far exceeds that of your normal chain restaurant pizza.

35-43 Lincolns Inn Fields, London WC2A 3PE

Guanabana

The National Portrait Gallery

A bit out of the way this one, but still in the golden tri- angle between UCH, The Free and the Whittington. A small restaurant on Kentish Town Road that does Carib- bean and South American food. The portions are huge, the food is excellent and you can bring your own alcohol. Top night out.

With Trafalgar square just a short walk away, the National Gallery is clearly an attraction. But the Portrait gallery, which clings, limpet like, to the reverse of it is a less busy, but equally impressive collection of art.

Saint Martin's Place, City of London WC2H 0HE 85 Kentish Town Road London NW1 8NY

The British Museum Recommended for its evening events, which vary f rom lectures, to film showings, to simply late openings at which refreshments are available. Demands inclusion in this list as it’s a matter of minutes’ walk away f rom UCL, and houses a huge amount of artefacts of worldwide importance.

Bars and Clubs Bar 55 Located in Camden, just behind the lock, it’s a trendy but reasonably priced cocktail bar, that’s usually happy for large groups of students to arrive en masse.

96 Euston Road, City of London NW1 2DB

31 Jamestown Road, London NW1 7DB £: Various deals but a cocktail will normally be around £5, with beer slightly cheaper.

Markets & Attractions

Jerusalem On Rathbone place off of Oxford Street, this literally un- derground bar does food and eventually morphs into a club. It’s very noisy, gets very busy and certainly isn’t the place for a quiet chat;; but for a group of you if can be a very enjoyable night out.

The Everyman cinema In both Hampstead & Belsize park, both close to the Roy- al Free, These are pricey, but classy, cinemas, offering sofas and a glass of wine whilst you watch a film. A nar- rower range of f ilms on offer, but a totally different experience to your average night out at the Odeon.

33-34 Rathbone Place, London, W1T 1JN

Belsize Park: 203 Haverstock Hill, NW3 4QG Hampstead: 5 Holly Bush Vale, London NW3 6TX

The Roxy

Camden Market

An awful place. But a place that will, on multiple nights be full to bursting with all your mates. Cheap, chart music, smelly and too hot, but also the cradle to some memo- rable revelry. Wednesday night is particularly good/bad depending on your affiliation with sports teams.

An obvious choice, but one which demands inclusion because of its sprawling, all-encompassing and ever evolving nature. A favourite haunt of celebrities, tourists and students, if you want food, shopping or just to walk around, it’s probably worthy of consideration.

3-5 Rathbone Place, London W1T 1HJ

Chalk Farm Road, London NW1 8AH

RUMS, attached to UCL, is the former Royal Free, University College and Middlesex Medical Schools. Based in North London, It is split across three campuses; the Bloomsbury campus, the Royal Free campus and the Whittington campus.

Money Saving Tip Number 5 Austerity measures to stop the bank going bust

Student Cards Get the National Union of Students (NUS) and Internation Student Identity Cards (ISIC). Both of these pieces of plastic will get you some great discounts, both at home and abroad, in high-street shops and more. Visit nus.org.uk or isic.org for further info. The Elgin Marbles at The British Museum

London For Medical Students by: Robyn Jacobs Kiranjeet Gill

Writers: Hayley Stewart - Barts Roshni patel - St Georges Hannah O’Riordan - GKT

Mihir Kelshiker - ICSM Nathan Grower - RUMS Toby Cox - Money Saving tips

Photographer: Yuanchao xue

Front cover courtesy of: www.freeimages.co.uk